Step 2 for Mild Persistent dz1 2 Daily controller meds prn SABA

¹ <b>Mild Persistent</b> = sx/SABA use >2 days/wk not daily or more than once/day, sx 3-4 nights/mo, minor limitations to NL activity, FEV1 >80%, FEV1/FVC >80%, ≥2 exac/yr requiring PO/IV steroids (inadequate data to correlate exac freq w/ severity; but ≥2/yr considered persistent despite impairment level). Dx: hx/exam to determine sx d/t recurrent airway obstruction: cough, recurrent wheeze/difficult breathing/chest tightness worse @ night or w/ exercise, viral infxn, allergens/irritants, weather, laugh/cry, stress, etc &#x2713; spirometry to determine at least partially reversibility.<br><br>
² <b>Differential Dx:</b> Allergic rhinitis, sinusitis, foreign body, vocal cord dysfxn, bronchostenosis, LN/tumor, viral or obliterative bronchiolitis, CF, heart dz, aspiration.
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³ Available SABAs (in alpha order):<br>
<b>• albuterol MDI</b> 90 mcg 2 puffs q4-6h prn<br>
<b>• albuterol NEB</b> 1.25-5 mg in 3 cc saline q4-8h prn<br>
<b>• levalbuterol MDI</b> 45 mcg 2 puffs q4-6h prn<br>
<b>• levalbuterol NEB</b> 0.31-0.63 mg q8h prn
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If SABA not tolerated, ipratropium may be used as alternative. Theophylline less desirable d/t level monitoring.
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⁴ SABA >2x/wk indicates poor control except for EIB pre-exercise prevention. Encourage full participation in physical activities. If cold-induced EIB: Warm-up period or mask/scarf over mouth.
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⁵ Allergens, irritants, pollutants: &#x2713; hx exposure-related sx. Avoid tobacco smoke. If persistent asthma, use skin/in vitro tests for perennial indoor allergens. If clear connection b/t sx and allergen, consider immuno-tx by trained personnel; immuno-tx requires preparation to tx anaphylaxis. Evidence best for dust mite, animal dander, pollen; evidence weak/lacking for molds, cockroaches; evidence strongest for single-allergen immuno-tx.
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⁶ Identify comorbidities: rhinitis, sinusitis, GERD, obesity, OSA, ABPA, stress, depression, etc.