Asthma and COPD Flashcards
In childhood, what sex is affected more often by Asthma?
Boys
In young adulthood, what sex is affected more often by Asthma?
Women
What sex achieves remission from Asthma more often?
Males
What is a predominant pre-natal risk factor for Asthma?
Prematurity
Besides prematurity, what are some other pre-natal risk factors for Asthma?
Ethnicity
Socioeconomic status
C-section
Maternal tobacco use
What are some post-natal risk factors for Asthma?
Toxins/allergens in the home, air pollution
Infections, medication use and obesity
What is the best studied prevention of Asthma?
Breast feeding
Describe the pathophysiology of the airway inflammation with Asthma?
T2 type inflammation with eosinophils, mast cells, etc.
– Defective Resolution process!!
Describe the pathophysiology of the airway remodeling with Asthma?
- Increased smooth muscle, mucus glands and production
- Thickened subepithelial reticular lamina
What are the symptoms of Asthma?
Cough, recurrent wheezing, dyspnea, chest tightness
What are the symptoms of Asthma?
Cough, dyspnea, recurrent wheezing, chest tightness
What are some things that can make Asthma worse?
Exercise, night time, weather and allergen exposure changes, laughing/crying/stress
Diagnosis of Asthma can be difficult. What 3 things need to be present?
- Appropriate symptoms
- Reversible airflow limitation
- Airway hyper-responsiveness
What are the spirometry results with Asthma?
- FEV1 < 80% predicted
- Age adjusted FEV1/FVC < 75%
- Reversibility of obstruction
= > 12% increase in FEV1 and > 200 ml volume
What are the spirometry results with Asthma?
- FEV1 < 80% predicted
- Age adjusted FEV1/FVC < 75%
- Reversibility of obstruction
= > 12% increase in FEV1 and > 200 ml volume
Does normal spirometry exclude Asthma?
NO
Intermittent Asthma and Treatment
Symptoms less than 2 days/week
= SABA as needed
Asthma symptoms greater than 2days/week but not daily
Mild Asthma
Daily Asthma symptoms with some activity limitations
Moderate Asthma
Asthma symptoms throughout the day with severe limitations on activities
Severe Asthma
What is the treatment for Mild, Moderate and Severe persistent Asthma?
ICS +/- LABA/LAMA
What is the treatment for Mild, Moderate and Severe persistent Asthma?
ICS +/- LABA/LAMA
What does the use of a SABA > 2 days/week for relief of asthma suggest?
Inadequate control of asthma and need to step up treatment
What are some complications of Asthma?
Poor quality of life, exacerbation of symptoms
- Pneumonia, Pneumothorax, respiratory failure, airway remodeling
With COPD there is ____ airflow limitation that is ____
Persistent airflow limitation that is irreversible
The mortality with COPD is associated with?
Poverty
Increasing male age
What are the main risk factors for COPD?
Smoking
History of Tuberculosis
– Genetics plays a role
Persistent airflow limitation that is irreversible
COPD
Common names for the presentations of COPD?
Blue bloaters
Pink Puffers
What are the main symptoms of COPD?
Dyspnea
Cough with sputum production
Recurrent respiratory tract infections
What are the spirometry results of COPD?
- FEV1 < 80% predicted
- FEV1/FVC < 0.7
- < 12% reversibility
What are the spirometry results with COPD?
- FEV1 < 80% predicted
- FEV1/FVC < 0.7
- < 12% reversibility
Gold 1/mild COPD
FEV1 > 80%
Gold2/Moderate COPD
FEV1 between 50-80%
Gold3/Severe COPD
FEV1 between 30-50%
Gold4/Very severe COPD
FEV1 < 30%
Non-pharmacologic treatments for COPD?
- Pulmonary rehab
- Lung volume reduction and transplant
Mainstay for pharmacologic treatment for COPD?
Long acting Bronchodilators
Mainstay for pharmacologic treatment for COPD?
Long acting Bronchodilators – LABA/LAMA
What is the pharmacologic treatment for those patients that are at high risk of COPD exacerbations?
Inhaled Corticosteroids
Why are Inhaled Corticosteroids only given for those COPD patients that are at risk for exacerbation?
The benefit/risk ratio is poor so not recommended for all
Inhaled Corticosteroids increase lung function but also the patient’s risk for?
PNA
Oral thrush
Hoarseness
Osteoporosis
What treatment for COPD reduced mortalitiy?
Oxygen
What treatment for COPD reduces mortality?
Oxygen
For Acute Exacerbations of COPD, what is the mainstay of treatment?
ORAL corticosteroids
For Acute Exacerbations of COPD, what is the mainstay of treatment?
ORAL corticosteroids
What are some actions to take in order to prevent COPD exacerbations?
- Vaccinations
- Long acting bronchodilators and ICS
What should you address at each visit with your COPD patient?
Smoking cessation
LABA + LAMA = 2x the lung function but not 2x the?
Symptom improvement
In effectiveness, is LABA = LAMA?
Yes
