Asthma and COPD Flashcards
what gender is more at risk for asthma?
childhood: boys; women when in puberty or young adulthood
what are the prenatal risk factors for asthma?
ethnicity, low SES, stress, c-section, maternal tobaccos smoking
what is the largest epidemiological risk factor for asthma?
prematurity
what are the postnatal risk factors for developing asthma?
levels of endotoxins and allergens within the home, viral and bacterial infection (especially RSV and adenovirus), air pollution, antibiotic use, acetaminophen exposure, obesity
what is the pathophysiology of asthma: airway inflammation?
T2-type inflammation, sensitized by allergens, accompanying inflammatory infiltrate= eosinophils, defective resolution of process
what is the pathophysiology of asthma: airway remodeling?
increased airway smooth muscle, thickened subepithelial reticular lamina, increased mucous cells in new areas, increased mucous production
how do you diagnose asthma?
appropriate clinical symptoms+ reversible airflow limitation and/or airway hyper-responsiveness
what would spirometry show in in a symptomatic asthmatic patient?
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
there are two main types of asthma, what are they?
intermittent asthma and persistent asthma
how is intermittent asthma defined?
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
how do you treat intermittent asthma?
SABA only
how is mild persistent asthma defined?
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
how do you treat mild persistent asthma?
they need an ICS
how is moderate persistent asthma defined?
symptoms daily, nighttime awakenings more than one time a week, but not daily, SABA use daily
how do you treat moderate persistent asthma?
add a LABA
how is severe persistent asthma defined?
symptoms present throughout the day, daily nighttime awakenings, SABA use several times per day
what occurs at an initial visit for asthma?
diagnose the asthma, assess asthma severity, initiate medication and demonstrate use, develop written asthma action plan, schedule follow up appointment
what is the major goal of the treatment and management of asthma?
provide the best quality of life through minimizing disease symptoms and abolishing disease exacerbations
how do you treat intermittent asthma?
SABA as needed
step 2 of asthma plan?
low dose ICS
step 3 of asthma plan?
low dose ICS + laba OR medium dose ICS
step 4 of asthma treatment plan
medium dose ICS + LABA
step 5 of asthma treatment plan
high dose ICS+ LABA AND consider omalizumab
step 6 of asthma treatment
high dose ICS + LABA + oral corticosteroid
what is important to remember about the treatment of persistent asthma?
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
how should SABAs be prescribed?
the intensity of treatment depends on severity of symptoms; up to 3 treatments every 20 minutes as needed
what is generally a sign of inadequate control of asthma?
use of saba more than 2 days per week for symptom relief
what are some of the complications associated with asthma?
poor QOL, PNA, pneumothorax, resp failure, COPD
what is one of the best studied asthma prevention measures?
breastfeeding
what is the strongest association with mortality from COPD?
poverty
what are the risk factors for COPD?
smoking, history of tuberculosis
what are the three main pathological features of COPD?
obstructive bronchiolitis, emphysema, and mucus hypersecretion
what are acute exacerbations of COPD?
episodes of symptom worsening that are usually associated with increased airway inflammation and systemic inflammatory effects
what are the symptoms of an acute exacerbation of COPD?
increased dyspnea, increased sputum purulence, increased cough, increased wheezing, and beyond normal day-to-day variation
what does spirometry show in a patient with COPD?
FEV1/FVC is going to be less than .7; low FEV1; less than 12% reversibility
what is the gold 1 classification of copd?
mild: FEV1 will be greater than 80% of the predicted value
what is the gold 2 classification of COPD?
moderate: 50% < FEV1< 80% predicted
what is the gold 3 classification of COPD?
severe: 30% < FEV1< 50% predicted
what is the gold 4 classification of COPD?
very severe: FEV1 < 30% predicted
what are the goals of COPD treatment and management?
to reduce symptoms and to reduce risk
how do you pharmacologically treat COPD?
bronchodilators are the mainstay: prefer long-acting meds: LABA=LAMA in effectiveness LABA+ LAMA= 2x the lung function but not 2x symptom improvement
when do you use inhaled corticosteroids in COPD patients?
for those at risk of exacerbations
what are the risks of using ICS in COPD patients?
increases risk of PNA, oral thrush, hoarse voice, maybe osteoporosis
how does oxygen affect copd?
oxygen for at least 15 hours per day if SaO2 is <88% REDUCES MORTALITY
when should you be against the use of ICS?
repeated PNA events, blood eosinophils less than 100, and history of mycobacterial infection
what is the mainstay for treatment of acute exacerbations of COPD?
oral corticosteroids
