3 - Asthma & COPD Therapy Flashcards
Identify common risk factors assoc’d w asthma devo
environ: SEC, family sie, second hand smoke allergen exposure urbanization RSV Abx exposure
genetic: polygenic inhertience
Identify risk factors assoc’d w COPD devo
smoking particles (smoke, occupation, indoor pollution) genes (involved in proteases) age/gender lung devo asthma and airways hyperreactivity SEC resp infx
asthma exacerbatinos sx and trgiggers
trigger: pets, exercise, emtoinos, pollution, smoke, dust, fungi, cold, inserts and fecal matter, pollen, aerosols
c/c asthma and COPD pathophys
asthma: chronic inflammx or airways, hypertrophy of BM, mucus plug, hyertrophy of SM
COPD: chronic brnchitis, emphysema, inflammx; exposure to particles/gases–> destroy epithelial cells–> incr T lymhocytes and inflamm cells, incr fibroblases; neutrophils and macrophages –> incr protease
asthma staging
based on freq of sx nighttime awakening SABA use interference w normal activity lung fxn exacerbations requiring oral steroids
What is normal FEV1
> =80%
what is normal FVC
normal adults can empty 80% of air in <6 sec
What is normal FEV1/FVC ratio
normal w/in 5% of predicted range (based on age)
- decr’d in dz
- normal or high in restrictive dz
what is normal PEFR
percent predicted correlates w FEV1
max rate that a person can exhale after a full inspiration
what are sx used for asthma dx
episodic sx of airflow obstruction: chest-tightness, SOB, non-productive cough (worse at night and early morning)
- obstruction is reversible
- often triggered
- signs of atopy-tendency to devo allergic rxn
- decr FEV1/FVC w reversibility following SABA admin
- incr eosinophil count and blood IgE conc
intermittent asthma stage
sx, SABA use <= 2d/wk awake <=2x/mon no interference lung fxn normal btw exacerbation 0-1 exacerbations w oral steroids
persistent mild asthma stage
sx, SABA use >2 d/wk (but no d SABA use) 3-4 x/mo awake minor interference lung fxn normal exac w po steroids >=2/yr
persis mod asthma stage
sx and SABA use d awake >1/wk some limitations FEV 60-80% FEV1/FVC red'd 5% exac w po steroids >=2/yr
persis sev asthma stage
sx, SABA use throughout day awake 7x/wk extremely limited activity FEV1 <60^% predicted FEV1/FVC red'd 5% exac w steroids >=2/yr
def EIB
sx of cough, chest tightness, or endurance prob during exercise
drop of FEV1 by >15% of baseline
BHR
describe emphysema
enlargement of airspaces that is accompanied by destruction of alveolar walls
describe chronic bronchitis
prescence of cough and sputum production for at least 3 mo in each of two consecutive yrs
airayws narrow d/t fibrosis: SM hyperplasia, inflammx, ronchial wall thickening, mucous gland enlargment, ciliary abnromality
decr inflammx in COPD
response to irritants
incr oxidants and decr endogenous antioxidatnts
protease-antiprotease imablance
describe COPD dx
chronic cough, SOB, sputum production
*FEV1/FVC <0.7
consider if >40 yoa w any above sx, hx of exosure to risk factors, family hx
What are signs of COPD
incr resp rate use of acessory muscles to breath hyperinflation (barrel chest) decr breath sounds prolonged expiration lips pursing on expiration
What is the spirometry cutoff for COPD
FEV1/FVC <0.7 –> confirms airflow limitation (ompared to predicted)
Describe GOLD 1 staging
FEV1 >=80% of predicted (post-bronchodilator)
mild COPD
GOLD 2 staging
50% <= FEV1 < 80%
moderate
Gold 3 staging
30% <= FEV1 < 50%
sev
GOLD 4 staging
FEV1 <30%
very sev
GOLD AC symptoms
CAT < 10
mMRC 0-1
GOLD BD sx
CAT >= 10
mMRC 2
GOLD AB
0-1 exac (no hosp)
GOLD CD
> = 2 exacerbations in past year
or 1 exac w hospitalization
What is the moa of BAs?
bronchorelaxation
activation AC, incr cAMP
What are the SABAS? their ooa?
albuterol (Proair, Ventolin, Proventil)
Levalbuterol (Xopenex)
3-5 min
DOG for acute asthma sx
What are the LABAs?
What is their ooa?
salmeterol (Serevent Diskus) formoterol (Foradil aerolizer) Arformoterol (Brovana Neblizer) Indacaterol (CArcapta Neohaler) Olodaterol (Striverdi Respimat) combo prod w ICS and LAMA
15–30 min
