AE-C cheat sheet

Asthma control is judged by daytime symptoms, nighttime awakenings, short-acting beta-2 agonist use, activity limitation, and lung function; severity is assigned before treatment begins.

Spirometry supports obstruction when FEV1/FVC is below 0.70 in adults; the lower limit of normal is preferred in children and young adults.

A positive bronchodilator response in adults and adolescents is an FEV1 increase of at least 12% and at least 200 mL after a short-acting beta-2 agonist.

Peak flow zones: green is at least 80% of personal best, yellow is 50% to 79%, and red is below 50%.

Asthma Control Test score 0 to 25: 20 or higher is controlled, 16 to 19 is not well controlled, and 15 or lower is very poorly controlled.

Childhood Asthma Control Test score 0 to 27: 20 or higher is controlled, 16 to 19 is not well controlled, and 15 or lower is very poorly controlled.

Fractional exhaled nitric oxide in adults: below 25 ppb is low, 25 to 49 ppb is intermediate, and 50 ppb or higher is high; elevated values predict corticosteroid response.

A methacholine PC20 of 16 mg/mL or less supports airway hyperresponsiveness; a negative challenge has a high negative predictive value for current asthma.

Allergy skin testing or specific IgE identifies sensitization but does not by itself establish a diagnosis of asthma.

Teach-back is effective when the patient explains the information or demonstrates the skill in their own words.

Plain-language teaching uses about a fifth- to sixth-grade reading level, limits content to three key points, and pairs spoken words with pictures.

Inhaler technique is observed and corrected at every visit; poor technique is linked to uncontrolled symptoms and exacerbations.

A written asthma action plan is provided to every patient and a copy is sent to school or work with medication authorization.

Adherence assessment asks specifically about cost, fear of corticosteroids, forgetfulness, regimen complexity, and cultural beliefs.

A valved holding chamber with a metered-dose inhaler improves lung deposition and reduces oropharyngeal thrush and hoarseness.

Brief smoking-cessation counseling combined with pharmacotherapy is offered to patients and household members who smoke.

Structured self-management education with a written action plan reduces emergency department visits, hospitalizations, and missed school or work.

Dust mite measures include mattress and pillow encasements, weekly bedding washing in water at least 130 degrees Fahrenheit, and indoor humidity below 50%.

Cockroach control uses integrated pest management: sealing cracks, removing food and water sources, and targeted baits.

Indoor relative humidity is kept between 30% and 50%, and water-damaged areas are dried within 24 to 48 hours to limit mold.

Pet allergen control is most effective with removal; otherwise keep pets out of the bedroom, use HEPA filtration, and wash hands after contact.

Tobacco smoke exposure is eliminated from homes and cars; electronic cigarettes are not a safe substitute.

Outdoor triggers include pollen, ozone, wildfire smoke, and thunderstorms; the air quality index guides outdoor activity decisions.

Exercise-induced bronchoconstriction is reduced by warm-up, cold-air face masking, and pre-exercise short-acting beta-2 agonist or inhaled corticosteroid-formoterol.

Aspirin and other nonsteroidal anti-inflammatory drugs can trigger severe bronchospasm in aspirin-exacerbated respiratory disease; beta-blockers may also worsen asthma.

Occupational asthma assessment includes identifying workplace exposures and referral for evaluation when symptoms improve away from work.

Current GINA guidance prohibits short-acting beta-2 agonist-only treatment for adults and adolescents; all receive inhaled corticosteroid-containing therapy.

Track 1 uses low-dose inhaled corticosteroid-formoterol as the reliever; track 2 uses a short-acting beta-2 agonist as the reliever.

Maintenance and reliever therapy uses the same inhaled corticosteroid-formoterol inhaler for daily maintenance and as-needed relief.

Long-acting beta-2 agonists are never used as monotherapy in asthma; they are prescribed only with an inhaled corticosteroid.

Daily inhaled corticosteroid therapy reduces symptoms, exacerbations, and asthma-related mortality.

Montelukast is an oral leukotriene receptor antagonist; its boxed warning describes serious neuropsychiatric events including agitation, depression, and suicidal thoughts.

Biologics target specific pathways: omalizumab binds IgE, mepolizumab and benralizumab target interleukin-5, dupilumab targets interleukin-4 receptor, and tezepelumab targets thymic stromal lymphopoietin.

A short oral corticosteroid course for an exacerbation is typically 5 to 7 days; tapering is unnecessary when the course is shorter than 2 weeks.

Metered-dose inhaler technique: shake, exhale fully, seal lips, press while inhaling slowly and deeply, and hold the breath about 10 seconds.

A written action plan uses green, yellow, and red zones based on symptoms and peak flow, with specific medication and care-seeking instructions for each zone.

Follow-up intervals are 1 to 6 months depending on control; after an exacerbation, follow-up occurs within 2 to 7 days.

Before stepping up therapy, confirm adherence, inhaler technique, and trigger exposure; step down after at least 3 months of good control.

Specialist referral is indicated for difficult-to-treat or severe asthma, frequent exacerbations, prior intensive care admission, suspected alternative diagnosis, or biologic consideration.

School coordination includes a copy of the asthma action plan, medication authorization, and staff education about symptom recognition.

Adolescent transition planning teaches self-management skills and arranges a gradual transfer to adult care.

Annual influenza vaccination is recommended; COVID-19 and pneumococcal vaccination follow current public health guidance.

Comorbidities that affect control include allergic rhinitis, obesity, obstructive sleep apnea, gastroesophageal reflux, and anxiety or depression.

A written asthma action plan is individualized and includes green, yellow, and red zones with medication instructions and when to seek urgent care.

Follow-up after an exacerbation occurs within 2 to 7 days to reassess symptoms, inhaler technique, adherence, and the action plan.

Routine follow-up intervals range from 1 to 6 months depending on asthma control and treatment changes.

Step-up therapy is considered only after confirming adherence, correct inhaler technique, and trigger exposure.

Step-down therapy is considered after at least 3 months of sustained good control.

Asthma specialist referral criteria include difficult-to-treat or severe asthma, frequent exacerbations, prior intensive care admission, and biologic candidacy.

School coordination includes a copy of the action plan, medication authorization, and staff education about symptom recognition.

Transition planning for adolescents teaches self-management skills and arranges a gradual transfer to adult care.