Asthma and COPD

Question 1

What is a distinguishing feature of asthma from COPD

Answer 1

pulsus paradoxus > 12

Question 2

what are ominous signs of asthma?

Answer 2

-fatigue, absent breath sounds, paradoxical chest/abd movement, inability to maintain recumbency, cyanosis

Question 3

Which PFTs are most affected in asthma?

Answer 3

F, particularly FEV1

Question 4

When is hospitalization recommended for asthma

Answer 4

initial FEV1 < 30% predicted or does not increase to 40% predicted after 1 hour therapy
or
if peak flow is < 60L/min initially or does not improve to > 50% predicted after 1 hour tx

Question 5

what are very concerning findings in an asthmatic?

Answer 5

• hypercapnea
• pCO2 > 45 indicates emergency
• normal pco2 (35-45) indicates sick pt

Question 6

What are the steps of managing asthma

Answer 6

1. short acting agent (albuterol)
   - if needs more
2. add corticosteroid (budesonide, triamcinolone, (corts) (rinse mouth!)
   - if needs more
3. can increase corticosteroid or add LABA (salmeterol) or theophylline or antimediators
   - if has lots of secretions
4. add atrovent (ipatropium bromide)
   - for long term stabilization
5. add antileukotrienes (singular)

Question 7

Inpatient management of asthma

Answer 7

if severe check ABG

• hydration
• inhaled sympathomimetics (alupent or proventil, ventolin)
• corticosteroids for those who don’t respond to sympathomimetics
• parenteral sympathomimetics in patients unable to cooperate (aqueous epic
• anticholinergic (atrovent) MDI 2-6 puffs q 4-6 hours

Question 8

Management of status asthmaticus

Answer 8

IV d5 1/2 NS
-inhalation and parenteral sympathomimetics
-methylprednisolone or hydrocortisone
-consider atrovent (secretions)
-pulse oximetry
ABG q 10-20 min
-intubate if needed- change in behavior most important sign

Question 9

Emphysema is

Answer 9

abnormal, permanent enlargement of the alveoli

Question 10

S & S of chronic bronchitis

Answer 10

intermittent dyspnea
-onset of symptoms after 35
-copious purulent sputum
-stocky, obese
-A-P diameter normal
-percussion normal
-bulla, blebs on cxr
-hyperinflation on cxr
hypercapnea, hypoxemia on abg
-hematocrit increased d/t thick secretions

Question 11

S & S of emphysema

Answer 11

progressive dyspnea

• after age 50
• mild clear sputum
• thin
• A-P diameter increased
• percussion hyperesonant
• hematocrit normal
• total lung capacity increased

Question 12

Labs and diagnostics of COPD

Answer 12

flattened diaphragm by cxr

• FEV1 and all other measurement of expiratory airflow reduced
• TLC, FRC and RV may be increased
• increased paCO2
• increased HCO3

Question 13

inpatient management of copd

Answer 13

same as for asthma except if have purulent sputum receive abs for 7-10 days
ampicillin or amoxicillin
doxy or bactrim

Question 14

What is a sign seen in asthma but not in COPD

Answer 14

pulsus paradoxus > 12 mm Hg

Question 15

what are other labs and diagnostics of asthma?

Answer 15

• slight elevation WBC with eosinophilia

- initially respiratory alkalosis with mild hypoxemia on ABG

Question 16

PFTs reveal abnormalities typical of obstructive dysfunction (asthma). when would hospitalization be recommended

Answer 16

• if initial FEV1 is < 30% predicted or does not increase to 40% predicted after 1 hour vigorous therapy
• if peak flow is < 60 L/m initially ro does not improve to > 50% predicted after 1 hour treatment

Question 17

what is the most sensitive reason to intubate asthmatic?

Answer 17

• falling ABGs or falling O2 sat or respiratory rate climbing to 30s or change in behavior
• change in behavior

Question 18

how is chronic bronchitis characterized?

Answer 18

excessive secretion of bronchial mucus and is manifested by productive cough x 3 months or more in at least 2 consecutive years

Question 19

what is the mainstay of therapy for COPD

Answer 19

-ipratropium bromide