Asthma and COPD

Question 1

What are prenatal risk factors for asthma?

Answer 1

ethnicity

low SES

stress

C-section

maternal smoking

prematurity

Question 2

What are postnatal risk factors for asthma

Answer 2

allergens

viral/bacterial infections

pollution

abx use

tylenol use

obesity

Question 3

How is an asthma diagnosis made?

Does normal spirometry rule out asthma?

Answer 3

12% improvement in FEV1 over baseline and a total improvement of at least 200ml

AKA reversibility of airway obstruction

No

Question 4

What qualifies as mild asthma?

Answer 4

symptoms >2 days/week but not daily

night time wakenings 1-2xmonth to 3-4xmonth

exacerbations requiring corticosteroids >2 in 6 months or wheezing >4x per year lasting >1 day and risk factors for persistent asthma

Question 5

What qualifies as moderate asthma?

Answer 5

SABA use daily with some limitation in daily activities

Question 6

What qualifies as severe asthma?

Answer 6

SABA use several times per day, extremely limited in daily acitivities

Question 7

What is the goal of ashtma management?

Answer 7

provide the best QOL through minimizing disease sx and abolishing exacerbations

Question 8

What are exacerbations caused by?

Best way to treat asthma exacerbations?

Answer 8

infections, allergens

Prevention, bronchodilators, glucocorticoids, O2

Question 9

How to prevent asthma?

Answer 9

breastfeeding

avoid tobacco smoke

target obestiy

balanced diet, Vit. D

allergy avoidance?

Gut microbiome?

vaccinations

Question 10

What is COPD?

Answer 10

persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles and gases

It is largely irreversible

Question 11

What are the common causes of COPD?

Answer 11

smoking

hx of TB

pollution?

likely genetic deficiency, esp. A1A deficiency

Question 12

What are the symptoms of COPD?

Answer 12

dyspnea

sputum

cough

wheezing

Question 13

What are some comorbidies associated with COPD?

Answer 13

CAD

arrhythmias

HTN

HF

Lung Ca

depression/anxiety

metabolic syndrome

osteoporosis

Question 14

What are the “Pink Puffers”

Answer 14

more emphysema

lower BMI

fewer heart problems/comorbidities

hyperinflation, lower diffusion for CO

more dyspnea

worse health status

Question 15

What are the “Blue Bloaters”

Answer 15

higher BMI

more co-morbidities/heart problems

OSA-COPD overlap

less hyperinflation

more chronic bronchitis, less emphysema

more diffusion capacity

higher IL6, CRP

Question 16

What are the spirometry findings for COPD?

Answer 16

FEV1/FVC <.70

Low FEV1

<12% reversibility

Question 17

What are the goals of COPD management?

Answer 17

reduce sx, prevent disease progression

Send to pulmonary rehab

consider lung volume reduction surgery and transplantation

Question 18

What is the mainstay of treatment for COPD?

Answer 18

bronchodilators

LAMA+LABA increase lung function 2x (not nec. sx)

Question 19

In which patients are inhaled corticosteroids used in COPD management?

Answer 19

for those at high risk of exacerbations

improves lung function but increases risk for PNA, thrush, etc.

Question 20

What is the benefit of using oxygen therapy in patients with COPD?

Answer 20

REDUCES MORTALITY

(Used at least 15hrs if SaO2 is <88%)

Question 21

what is the initial management of COPD?

Answer 21

smoking cessation

vaccination

encourage xercise

patient education

manage co-morbidities

Question 22

Inhaled corticosteroids are indicated for COPD pt’s when?

Consider ICS when?

Stop ICS when?

Answer 22

history of exerbation requiring hospital stay, >2 exerbations per year, blood eosinophils >300, hx of asthma

1 exacerbation per year, eosinophils 100-300

repeated PNA, eosinophils <100, mycobacterial infection

Question 23

What is the mainstay of COPD treatment for acute exacerbations?

Answer 23

Oral corticosteroids

consider abx and oxygen if needed

Question 24

prevent COPD exacerbations how?

Answer 24

flu and pneumococcal vaccine

long acting bronchodilators and ICS

consider mucolytics