Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MS-PA: Respiratory Diseases > Asthma and COPD > Flashcards

Asthma and COPD Flashcards

1
Q

What is the WHO definition of COPD ?

A

COPD s a lung disease
characterised by chronic obstruction of lung airflow that interferes with
normal breathing and is not fully reversible.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Chronic Bronchitis?

A

Productive cough on most days for
at least 3 months a year, for at least 2 consecutive years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is Emphysema ?

A

Abnormal and permanent enlargement of the airways distal to the terminal bronchiole.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the symptomatology of Emphysema ( Pink Puffers) ?

A

These are thin patients who presents with orthopnea, dyspnea on exertion and at rest. They may appears to have anxiety, pursed lip breathing, speaks in short jerky sentences, barrel chest, prolonged exertional time, hyperresonance on percussion and minimal cyanosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the symptomatology of Chronic bronchitis ( The blue puffers) ?

A

They appear very cyanotic, they have recurrent productive cough and airflow problems. They often have exertional dyspnea and bilateral pedal edema. They often have hypoxia, hypercapnia, respiratory acidosis. They may also have high Hb,digital clubbing, and cardiac enlargement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the C-XR findings in COPD ?

A
  • Hyperinflation marked by > 7 anterior and > 11 posterior rib visibility above diaphragm.
  • Flatent diaphragm and hyper lucent lungs.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the risk factors for COPD ?

A
  • Active and passive smoking
  • Occupational and environmental factors.
  • Alpha one anti-trypsin deficiency.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the GOLD classification of COPD ?

A

*GOLD 1 - mild: FEV1 ≥80% predicted
*GOLD 2 - moderate: 50%≥ FEV1 <80% predicted
*GOLD 3 - severe: 30% ≤ FEV1 <50% predicted
*GOLD 4 - very severe: FEV1 <30% predicted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the GOLD group A COPD ?

A

Low risk (0-1 exacerbations per year, not requiring hospitalization) and fewer symptoms (mMRC 0-1 or CAT <10)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is GOLD group B COPD ?

A

Group B: low risk (0-1 exacerbations per year, not requiring hospitalization) and more symptoms (mMRC ≥2 or CAT ≥10)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is GOLD group E COPD ?

A

Group E: high risk (≥2 exacerbations per year, or ≥1 requiring hospitalization) and any level of symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is modified MRC dyspnea scale ?

A

https://www.ncbi.nlm.nih.gov/books/NBK559281/figure/article-26083.image.f5/

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is COPD Assessment Test CAT ?

A

https://www.mdcalc.com/calc/10161/copd-assessment-test-cat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the general management of COPD ?

A
  • Smoking cessation
  • Exercise
  • Vaccinations
  • Manage co-morbidities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the GOLD recommendation for the initial pharmacotherapy of GOLD group E COPD?

A
  • Long Acting Beta2 Agonist ( LABA) + Long-acting muscarinic antogonists (LAMA)
  • LABA+ LAMA + ICS if eosinophil counts ≥300 cells/μL.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the GOLD recommendation for the initial pharmacotherapy of GOLD group A COPD?

A

Bronchodilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the GOLD recommendation for the initial pharmacotherapy of GOLD group B COPD?

A

LABA + LAMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the causes of acute exacerbation of COPD ?

A
  • Infective: bacterial, viral, mycoplasma, atypicals.
  • Non-infective: non compliance, environmental triggers.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is type 01 respiratory failure in COPD ?

A

hypoxemia, PaO2 <8kPa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is type 02 respiratory failure in COPD ?

A

hypercapnia, paCO2> 6kPa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the lab findings in compensated or non acidotic type 02 respiratory ?

A

pH Normal
PaO2 normal or <8kPa
pCO2 >6KPa
HCO3-Elevated to Compensate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the lab findings in decompensated or Acidotic Type 2 Respiratory Failure ?

A

pH low<7.35
Pa PaO2 <8kPa
pCO2>6kPa
HCO3- Normal or elevated
Decompensated

23
Q

What is the relationship between COPD mortality and acidosis ?

