Mnemonics: Asthma

Author: V. Dimov, M.D., Allergist/Immunologist and Assistant Professor at University of Chicago
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at LSU (Shreveport) Department of Allergy and Immunology

Asthma is the most common chronic respiratory disease, affecting up to 10% of adults and 30% of children (JACI, 2011). Prevalence of asthma is 8%, prevalence of AR is 3 times higher (24%). 40% of patients with AR have asthma, 80% of patients with asthma have AR.

Classification of asthma - mnemonic

I'M MS ("I'm a Master of Science")

Intermittent

Mild persistent

Moderate persistent

Severe persistent

Number of controllers used in each stage of the classification of asthma - mnemonic:

I'M MS

0 1 2 3

0 - SABA PRN (albuterol) only

1 - ICS or LTRA

2 - ICS/LABA or ICS plus LTRA

3 - ICS/LABA and LTRA, consider omalizumab (anti-IgE mAb)

Allergic Rhinitis and its Impact on Asthma (ARIA): Achievements in 10 years and future needs. ARIA has reclassified AR as mild/moderate-severe and intermittent/persistent. This classification closely reflects patients' needs and underlines the close relationship between rhinitis and asthma. http://buff.ly/QL1eYI

Pathogenesis of Asthma

Lymphocytes

CD4, Th2
Central effector cells
Cytokine release

Overview of adhesion molecules, 3 groups remembered by the mnemonic SIS:
Selectins
Integrins
Superfamily Ig

Mast cells are subdivided into 2 types based on proteinase content:
TC mast cells -- Tryptase and Chymase in granules
T mast cells -- Tryptase only granules

Mast cells
Mediator release
Mucosal inflammation

Mediators from eosinophils are remembered by the mnemonic CML EEE:

Cytokines
MBP
Lipid Mediators

EDN
ECP
EPO

Eosinophils
Emit
Eight mediators (at least 8, the first C in the mnemonic covers cytokines, chemokines and growth factors)

Overview of adhesion molecules, 3 groups remembered by the mnemonic SIS:
Selectins
Integrins
Superfamily Ig

There are 4 families of eicosanoids (PP-LT): prostaglandins (PG), prostacyclins (PGI), leukotrienes (LT) and thromboxanes (TX).

Diagnosis of Asthma

A mnemonic to remember the different PFTs is SPIROMEtry:

Spirometry
PEFR
Inhalation tests:
Reversibilty of
Obstruction with beta-agonist
Metacholine challenge
Exhaled NO

The phases of spirometry can be remembered by the mnemonic BEIF:
Breath normally x 6 times
Exhale fully
Inhalation (deep)
Forceful exhalation for 6 seconds

FEV1/FVC
FEF 25-75
R
Regular (normal) or
Raised in
Restriction

FEV1
1ow in both obstructive and restrictive disease

Bronchodilation test: BB RR
Baseline spirometry
Beta-agonist
Repeat spirometry
Reversibilty of obstruction

Methacholine challenge test, remember the numbers: 5-25-20-5:
5 breaths
25 mg/mL metacholine
20% FEV1 reduction
5% of patients with asthma have a negative test, 95% react to the challenge

Test for Respiratory and Asthma Control in Kids (TRACK)

5
5 questions
5 year-old or younger (2-5 years)

Test for respiratory and asthma control in kids (TRACK) - mnemonic: 3S

Symptoms (3 questions)
SABA use
Steroid use

Test for respiratory and asthma control in kids (TRACK) - complete mnemonic: 3S

Symptoms - SPA: Symptoms - how often, Play, At night, past 4 weeks
SABA use, past 12 weeks (3 months)
Steroid use, past 12 months (1 year)

Time frame of TRACK:

Symptoms - 4 weeks (1 month)
SABA use - 12 weeks (3 months), quarter
Steroid use - 12 months (1 year)

References:
Test for Respiratory and Asthma Control in Kids (TRACK): A caregiver-completed questionnaire for preschool-aged children. Kevin R. Murphy et al. JACI. Volume 123, Issue 4, Pages 833-839.e9 (April 2009).

Differential Diagnosis of Asthma

C
Children
Congenital conditions
CF

A
Adults
Acquired conditions

Asthma Classification: M MMS

Mild intermittent

Mild persistent
Moderate persistent
Severe persistent

Treatment

One can remember the stages by the number of controller medications a patient would need at each stage:

I'M MS
0 1 2 3

"Rule of 2s” is used to determine level of control. If any of these are positive, consider a daily controller medication:

- daytime symptoms more than 2 days/wk
- rescue β2 -agonist use more than 2 times per week
- nighttime symptoms more than 2 nights/mo
- more than 2 asthma exacerbations per year
- more than 2 rescue β2-agonist canisters/yr

Reference for rule of 2's: Audio: Asthma, noon conference. Muthiah Pugazhenthi. Podcasting Project for the UT Internal Medicine Residency Program, 12/2006.

If asthma treatment is not working, check DAT:

Diagnosis - not asthma at all (VCD, CF, FBA), asthma plus AR, GERD

Adherence - compliance with medication

Technique - NEB, HFA with spacer, DPI, etc.

3 C's of care - communication, continuity, concordance (finding common ground) are critical for asthma management (http://goo.gl/8gJM6).

Medications

S
Singulair
Single daily dose
Suicude risk (potential)

LABA
M
Monotherapy
Masks inflammation
Mortality increase

Corticosteroids
C category during pregnancy

Budesonide
B category during pregnancy

Exercise-induced asthma treatment: CLIMB

Cromolyn
Leukotriene receptor antagonist
Inhaled steroids
Mast cell stabilizers other than cromolyn
Beta agonists

Leukotriene receptors

Leukotriene
B4
BLT 1, 2 receptors

Leukotriene
C4, D4, E4
CysLT 1, 2 receptors

Ciclesonide mnemonic

C

Ciclesonide

Converted to active form (des-CIC)

Carboxyl-esterases in bronchial epithelial cells

Clearance by liver

Published: 01/24/2008
Updated: 11/27/2012