This student "cheat sheet" is designed to provide medical students with basic information regarding the diagnosis and treatment of chronic asthma. It includes Questions to Ask, what to look for on a Physical Exam, Labs to Order, and basic Treatment Plans. These guides are particularly designed for first and second-year medical students as an introduction to ambulatory care medicine and attempts to tie in the basic pathophysiology that is high-yield for USMLE Step 1. Any and all feedback is very welcomed.

1. Revised 2/17/14. Email Justin.berk@ttuhsc.edu with any feedback.
ASTHMA CHEAT SHEET
Asthma is: an obstructive pulmonary disease, resulting from hyper-responsiveness of the airway.
Inflammation of the airway causes smooth muscle contraction leading to bronchoconstriction. This
bronchoconstriction increases the work of breathing and causes distress. Inflammatory pathways and
sympathetic tone mediate the constriction.
Presenting symptoms often include: expiratory wheezing, cough, shortness of breath.
Triggers of asthma:
 Viral URIs
 Allergies
 Irritants
o Exercise, weather, dust, smoke
Ask about:
 Nocturnal coughing
 Albuterol use per day
 Symptoms per day
 Limited function because of
asthma
 Allergies (e.g. hayfever)
 Household pets
 Smoking
 Family history of asthma
 Medication compliance
 Hospitalizations due to asthma
 Previous corticosteroid
treatments for asthma
 Intubations from asthma
 Side effect of asthma meds
Physical Exam Findings May Include:
Vitals:
 Increased respiratory rate
o Stress response
o Increases minute volume
o combats acidosis (in
extreme cases)
HEENT:
 Nasal polyps
o if aspirin sensitivity
 Allergy signs
o e.g. “cobblestone throat”
Lung exam:
 Expiratory wheezing (high-
pitched whistling sounds)
 Prolonged expiratory phase
 No air movement = emergency
Skin:
 Often associated with atopic
dermatitis / eczema (in
pediatrics)
Labs
Peak Flow measurements assess expiratory air flow.
- Calculated as % of predicted.
CXR shows hyperinflation (flattened diaphragm) during acute phase.
CXR is normal when asthma is controlled.
Sputum may show Charcot-Leyden crystals, Curschmann’s spirals.
Allergy-related asthma can be associated with eosinophils.

2. Revised 2/17/14. Email Justin.berk@ttuhsc.edu with any feedback.
Classification of Asthma
Intermittent Mild Moderate Severe
Symptoms <2 days / wk >2 days/wk Daily Throughout day
Inhaler use <2 days / wk >2 days/wk Daily Multiple per day
Nighttime
awakening
1 / month 3 / month 1 / week Every night
Activity -
Minor
limitation
Some limitation
Extremely
limited
PFTs Normal Normal
FEV1 < 80%
FEV1/FVC:
reduced 5%
FEV1 < 60%
FEV1/FVC:
reduced >5%
*PFT = pulmonary function tests
Treatment Steps of Asthma
“Rescue inhaler” = short-acting Beta agonist = SABA = Albuterol
If SABA used >2 days a week, asthma is uncontrolled: Step Up treatment.
STEP TREATMENT EXAMPLE NOTE
#1 Rescue inhaler (SABA) Albuterol
β- agonists decreases smooth muscle
constriction
#2
#1 + inhaled
corticosteroid
Beclomethasone,
Fluticasone,
Budesonide
- Steroids decrease inflammation
(inactivate NF-KB)
- Instruct patient to brush teeth after
corticosteroid use to avoid thrush
#3
#2 + Long b-agonist
(LABA)
Salmeterol,
formoterol
Combination therapy:
Advair (Fluticasone + Salmeterol),
Symbicort (Budesonide + Formoterol)
#4
#3 + Leukotriene
receptor antagonist
Montelukast
Can relieve symptoms of seasonal
allergies
#5 #4 + Increase dose of corticosteroids. *
#6 Add oral corticosteroids Prednisone
*Can also consider Omalizumab (anti-IgE) at Step 5, but it is very cost prohibitive
**Items in Red available at the Free Clinic.
Other USMLE asthma drugs include: theophylline (PDE-I), ipratropium (muscarinic
antagonists), cromolyn (blocks mast cell cytokines), Zileuton (5-LPO inhibitor).