Asthma and COPD

Question 1

Presentation: Episodic wheezing, SOB, chest pain, cough

Answer 1

Asthma

Question 2

Asthma spirometry test after give bronchodilator will improve FEV by what percentage?

Answer 2

12%

Question 3

Positive asthma DX with Methacholine challenge

Answer 3

Drop in lung function or FEV by 20%

Question 4

Lab finding: CXR can show hyperinflation, bronchiole wall thickening, and diminished lung markings

Answer 4

Asthma

Question 5

Asthma patient that experiences 1-2 of the four symptoms in a four week period

Answer 5

Partially controlled

Question 6

Patient with asthma who experiences 3-4 symptoms in past four weeks?

Answer 6

uncontrolled

Question 7

Asthma with 2+ exacerbations per year, daily symptoms, and nighttime wakings 1x per week

Answer 7

Persistent moderate

Question 8

Presentation: 53 y/o patient, leaned forward, uncomfortable, having trouble breathing, appears cachectic,

Answer 8

Emphysema

Question 9

Presentation: 53 y/o patient, leaned forward, uncomfortable, having trouble breathing, appears cachectic, quiet lung sounds with no adventitious sounds

Answer 9

Emphysema

Question 10

HgB high; low Pa02; CXR increased interstitial markings at bases; diaphragm not flattened

Answer 10

Chronic bronchitis

Question 11

CXR hyperinflation with diminished markings; flat diaphragm; Total lung capacity increased; DlCO reduced

Answer 11

Emphysema

Question 12

Presentation: 37 y/o patient with major chronic cough with production, overweight, cyanotic skin tone, wheezes and rhonchi heard on auscultation

Answer 12

Chronic bronchitis

Question 13

Treatment for patients with COPD in class B-D

Answer 13

Smoking cessation; pulmonary rehab; Prescribe bronchodilator, & Group B give LABA and LAMA
LABA, LAMA, and ICS if eosinophil count is >300

Question 14

Short acting Beta agonists for asthma/COPD (bronchodilator) & Adverse effects

Answer 14

SABA, SAMA: relaxes airways in 5 minutes: can cause tachycardia, tremor, ECG changes if overdosed

Question 15

Long term pharmacological control for asthma

Answer 15

Inhaled corticosteroids (ICS); Long acting B2 agonist (LABA); long-acting muscarinic agonist (LAMA); Leukotriene modifiers (LTRA)

Question 16

When are biologics indicated as treatment for asthma?

Answer 16

for allergic asthma or >300 eosinophil & on high dose ICS, not doing well

Question 17

What drug class can never be used as monotherapy for asthma patients?

Answer 17

LABA - long acting beta agonist

Question 18

What asthma treatment can cause dry mouth, blurred vision, flushing, and agitation?

Answer 18

LAMA - long acting muscarinic agonist

Question 19

Most common treatment for severe uncontrolled asthma with eosinophil count >300?

Answer 19

ICS+LABA+LAMA

Question 20

What is the best first line LAMA for COPD exacerbations?

Answer 20

Tiotropium

Question 21

What drugs are very helpful for all severity levels of asthma patients, but aren’t very effective in patients with COPD?

Answer 21

ICS - inhaled corticosteroid

Question 22

When is it appropriate to prescribe antibiotics in the treatment of COPD?

Answer 22

PT has increased dyspnea, sputum volume and purulence, if they need mechanical ventilation; altered mental status likely due to lack of 02

Question 23

First line non-nicotine replacement drugs for smoking cessation and their adverse effects

Answer 23

Bupropion - seizures, suicide risk, insomnia
Chantix (varenicline): nausea dose dependent; somnambulism; CNS events