Asthma and COPD

Question 1

What are the risk factors for asthma?

Answer 1

Genetics, prematurity, C section, environmental allergens, viral infections, abx use, acetaminophen exposure, air pollution, tobacco smoke, obesity

Question 2

What should the history focus on?

Answer 2

presence of sx, typical sx patterns, precipitating factors and known asthma RFs

Question 3

What are the asthma sx patterns?

Answer 3

Intermittent exacerbations superimposed upon asymptomatic baseline, chronic sx punctuated by periods of exacerbations, morning worsening of sx and decreased peak flow in early morning with improvement as the day progresses

Question 4

What are the three key elements required for an asthma diagnosis?

Answer 4

demonstration of variable expiratory airflow limitation by spirometry, documentation of reversible obstruction, exclusion of alternative diagnosis

Question 5

What spirometry characteristics are seen with asthma?

Answer 5

FEV1 <80% preducted, FEV1/FVC <85%, measure before and after administration of bronchodilator

Question 6

What are the medications used for asthma?

Answer 6

SABA (albuterol), LABA (salmeterol), ICS (budesonide), luekotriene receptor antagonist (Montekulast), SAMA (ipratropium bromide), systemic corticosteroids (prednisone)

Question 7

What is the tx for intermittent asthma?

Answer 7

SABA only

Question 8

What is the treatment for persistent asthma?

Answer 8

Need ICS +/- LABA

Question 9

What is COPD?

Answer 9

disease that is characterized by persistent sx and airflow limitation due to alveolar abnormalities caused by significant exposure to noxious particles

Question 10

How does COPD present?

Answer 10

dyspnea, chronic cough, sputum production, exertional dyspnea, wheezing, chest tightness, recurrent lower RTI, decreased capacity of exercise, low BMI

Question 11

What features are seen on PE for COPD?

Answer 11

wheezing or forced breathing and prolongation of forced expiratory time, pursed lip breathing, use of accessory muscles, retraction of intercostal spaces, hyperresonant, on percussion, decreased lung and heart sounds, tripod positioning, mild dependent edema, barrel chest

Question 12

What are the spirometry features for COPD?

Answer 12

FEV1/FVC <0.70, low FEV1, <12% reversibility

Question 13

What are GOLD pharmacological therapies for COPD?

Answer 13

bronchodilators, ICS, oxygen

Question 14

What are non-pharmacological options for COPD?

Answer 14

pt education and counseling, smoking cessation, inhaler technique, pulmonary rehab (improves exercise capacity, breathlessness), vaccination (pneumococcal, influenza, pertussis)

Question 15

What are other pharmacological therapies for COPD?

Answer 15

LABA, SABA, muscarinic antagonists (LAMA, SAMA), ICS, combination tx, oral glucocorticoids, phosphodiesterase 4 inhibitors, mucolytics, O2

Question 16

What should be done for acute exacerbations of COPD?

Answer 16

assess oxygen saturation with continuous pulse ox, obtain ABG, ETCO2 monitoring, non invasive O2, CXR, CMP, cardiac profile, BNP, ECG, nebulizer beta agonists, IV glucocorticoids, oral abx if increased sputum production and purulence

Question 17

What is RLD?

Answer 17

defined as destruction or fibrosis of interstitium, not reversible, reduced lung volumes (decreased TLC)

Question 18

What is seen on PE for ILD?

Answer 18

no wheezing, inspiratory crackles, clubbing, decreased O2 saturation at rest, extra pulmonary findings (LAD, synovitis, muscle weakness, scleritis, ulcers)

Question 19

What is needed for an ILD diagnosis?

Answer 19

PFTs, CXR showing ground glass opacities, high resolution CT, labs, biopsy

Question 20

What are the two most common ILD?

Answer 20

IPF and sarcoidosis

Question 21

Review

Answer 21

asthma and COPD study sheet