Asthma
Pulmonary and Critical Care Medicine · Airways Disease 🎯 Practice these cards
About ____% of the U.S. population has been diagnosed with asthma; prevalence is increased in persons older than 65, women, Black persons, and those living below the ____ level.
About 7.9% of the U.S. population has been diagnosed with asthma (~9.6 million physician visits/year). Prevalence is increased among persons older than 65, women, Black persons, and persons living below the poverty level; mortality (~9.9 per million) is highest among Black patients and those over 65.
Significant reversibility supporting asthma is an FEV1 increase of at least ____% and at least ____ mL after bronchodilator.
A significant bronchodilator response in adults is an increase in FEV1 (or FVC) of at least 12% and at least 200 mL from baseline; it is a cornerstone of asthma diagnosis.
A ____ bronchial challenge test effectively excludes asthma, while a positive test requires clinical ____.
When spirometry is normal but symptoms suggest asthma, methacholine (or exercise/mannitol) challenge demonstrates hyperreactivity. A negative test effectively excludes asthma; a positive test is not specific and requires clinical correlation.
GINA no longer recommends ____ alone for exercise-induced bronchoconstriction; initial therapy is as-needed ICS plus SABA or low-dose ICS-____.
GINA no longer recommends SABA alone for EIB. Initial pharmacotherapy is an inhaled glucocorticoid plus SABA, or low-dose ICS-formoterol, as needed or before exercise; nonpharmacologic measures include warm-up and warming cold air.
About ____% of adult asthma is work related; the key clinical indicator is improvement during ____, confirmed cost-effectively by spirometry before and after workplace exposure.
About 15% of adult asthma is work related. The key clinical indicator is symptom improvement during weekends and time away from work; spirometry before and after workplace exposure is a cost-effective way to confirm the diagnosis. Treatment centers on exposure reduction/removal; prevention is paramount.
AERD is asthma and rhinosinusitis precipitated by aspirin or other ____-inhibiting NSAIDs; chronic management includes leukotriene receptor antagonists and aspirin ____.
AERD = asthma and rhinosinusitis precipitated by aspirin or other COX-1-inhibiting NSAIDs; adult onset, eosinophilia, nasal polyposis, often severe. Ingestion can cause life-threatening bronchospasm within minutes to hours. Management: avoid all aspirin/NSAIDs, leukotriene receptor antagonists, and aspirin desensitization in specialized centers.
ABPA presents with difficult-to-control asthma, markedly elevated IgE, and ____ bronchiectasis; treatment is systemic glucocorticoids plus ____ agents.
ABPA: ongoing immune response to Aspergillus causing difficult-to-control asthma, mucus plugs, elevated total and Aspergillus-specific IgE, and central bronchiectasis. Treatment: systemic glucocorticoids plus antifungal agents.
Well-controlled asthma = daytime symptoms less than twice ____ and nocturnal symptoms less than twice ____ over the preceding 4 weeks.
Patients with daytime symptoms less than twice weekly and nocturnal symptoms less than twice monthly during the preceding 4 weeks are considered well controlled (validated by the Asthma Control Test / Questionnaire).
Needing a SABA more than ____ days per week (excluding pre-exercise use) indicates inadequate control and the need to step ____ therapy.
SABA use more than 2 days per week (excluding EIB prevention) indicates inadequate control and the need to step up therapy; frequent SABA use is a marker of poor control and has been associated with increased mortality. No guideline now endorses SABA-only treatment.
Single-agent ____ use is not recommended in asthma because of increased risk of asthma-related death; LABAs are safe only when combined with an inhaled ____.
Single-agent LABA use carries a boxed warning for increased asthma-related death and is never prescribed without a simultaneous controller. Five large trials showed ICS-LABA combinations do not increase hospitalization, intubation, or death versus ICS alone and reduce exacerbations.
Systemic ICS adverse effects generally do not occur below about ____ mcg/day of budesonide equivalent; oral candidiasis and dysphonia are reduced by spacer use and ____.
ICS are the most effective controller class. Systemic effects (adrenal suppression, bone loss, cataracts) generally do not occur below ~400 mcg/day budesonide equivalent; local candidiasis and dysphonia are reduced by spacer use and gargling. High-dose/high-potency ICS increase pneumonia risk; smoking diminishes efficacy.
Montelukast carries a boxed warning for ____ events, including suicidal thoughts and actions.
Montelukast carries a boxed warning for neuropsychiatric events, including suicidal thoughts and actions; reserve for patients who cannot use or do not respond to alternatives.
Before biologics, verify medication ____ and inhaler technique and address comorbidities; the predictive blood eosinophil threshold ranges from about 150 to ____ cells/mcL.
Biologics are considered only after verifying adherence and inhaler technique and addressing comorbidities. The blood eosinophil threshold predicting efficacy ranges ~150-400 cells/mcL by agent; omalizumab causes anaphylaxis in ~0.2% of recipients.
Acute exacerbation management: frequent inhaled SABA, prompt systemic glucocorticoids, and supplemental oxygen to maintain SpO2 above ____%.
Signs of a severe exacerbation: unable to speak in full sentences, accessory muscle use, RR >30/min, HR >120/min, SpO2 <90%, agitation/confusion/drowsiness. Acute care: frequent inhaled SABA, prompt systemic glucocorticoids, adjunctive ipratropium, and oxygen to keep SpO2 above 93%.
In pregnancy, asthma exacerbations are most frequent in the ____ trimester, and the advantages of treatment outweigh the potential ____ risks of asthma therapies.
The advantages of asthma treatment substantially outweigh the potential fetal risks of therapy; exacerbations are most frequent in the second trimester. ICS, OCS, SABAs, LABAs, and leukotriene receptor antagonists have been used extensively without data suggesting fetal harm; do not initiate allergen immunotherapy during pregnancy.
FDA-approved in December 2025, ____ is the first ____-yearly add-on maintenance biologic for severe eosinophilic asthma.
Depemokimab-ulaa (Exdensur), an ultra-long-acting anti-IL-5 antibody given twice yearly, was FDA-approved in December 2025 for add-on maintenance in severe eosinophilic asthma (ages >=12) - the first twice-yearly biologic in asthma. In SWIFT-1/SWIFT-2 it reduced annualized exacerbations with rate ratios of 0.42 and 0.52 versus placebo.
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