A

*12% if the presentation pH is the lowest value reached
*24% when acidosis worsens after presentation
*33% when acidosis only develops after admission

24
Q

What are the complications of COPD ?

A
  1. Secondary Pneumothorax Majority need chest drain,
    recurrent need VATS + pleurodesis
  2. Cachexia/ weight loss
  3. Depression
  4. Pulmonary Hypertension
  5. Cor Pulmonale
  6. Anaemia of chronic disease affects 25%
  7. Polycythemia
25
Q

What should be the approach to managing COPD exacerbations?

A
  • Bronchodilators SABA, SAMA (inhaler or nebuliser)
  • Targeted O2 therapy
  • +- Oral/IV steroids if wheezy
  • +- anti-biotics if infection suspected
  • If GOLD E use ICS
  • Chest physio and mobility
  • If acidotic type 2 respiratory failure: Bi-PAP
26
Q

How does BPAP work ?

A

It provides two positive pressures inspiratory PAP > expiratory PAP.

27
Q

What is the advantage of BPAP in COPD exacerbation?

A

It mainly fixes pH and PaCO2 and the O2 will fix itself as the ventilation improve.

28
Q

What are the advantages of non invasive ventilation ?

A

Improves ABG evidence of respiratory failure
Reduces dyspnea
Reduces work of breathing
Outcomes: 50% improvement
Reduces intubation rates: From 27% to 15%*
Reduces in hospital mortality: From 20% to 10%*

29
Q

What is the definition of Asthma?

A

A heterogenous disease of the lower airways characterised by:
1. Airway hyperresponsiveness
2. Inflammation
3. Episodic or persistent symptoms
4. Variable degrees of airflow obstruction on PFTs

30
Q

What is the epidemiology of asthma in Ireland ?

A
  • 470,000 current cases.
  • Ireland has the fourth highest prevalence in the world
  • Over-diagnosis very common (1/3)
31
Q

what is the utility of bronchodilatory response testing or reversibility testing in Asthma ?

A

It can help to differentiate revisable asthma from unrevisable COPD.

32
Q

What is the definition of a positive bronchodilatory response ?

A

+ve BDR is 12% AND 200ml increase in FEV1 after SABA.

33
Q

what are the triggers in Asthma attack ?

A

The Hx is key
Animal dander - Smoke
* House dust mite - Temperature changes
* Pollen - Aerosol chemicals
* Fungi - Strong emotional expression
* Exercise - Drugs: β-blockers, NSAIDS
* Viral infection

34
Q

What are the blood findings in Asthma?

A
  • FBC (eosinophilia)
  • pANCA (Churg-Strauss)
  • Total IgE
  • RAST Asthma
35
Q

What are the lab work ups in Asthma ?

A
  • X-ray/CT sinuses
  • CT Thorax
  • Skin prick testing
  • Sputum culture including fungal
    culture
36
Q

What are the functional tests in Asthma ?

A
  • PEFR variability
  • Spirometry with
    reversibility
  • Bronchial Provocation (To
    detect mild asthma)
37
Q

What is Peak expiratory flow rate (PEFR)?

A

Peak expiratory flow rate (PEFR) is the volume of air forcefully expelled from the lungs in one quick exhalation, and is a reliable indicator of ventilation adequacy as well as airflow obstruction. The normal peak flow value can range from person to person and is dependent upon factors such as sex, age and height.

38
Q

What is the normal standardised PEFR?

A

The normal peak flow is 450-550 L /min in adult males and it is 320-470 L/min in adult females. PEFR is the reflection of the functioning of the larger airways and any amount of stress/ infection/ inflammation in these airways causes alteration in normal PEFR

39
Q

What should be the GOLD steps in prescribing controller and preferred relivers in Asthma ?

A

Using ICS-formoterol as reliever reduces the risk of exacerbations compared with using a SABA reliever.
STEP 01 and 02: low dose ICS-formoterol PRN
STEP 03: Low dose maintenance
ICS-formoterol.
STEP 04: Medium dose maintenance
ICS-formoterol.
STEP 05: Add-on LAMA Refer for assessment of phenotype. Consider
high dose maintenance ICS-formoterol, ± anti-IgE, anti-IL5/5R,
anti-IL4R, anti-TSLP.

