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Respiratory > Asthma and COPD > Flashcards

Asthma and COPD Flashcards

1
Q

at what age does asthma develop?

A

Any age, common in pediatrics. Can happen in adults.

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2
Q

Most predominant symptoms of asthma?

A

Cough worse at night, wheezing, sob, chest tightness, tripod breathing
Symptoms come and go, triggered by allergens and exercise.

Other common symptoms: Wheezing (can be only during an active flare)
Tycpnia or accessory muscle use; more advanced asthma

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3
Q

How to confirm asthma

A

FEV1: amount of air patient can force out of lungs in one second

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4
Q

what is an abnormal FEV1 for asthma patients?

A

FEV1 <0.7= airflow obstruction.

An increase of FEV1 >10% after administration of bronchodilator is highly suggestive of asthma.

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5
Q

When determining a patients asthma sevirity what are you looking at?

A

difficulty level to control patients symptoms

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6
Q

what is an example of a SABA

A

albuterol

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7
Q

what is an example of a LAMA

A

fomoterol

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8
Q

what is an example of ICS-LABA

A

budesonide-fomoterol (symbicort)

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9
Q

ASTHMA STEPS

How do you characterize someone in step 1 and how do you treat it?

A

<2 times a month
rare symptoms, no exacerbation risk factors

Symbicort (budesonide-fomoterol) as needed

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10
Q

ASTHMA STEPS

How do you characterize someone in step 2 and how do you treat it?

A

Asthma symptoms twice a month or more but less than 4-5 days a week

Symbicort (budesonide-fomoterol) as needed

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11
Q

How do you characterize someone in step 3 and how do you treat it?

A

asthma symptoms occur most days, and have some activity limitations

Implement “SMART” strategy, Single inhaler maintenance and reliever therapy

Combination low dose ics fomoterol daily AND as a PRN

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12
Q

How do you treat someone in step 4?

A

medium dose ICS formoterol daily: refer

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13
Q

How do you treat someone in step 5?

A

high dose ICS fomoterol, LAMA, refer

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14
Q

How do we know treatment for asthma is succesful?

A

Regular followup, asthma treatment can take a few months
Have them do peak flow reads at home and determining succes of their treatment is NOT based on how often they are using their medication but how WELL their symptoms are controlled

Well controlled asthma is considered to be symptoms that occur no more than 2 times a week and nighttime symptoms no more than 2 times a month. Only step down treatment if those are matched.

“I have only had to use my rescue inhaler once a week and I used to used it 5 times a week”, thats great but it doesn’t mean to scale back their treatment regimen

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15
Q

3 things that impact peak flow readings in adults
In order of importance.

A

Height
Age
sex

“HAS”

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16
Q

What are risk factors for COPD?

A

Smoking and long term exposure to pollutants.

17
Q

what are the two main types of COPD and what is the difference between the two?

A

Chronic bronchitis (cilia destruction and mucus build-up; chronic productive cough) and emphysema (destroys alveoli in lungs, wheezing and dyspnea)

18
Q

Clinical findings of COPD

A

Difficulty taking a deep breath and chest tightness
Physical exam: hyper resonance, decreased breath sounds, crackles, increased diameter of the chest (barrel chest)

19
Q

How do you diagnose COPD?

A

Spirometry: FEV1/FVC ratio: <0.70 or less = COPD

20
Q

What does treatment for COPD depend on?

A

exacerbations.
“CAT score” COPD assessment tool, and exacerbation history help determine which medication treatment.

> 2 exacerbations or > 1 hospitalization:

0-1 exacerbations (no hospitalization)

21
Q

How do you determine a patient is in Group A treatment for COPD?

A

0-1 moderate exacerbations (without hospitlization), CAT score is <10

22
Q

How do you determine a patient is in Group B treatment for COPD?

A

0 or 1 moderate exacerbations (without hospitlzation), CAT score is > or equal to 10

23
Q

How do you determine a patient is in Group E treatment for COPD?

A

> 2 moderate exacerbations or >1 exacerbation that leads to hospitalization.

24
Q

What is the treatment for Group A?

A

Bronchodilator LABA

25
Q

What is the treatment for Group B?

A

LABA-LAMA (long-acting bronchodilator and long-acting muscarinic antagonist)

26
Q

What is the treatment for Group E?

A

LABA-LAMA + ICS
long acting bronchodilator and long acting muscarinic antagonist and maybe inhaled corticosteroid

27
Q

No matter what treatment group patients with copd are in they should have what prescribed?

A

All patients should have a SABA for episodes of dyspnea.

28
Q

A patient with COPD lost 17 pounds. Is this a good thing?

A

Unintentional weight loss can mean cancer. COPD patients are at a high risk for lung cancer.
You might need to have them do high calorie high protein meals 5-6 times a day if its due to smptom severity.

29
Q

what are ICS side effects?

A

dysphonia, thrush, and contact dermatitis

30
Q

what are side effects of fomoterol?

A

anxiety, chest pain, dizziness

31
Q

who should get screened for alpha-1 anititrypsin?

A

anyone with COPD.

Alpha-1 antitrypsin (AAT) deficiency is an inherited disorder that can affect the liver, lungs, and skin. AAT deficiency predisposes individuals to COPD. Therefore, the WHO recommends that AAT deficiency screening be performed in all patients with a diagnosis of COPD, regardless of age at diagnosis.

32
Q
A
33
Q

What pain medication should patients with asthma avoid?

A

Asthma patients may be sensitive to aspirin and NSAIDs, which can trigger asthma attacks; acetaminophen is a safer alternative.

34
Q

what medication is used for treatment of asthma for patients who corticosteroids are a contraindication?

A

Leukotriene inhibitors

They are an approved treatment for mild to moderate asthma.

They are an acceptable alternative for patients with a contraindication to inhaled corticosteroids.

35
Q

If treatment is recently modfied in a patient with asthma when should you do a follow up?

A

two weeks

36
Q

For moderate asthma with daily symptoms and waking more than once a week, prescribe?

A

low-dose of ICS-LABA as maintenance therapy and reliever therapy.

Respiratory (5 decks)

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