From:
http://www.militarydisabilitymadeeasy.com/therespiratorysystem.html
Code 6602: Asthma is a condition where the airways and bronchi swell, causing them to close up.
This condition has slightly different rating requirements than the Respiratory Rating System. These are outlined in the table below.
It is important to note that it is difficult to get a proper test for asthma since the tests must be run while an attack is happening. An FEV-1 test done when there is not an attack will give normal results that will not properly define the condition. A methacoline challenge test is often done instead since the methacoline triggers an asthma attack. Once the methacoline is inhaled and an asthma attack begins, the spirometry tests are performed. After the tests are done, medications are given to treat the asthma attack. If spirometry is done with and without methacoline, the condition is rated on the methacoline results.
If FEV-1 and FVC tests with methacoline are not performed, then asthma can be rated based on the kind of medication that is used to treat the condition or on the severity of the condition based on the number of ER visits. In these cases, however, the physician must clearly record a thorough history of asthma attacks.
Test
Result/Condition
Rating
FEV-1
Less than 40%
100%
FEV-1
40-55%
60%
FEV-1
56-70%
30%
FEV-1
71-80%
10%
FEV-1/FVC
Less than 40%
100%
FEV-1/FVC
40-55%
60%
FEV-1/FVC
56-70%
30%
FEV-1/FVC
71-80%
10%
ER visits
2 or more attacks per week with respiratory failure thatrequires ER visits to save life
100%
ER visits
Requires monthly ER visits to save life
60%
Medication
Requires daily high doses of steroids or immunosuppressive medications taken by mouth or by injection*
100%
Medication
Requires the use of steroids or immunosuppressive medications taken by mouth or by injection 3 or more times a year*
60%
Medication
Requires occasional use of inhaled anti-inflammatory medication*
30%
Medication
Requires daily bronchodilator therapy taken by mouth or inhaled*
30%
Medication
Requires occasional bronchodilator therapy taken by mouth or inhaled*
10%
*A definition of these medications is listed below.
Swelling is the biggest problem with asthma, and so the majority of medications that treat asthma are for controlling swelling.
Swelling is often a reaction of the immune system to things it doesn’t like. Immunosuppressive medications suppress this response, allowing the airways to remain open in an asthma attack. Similarly,steroids taken by mouth or injection are able to greatly reduce swelling. Both of these treatments are only used for the most severe cases of asthma and only when all the other medications listed below do not satisfactorily treat the condition. Some of the most common medications in these categories are Prednisone, Prednisolone, Decadron, Deltasone, Dexamethasone, Medrol, Orasone, Pediapred, and Prelone.
Inhaled anti-inflammatory medications are steroids, but a smaller dose than oral or injected steroids. These reduce swelling and mucus production. They are used to prevent asthma attacks. Some of the most common medications in this category are Aerobid (Flunisolide), Flovent HFA (Flutocasone HFA), Azmacort (triamcinolone), Ipratropium Bromide (Atrovent), Asmanex, Pulmicort, and Qvar. The following are a combination of an anti-inflammatory medication and a bronchodilator (discussed next), but they are rated as anti-inflammatory medication: Advair (Fluticasone and Salmeterol), Duleva, and Symbicort.
Bronchodilators are used by pretty much anyone with asthma. These keep the bronchi from swelling and blocking the airway. They are all inhaled, and there are short-acting and long-acting bronchodilators. Short-acting ones are the rescue inhalers that work very quickly and last between 1 hour and 4 hours. Common short-acting bronchodilators include Proventil, Albuterol, Ventolin, Salbutamol, AccuNeb, Levosalbutamol, Levalbuteral, Xopenex, Terbutaline, Bricanyl, Pirbuteral, Maxair, Procaterol, Metaproterenol, Alupent, Fenoterol, Bitolterol mesylate, and Ritodrine.
Long-acting bronchodilators are used to control asthma and prevent attacks. Common long-acting bronchodilators include Sereveut, Salmeterol, Formoterol, Foradil, Symbicort, Bambuterol, Clenbuterol, and Indacaterol
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