40
Q

What should be the GOLD steps in prescribing controller and Alternative relivers in Asthma ?

A

*STEP 1:Take ICS whenever
SABA taken.
* STEP 2: Low dose maintenance ICS.
* STEP 3: Low dose maintenance ICS-LABA.
* STEP 4 Medium/highdose
maintenance ICS-LABA.
* STEP 5: Add-on LAMA
Refer for assessment
of phenotype. Consider
high dose maintenance
ICS-LABA, ± anti-IgE,
anti-IL5/5R, anti-IL4R,
CONTROLLER and anti-TSLP

41
Q

What are the pharmacological Tx that should be done under pulmonology or allergy specialist only ?

A
  • Leukotriene receptor agonist (montelukast)
  • Sublingual Immunotherapy (allergic rhinitis, HDM sensitivity)
  • Azithromycin prophylaxis (recurrent exacerbators)
  • Oral corticosteroids
  • Biologics (Anti IgE/Anti- IL5) – Omalizumab, Mepolizumab,
    Benralizumab
42
Q

What are the goals of pharmacology therapy in COPD ?

A
  • The aim is to ideally achieve complete disease control which is defined as no night or day time symptoms, no need of rescue medications and no exacerbation attacks, no limitation of ADLs and exercise. Normalization of lung function ( FEV1and or PEF > 80% predicted).
43
Q

What should be the pharmacological approach in Asthma ?

A
  • start Tx at the most appropriate level of initial severity.
  • Achieve early control
  • Maintain control by increasing and decreasing tx as needed.
  • Before initiating any new Tx check adherence to the current one.
44
Q

What is the presentation of mild acute asthma ?

A
  • increasing symptoms
  • PEF > 50 to 70% best or predicted.
  • No features of acute severe asthma
45
Q

What is the presentation of severe acute asthma ?

A

Any one of the following:
* PEF 33 to 50% predicted or best.
* RR greater than equal to 25 / min.
* HR > or equal to 110/min
* Inability to complete a sentence in one breath.

46
Q

What is the presentation of life threatening asthma ?

A

Any one of the following in patients with severe Asthma:
* PEF < 33% or SpO2 < 92% or PaO2 < 8 kPa or normal PaCO2.
* Silent chest, cyanosis, poor respiratory effort.
* Arhythmia, exhaustion, altered consciousness and hypotension.

47
Q

What is the presentation of near fatal asthma ?

A

Raised PaCO2 and or requiring mechanical ventilation with raised inflation pressure.

48
Q

What is the indication for O2 in acute asthma ?

A

All asthma patients with hypoxia should be given O2 to maintain SpO2 b/w 94 to 98%.

49
Q

What is the indication for steroids in acute asthma ?

A

Give steroids in all cases of acute asthma and continue prednisolone 40 to 50 mg / day until recovery or at least 5 days.

50
Q

What is the indication for beta 2 agonist bronchodilator in acute asthma ?

A
  • Use high dose beta 2 agonists as first line agent in all cases of acute asthma.
  • Reserve IV beta 2 agonist for those patients in whom inhaled therapy can not be reliably done.
51
Q

What is the indication for ipratropium bromide acute asthma ?

A

Add ipratropium bromide 0.5 mg four to six hourly with beta two agonist Tx for patients with acute severe or life threatening asthma. It can also be used for those with poor response to initial bronchodilator Tx.

52
Q

What are the important mediator molecules of asthma pathogenesis ?

A

Important mediators include leukotriene B 4 and cysteinyl leukotrienes (C 4 and D 4 ); interleukins (IL)-4, IL-5, IL-13; and tissue-damaging eosinophil proteins.

53
Q

How is asthma treatment is monitored ?

A

Treatment is monitored by measuring forced expiratory volume in 1 second (FEV 1 ) or PEFR and, in acute severe disease, oxygen saturation and arterial blood gases.

MS-PA: Respiratory Diseases (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions