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CPR 2 Exam 2 > Asthma And COPD - Dr. Miller > Flashcards

Asthma And COPD - Dr. Miller Flashcards

1
Q

Prevalence in the Asthma

A 
Boys childhood (genetics), women adult and puberty (maybe sex hormones)
(Also farther away from equator and rural places have higher rates)
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2
Q

Risks of asthma

A
  1. GI microbiome —> pulmonary microbiome
  2. Lung function
  3. Delayed immune maturation
  4. Viral and LRTI
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3
Q

Prenatal risks for asthma

A

Ethnicity, C section, Stress, Low Socioeconomic, tobacco use mother

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4
Q

Postnatal risks for asthma

A
  1. Endotoxins and allergens at home (duct mites)
  2. Viral and bacterial infection (RSV, adenovirus)
  3. Pollution
  4. ABs, acetaminophen
  5. Obesity
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5
Q

Inflammation in asthma consists of what

A
  1. T2 type inflammation (M2 cells)
  2. Allergens (dust, fungi, pets, pollen) cause inflammation = Eosinophils
  3. Defect in resolution of inflammation
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6
Q

Airway remodeling in asthma consists of

A
  1. SM proliferation in airway
  2. Mucous cells production increased + more mucous production
  3. Thickened subepithelial reticular lamina
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7
Q

Asthma SX

A
  1. Exacerbations
  2. Worse at night, exercise, viral inf, allergen exposure, weather changes, laugh/crying, stress
  3. Chest tightness, SOB
  4. Wheezing
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8
Q

Asthma DX

A

SPIROMETRY (does not exclude disease if normal)

  1. FEV1 <80%
  2. FEV1/FVC <75%
  3. obstruction of airway is reversible (12% improvement in FEV1, at least 200mL improvement total)** ——> you know its not COPD
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9
Q

Asthma with normal spirometry what do you do

A
  1. Give bronchodilator or corticosteroids and see improvement
  2. Give give methocholine or menatol and see hyperrespnsive reaction (you need to be prepared for severe attack)
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10
Q

Classifying Asthma (what are the 2 types)

A

Intermittent and persistent

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11
Q

Intermittent asthma is what

A
  1. Sx less then 2d / week
  2. Night time awakening < 2d/month
  3. Asthma exacerbation needing corticosteroids 0-1/year
  4. Normal activity no sx
  5. Rescue inhaler < 2days/week
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12
Q

Persistent Asthma MILD

A
  1. More then 2d/week sx
  2. Minor limitation in normal activity
  3. <2/month awake from night
  4. 2 or more exacerbation needing tx/ year
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13
Q

Persistent Asthma moderate

A
  1. Sx daily
  2. 3-4 nights / month awake
  3. Daily inhaler need
  4. > 2 exacerbation per year
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14
Q

Persistent Asthma severe

A
  1. Sx throughout day
  2. Several times a week awake night
  3. Inhaler multiple times a day
  4. Extreme limitation in normal activity
  5. More then 2 exacerbation per year
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15
Q

Most severe and risky effect of asthma

A

Exacerbations

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16
Q

Intermittent asthma TX

A

SABA as needed (inhaler), short-acting beta agonist = ALBUTEROL

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17
Q

Persistent asthma TX step 2-6

A

STEP 2 : SABA + LOW ICS (inhaled corticosteroids)
STEP 3 : + LABA (long acting beta agonist) or MEDIUM ICS
STEP 4 : + LABA (long acting beta agonist) and MEDIUM ICS
STEP 5 : + HIGH ICS + LABA + omalizumab
STEP 6 : + HIGH ICS + LABA + corticosteroid

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18
Q

SABA more then 2 times a week

A

Inadequate therapy and need more therapy

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19
Q

Asthma TX not responding appropriately causes

A
  1. Correct inhaler use
  2. Infections
  3. Obesity
  4. GERD, exposure to smoke
  5. Low VIT D
  6. Anxiety Depression, sleep apnea
20
Q

TX exacerbations

A
  1. Bronchodilator
  2. Glucocorticoids
  3. O2
  4. MgSO4 = relax SM
  5. Epinephrine
  6. Iprotropram
21
Q

Preventing asthma

A
  1. Breastfeeding
  2. Avoid tobacco and secondary smoke
  3. Prevent obesity
  4. Vit D
  5. Vaccinations
22
Q

COPD is what

A

Persistent airflow limitation progressive, and chronic inflammation response
= irreversible airflow limitation (more in men, 3rd leading cause of world death)

23
Q

Genetics playing in COPD

A

A1-antitrypsin deficiency = 1% of COPD (only one we know right now)

24
Q

What happens in COPD

A
  1. Obstructive bronchitis (inflammation, bacteria colonization)
  2. Emphysema (elastic walls destroyed)
  3. Hypersecretion of mucous
    = lung is like a paper lunch bag
25
Q

COPD FEV

A

Acceleration in decline of FEV1

26
Q

COPD SX

A
  1. Dyspnea, SOB (progressively worsening, worse with exercise)
  2. Sputum and purulence chronic
  3. Cough (unproductive)
  4. Wheezing
  5. Tiggers in Day by day variation
27
Q

COPD TX

A
  1. ABs
  2. Steroids = lower inflammation
  3. Bronchodilators
  4. Pulmonary rehabilitation = increase pulmonary function
28
Q

Pink puffers

A

COPD more like emphysema

  1. Expanded lung, low BMI
  2. Fewer cardiac + comorbidities probs
  3. Hyperinflation
  4. Low CO capacity
  5. More SOB + lower exercise tolerance
  6. