Asthma and COPD Flashcards
What are prenatal risk factors for asthma?
ethnicity
low SES
stress
C-section
maternal smoking
prematurity
What are postnatal risk factors for asthma
allergens
viral/bacterial infections
pollution
abx use
tylenol use
obesity
How is an asthma diagnosis made?
Does normal spirometry rule out asthma?
12% improvement in FEV1 over baseline and a total improvement of at least 200ml
AKA reversibility of airway obstruction
No
What qualifies as mild asthma?
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
What qualifies as moderate asthma?
SABA use daily with some limitation in daily activities
What qualifies as severe asthma?
SABA use several times per day, extremely limited in daily acitivities
What is the goal of ashtma management?
provide the best QOL through minimizing disease sx and abolishing exacerbations
What are exacerbations caused by?
Best way to treat asthma exacerbations?
infections, allergens
Prevention, bronchodilators, glucocorticoids, O2
How to prevent asthma?
breastfeeding
avoid tobacco smoke
target obestiy
balanced diet, Vit. D
allergy avoidance?
Gut microbiome?
vaccinations
What is COPD?
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
What are the common causes of COPD?
smoking
hx of TB
pollution?
likely genetic deficiency, esp. A1A deficiency
What are the symptoms of COPD?
dyspnea
sputum
cough
wheezing
What are some comorbidies associated with COPD?
CAD
arrhythmias
HTN
HF
Lung Ca
depression/anxiety
metabolic syndrome
osteoporosis
What are the “Pink Puffers”
more emphysema
lower BMI
fewer heart problems/comorbidities
hyperinflation, lower diffusion for CO
more dyspnea
worse health status
What are the “Blue Bloaters”
higher BMI
more co-morbidities/heart problems
OSA-COPD overlap
less hyperinflation
more chronic bronchitis, less emphysema
more diffusion capacity
higher IL6, CRP
What are the spirometry findings for COPD?
FEV1/FVC <.70
Low FEV1
<12% reversibility
What are the goals of COPD management?
reduce sx, prevent disease progression
Send to pulmonary rehab
consider lung volume reduction surgery and transplantation
What is the mainstay of treatment for COPD?
bronchodilators
LAMA+LABA increase lung function 2x (not nec. sx)
In which patients are inhaled corticosteroids used in COPD management?
for those at high risk of exacerbations
improves lung function but increases risk for PNA, thrush, etc.
What is the benefit of using oxygen therapy in patients with COPD?
REDUCES MORTALITY
(Used at least 15hrs if SaO2 is <88%)
what is the initial management of COPD?
smoking cessation
vaccination
encourage xercise
patient education
manage co-morbidities
Inhaled corticosteroids are indicated for COPD pt’s when?
Consider ICS when?
Stop ICS when?
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
What is the mainstay of COPD treatment for acute exacerbations?
Oral corticosteroids
consider abx and oxygen if needed
prevent COPD exacerbations how?
flu and pneumococcal vaccine
long acting bronchodilators and ICS
consider mucolytics
