#7: Asthma And COPD

Question 1

What are the asthma triggers? (12)

Answer 1

1 • Atopy (Cockroaches, Dust mites, and Animal dander)
2• Exercise – especially in cold weather
3• URI
4• GERD 
5• Weather changes: cold weather and wind
6• Tobacco smoke 
7• Airborne particulates: Pollution, Pollen, Vacuuming 
8• Ozone 
9• ASA, NSAIDS 
10• Hormonal changes 
11• Stress/ Strong Emotions 
12• Occupational exposures

Question 2

What are the clinical sxs of asthma? (7)

Answer 2

1– Wheezing (bronchospasm) 
2– Cough 
3– SOB 
4– Chest Tightness 
5– Accessory muscle use 
6– Shortened sentences 
7– Anxiety

Question 3

A genetic tendency to develop an IgE response to common environmental proteins results in wheezing, eczema, and season rhinitis

Answer 3

Atopy

Question 4

Atopy results in these 3 sxs:

Answer 4

1- wheezing
2- season rhinitis
3- eczema

Question 5

3 Key components in developing asthma:

Answer 5

1. AIRWAY OBSTRUCTION
2. AIRWAY HYPERACTIVITY
3. CHRONIC AIRWAY INFLAMMATION

Question 6

Asthma MC affects these populations:

Answer 6

• MC chronic disease in children

- MC disease that results in hospitalization in children in US

Question 7

Asthma epidemiology take-a-ways: (6)

Answer 7

1- likely more related to environmental factors
2- MC presents in ED
3- common in industrialized nations
4- MC in boys (2:1) in childhood, but evens out into adolescence
5- MC in females after puberty and by age 40, most new adult onset cases are in women
6- 65% of dx is made in children <18 y.o.

Question 8

Only tx for COPD shown to significantly improve lung function or decrease mortality:

Answer 8

Lung transplant

Question 9

5 A’s for quitting smoking:

Answer 9

1- ask about tobacco use
2- advise to quit through personalized messages
3- assist with quitting
4- arrange f/u care and support
5- assess willingness to quit

Question 10

In asthma, the immune system activation results in chemical release and these pathophys. changes occur: (4)

Answer 10

1- mucous hypersecretion (limited expiratory outflow)
2- smooth muscle contraction (cough and airway narrowing)
3- vasodilation w/ endothelial leak and edema (narrowing, loss of lung compliance, and decreased ability for oxygen exchange)
4- impairment of the mucociliary elevator (reduced ability to remove allergens from the lung)

Question 11

In asthma, the immune system activation results in these chemicals released: (3)

Answer 11

• prostaglandins
• histamine
• leukotrienes

Question 12

Anatomic results 2/2 to the pathophysiologic process in asthma: (5)

Answer 12

1. Mucosal thickening and infiltration of the airway wall with inflammatory cells
   2- Hypertrophied and contracted airway smooth muscle
   3- Damaged or dead bronchiole ET cells, stripping portions of the airway and exposing nerves to stimulation (hyperresponsiveness)
   4- Increased number of mucus glands, mucus hypersecretion and mucus plugging of airways
   5- Airway remodeling and fibrosis

Question 13

COX-inhibitors to avoid with asthma: (5)

Answer 13

1- Aspirin
2- Motrin
3- Naproxen
4- Ketoprofen
5- Indomethacin

Question 14

Non-selective BB to avoid with asthma: (5)

Answer 14

1- Propanolol
2-Nadolol
3- Pindolol
4- Timolol
5- Sotalol

Question 15

These classes of drugs should be avoided in asthma: (3)

Answer 15

1- ACE inhibitors
2- Non-selective BB
3- COX-inhibitors

Question 16

asthma pts. should have these two vaccinations:

Answer 16

• influenza (annually)

- pneumococcal

Question 17

SABA drugs: (3)

Answer 17

1- albuterol (proventil, ProAir, ventolin)
2- pirbuterol (maxair)
3- Levoalbuterol (xopenex)

Question 18

SABA AE’s: (5)

Answer 18

1- angina
2- palpitations
3- tachycardia
4- HTN
5- hyponatremia

Question 19

LABA drugs: (2)

Answer 19

1- salmeterol (serevent)

2- formeterol (foradil)

Question 20

Inhaled Corticosteroids: (4)

Answer 20

1- Budesonide (pulmicort, flexhaler, Respules)
2- Beclomethasone (Beclovent, QVAR HFA)
3- Triamcinaclone (Azmacort)
4- Fluticasone (Flovent HFA)

Question 21

Inhaled Corticosteroids AE’s: (2)

Answer 21

1- oropharyngeal candidiasis

2- dysphonia

Question 22

Combo drugs: (3)

Answer 22

1- Fluticasone/Salmeterol (Advair disku, advair HFA)
2- Formoterol/Mometasone (Dulera)
3- Budesonide/Formoterol (Symbicort)

Question 23

Systemic Corticosteroids: (3)

Answer 23

1- Prednisone
2- Prednisolone
3- Methylprednisolone

Question 24

Antihistamine drugs: (5)

Answer 24

1- Cetirizine (Zyrtec)
2- Desloratidine (Clarinex)
3- Loratidine (Claritin, Alavert)
4- Levocetirizine (Xyzal)
5- Fexofenadine (allegra)

Question 25

Indications for Intubation and mechanical ventilation in asthma exacerbation: (4)

Answer 25

1- respiratory muscle fatigue
2- respiratory acidosis
3- AMS
4- hypoxia refractory to standard therapies

Question 26

High suspicion for PNA and requires CXR with any one of the following 5 criteria:

Answer 26

1- HR>100 BPM
2- RR>24 breaths/min
3- Temperature>38 degrees C (100.4 F)
4- Chest exam findings of egophony, focal consolidation, or tactile fremitus
5- Pt age>64 y.o.

Question 27

This phrase should raise awareness for what dz: “muculopurulent discharge or recurrent PNA”

Answer 27

cystic fibrosis