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Hi everyone so you can guess from the title we’re going to be talking about asthma the two popular guidelines that are important for boards and awards that are both relatively recent in terms of updates and also different i’m only focusing on adults and adolescents 12 years old and older i combined both sets of guidelines as you can see already so you have epr4
Here and you have gina here because it can get confusing memorizing both sets of guidelines separately these are only the bare bone guidelines however there are alternative options and even tracks i didn’t include because it is not the preferred track like as in the case with gina i’ll get to that later the link to the guidelines will also be in the description
For the purposes of exams this is more than enough and it is why we made this chart in this way you can email me at mymessynotes at protonmail.com to get a copy of this chart for free of course so that you can have it on one sheet rather than taking a screenshot of this video email will be in the description i left space on the right side of this chart so that
You can add what is relevant to you and your studies so the two sets of guidelines epr4 and gina epr4 is from the national asthma education and prevention program of the national heart lung and blood institute so epr 4 is the latest update as of 2020. and the guidelines before that epr3 was in 2007 2020 and they include data up to 2016 and then we have gina gina
Is the global initiative for asthma it is updated annually it has the most recent data and it is what is included at the time this video was uploaded so just so you understand this chart gina has two tracks one has a preferred reliever and the other has a saba alternative reliever for the purposes of exams you’ll only need to care about the preferred reliever
But you can feel free to add to the chart the saba alternative reliever so you understand what i’m referring to here is the gina pocketbook we have track one and track two track one is the preferred reliever which is included in the chart we provided track two is the alternative reliever you could memorize track two it’s not very different from track one it’s
Very simple to memorize but just so we can make the chart simple we just included track one with the preferred reliever so the first thing you might notice is that there is one two three four five and six steps for epr4 okay epr4 has six steps for gina it stops at five stops at five because the the green is gina as you can tell the all the green is gena the
Blue is epr4 so here is the treatment for step five for gina and because gina does not have a step six you only see the treatment in blue now something else you might have realized is that step one you have intermittent which you guys probably already know intermittent mild persistent moderate persistent and severe persistent and it correlates with the steps
Now gina doesn’t distinguish between intermittent and mild persistent asthma due to the fact that gina says the historical distinction is arbitrary and based on an untested assumption that patients with symptoms twice a week or less would not benefit from inhaled corticosteroids so as you can tell from here the treatment for step one for gina is as needed in
Held corticosteroids and for motorol right however for epr4 there is no inhaled corticosteroid so gina does not make the distinction between intermittent and mild persistent asthma gina does have mild moderate and severe asthma severe doesn’t correlate with any steps and hence why it isn’t labeled it is asthma that requires high dose ics laba to be controlled
Or it’s uncontrolled despite high dose ics lava gina is also planning on reviewing the definition of mild asthma so i won’t label it here and age the video so what you learned from epr3 intermittent mild persistent moderate and severe persistent asthma is the same in epr4 as well so this is how you’ll use the chart you have step one and it’s divided into epr4 and
You have gina step one epr4 is labeled as intermittent and then you have the symptoms you have the daytime symptoms and nocturnal awakenings so based on the symptoms then you go to the treatment treatment for step one for epr4 as needed saba like i said before for gina is as needed ics for motorola same thing with step two you look at the symptoms and then you
Correlate the treatment based on the symptoms which is how your test is also going to ask the question what’s important here is that you realize that the symptoms are actually different for epr4 versus gina and then here epr4 versus gina the symptoms are different something else you might notice is that step one and step two of gina have the same symptoms and
Have the same treatment now gina does not use saba only because they say patients treated with sabo only are at risk of asthma related death and exacerbations even if they have good symptom control so you will never see a short acting beta agonist alone you’ll always see it paired with an inhaled corticosteroid in fact a long-acting beta agonist is used as in
The case with four motorol because for motorola has a rapid onset of action and a long duration of action which gives it a bit of an advantage so let’s look at step 2 epr 4 treatment so you look at the symptoms so you know the treatment plan so the treatment plan is everyday low dose inhaled corticosteroids and as needed saba or as needed low-dose inhaled
Corticosteroids taken when saba is used so you use saba and inhaled corticosteroids concomitantly in step two now there’s a star here and the star if you look at the key these are the changes from epr3 so because a lot of you memorized epr3 i put stars on where you’ll have to either change or add to your memorization so there’s a star here start here start here
Again i’m not going to go through everything in the chart i’m just pointing out the things that i want you to realize so that you can look at the chart and memorize it on your own time now what i want to point out for steps three and four is that for epr4 you have smart as the preferred therapy you have smart and you have smart okay the treatment for step three and
Step four is smart what’s smart it’s single maintenance and reliever therapy for countries outside the us it’s going to be called mar maintenance and reliever therapy so smart low dose smart for step three and medium dose smart for step four so you’re using ics lava ics for motorola for maintenance and reliever and of course this is all backed by evidence-based
Medicine so again you have gina you have epr4 different symptoms for both obviously this correlates with nocturnal awakenings and this correlates with daytime symptoms so you have step four here and then you have step five treatment and step six treatment again gina does not have step six so epr4 and gina have the same treatment in steps three and step four
You have low dose smart for step three treatment and medium dose smart for step four treatment and smart is ics laba for both ics for motorol now for step five treatment it differs again so you have an ics lava and the llama and the saba as needed for gina you add a llama you consider high dose smart so you consider high dose ics for motorol and you refer for a
Phenotypic assessment for step six treatment it’s daily high dose ics laba and oral corticosteroids and as needed saba now for step four for gina you can add a short course of oral cortical steroids for patients presenting with severely uncontrolled asthma so i hope this chart is comprehensive enough for you and easy to understand email me if you want the chart
In good quality so just not a screenshot and you’ll have room on the right side to add your notes and you also have a bunch of negative space here anyway to add whatever you want to add and thank you see you soon take care bye
Transcribed from video
Updated Asthma Guidelines! EPR-4 AND GINA By Med Messy Notes
