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Pulmonology Exam > Asthma and COPD > Flashcards

Asthma and COPD Flashcards

1
Q

what gender is more at risk for asthma?

A

childhood: boys; women when in puberty or young adulthood

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2
Q

what are the prenatal risk factors for asthma?

A

ethnicity, low SES, stress, c-section, maternal tobaccos smoking

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3
Q

what is the largest epidemiological risk factor for asthma?

A

prematurity

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4
Q

what are the postnatal risk factors for developing asthma?

A

levels of endotoxins and allergens within the home, viral and bacterial infection (especially RSV and adenovirus), air pollution, antibiotic use, acetaminophen exposure, obesity

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5
Q

what is the pathophysiology of asthma: airway inflammation?

A

T2-type inflammation, sensitized by allergens, accompanying inflammatory infiltrate= eosinophils, defective resolution of process

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6
Q

what is the pathophysiology of asthma: airway remodeling?

A

increased airway smooth muscle, thickened subepithelial reticular lamina, increased mucous cells in new areas, increased mucous production

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7
Q

how do you diagnose asthma?

A

appropriate clinical symptoms+ reversible airflow limitation and/or airway hyper-responsiveness

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8
Q

what would spirometry show in in a symptomatic asthmatic patient?

A

a predicted FEV1 of less than 80%; age adjusted FEV1/FVC of less than 75%; reversibility of airway obstruction: 12% improvement in FEV1 over baseline + total improvement of at least 200 ml; but normal spirometry does not exclude this disease

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9
Q

there are two main types of asthma, what are they?

A

intermittent asthma and persistent asthma

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10
Q

how is intermittent asthma defined?

A

symptoms fewer than 2 days a week, nighttime awakenings less than 2 times a month, going to need their rescue inhaler less than 2 times a week

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11
Q

how do you treat intermittent asthma?

A

SABA only

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12
Q

how is mild persistent asthma defined?

A

symptoms more than 2 days a week, but not daily, nighttime awakenings 3-4x/month, SABA use more than 2 times a week but not daily

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13
Q

how do you treat mild persistent asthma?

A

they need an ICS

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14
Q

how is moderate persistent asthma defined?

A

symptoms daily, nighttime awakenings more than one time a week, but not daily, SABA use daily

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15
Q

how do you treat moderate persistent asthma?

A

add a LABA

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16
Q

how is severe persistent asthma defined?

A

symptoms present throughout the day, daily nighttime awakenings, SABA use several times per day

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17
Q

what occurs at an initial visit for asthma?

A

diagnose the asthma, assess asthma severity, initiate medication and demonstrate use, develop written asthma action plan, schedule follow up appointment

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18
Q

what is the major goal of the treatment and management of asthma?

A

provide the best quality of life through minimizing disease symptoms and abolishing disease exacerbations

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19
Q

how do you treat intermittent asthma?

A

SABA as needed

20
Q

step 2 of asthma plan?

A

low dose ICS

21
Q

step 3 of asthma plan?

A

low dose ICS + laba OR medium dose ICS

22
Q

step 4 of asthma treatment plan

A

medium dose ICS + LABA

23
Q

step 5 of asthma treatment plan

A

high dose ICS+ LABA AND consider omalizumab

24
Q

step 6 of asthma treatment

A

high dose ICS + LABA + oral corticosteroid

25
Q

what is important to remember about the treatment of persistent asthma?

A

need to have an ICS and if they are at a moderate or severe persistent stage or classification then you will likely add a LABA while considering increasing the intensity of their ICS

26
Q

how should SABAs be prescribed?

A

the intensity of treatment depends on severity of symptoms; up to 3 treatments every 20 minutes as needed

27
Q

what is generally a sign of inadequate control of asthma?

A

use of saba more than 2 days per week for symptom relief

28
Q

what are some of the complications associated with asthma?

A

poor QOL, PNA, pneumothorax, resp failure, COPD

29
Q

what is one of the best studied asthma prevention measures?

A

breastfeeding

30
Q

what is the strongest association with mortality from COPD?

A

poverty

31
Q

what are the risk factors for COPD?

A

smoking, history of tuberculosis

32
Q

what are the three main pathological features of COPD?

A

obstructive bronchiolitis, emphysema, and mucus hypersecretion

33
Q

what are acute exacerbations of COPD?

A

episodes of symptom worsening that are usually associated with increased airway inflammation and systemic inflammatory effects

34
Q

what are the symptoms of an acute exacerbation of COPD?

A

increased dyspnea, increased sputum purulence, increased cough, increased wheezing, and beyond normal day-to-day variation

35
Q

what does spirometry show in a patient with COPD?

A

FEV1/FVC is going to be less than .7; low FEV1; less than 12% reversibility

36
Q

what is the gold 1 classification of copd?

A

mild: FEV1 will be greater than 80% of the predicted value

37
Q

what is the gold 2 classification of COPD?

A

moderate: 50% < FEV1< 80% predicted

38
Q

what is the gold 3 classification of COPD?

A

severe: 30% < FEV1< 50% predicted

39
Q

what is the gold 4 classification of COPD?

A

very severe: FEV1 < 30% predicted

40
Q

what are the goals of COPD treatment and management?

A

to reduce symptoms and to reduce risk

41
Q

how do you pharmacologically treat COPD?

A

bronchodilators are the mainstay: prefer long-acting meds: LABA=LAMA in effectiveness LABA+ LAMA= 2x the lung function but not 2x symptom improvement

42
Q

when do you use inhaled corticosteroids in COPD patients?

A

for those at risk of exacerbations

43
Q

what are the risks of using ICS in COPD patients?

A

increases risk of PNA, oral thrush, hoarse voice, maybe osteoporosis

44
Q

how does oxygen affect copd?

A

oxygen for at least 15 hours per day if SaO2 is <88% REDUCES MORTALITY

45
Q

when should you be against the use of ICS?

A

repeated PNA events, blood eosinophils less than 100, and history of mycobacterial infection

46
Q

what is the mainstay for treatment of acute exacerbations of COPD?

A

oral corticosteroids

Pulmonology Exam (11 decks)

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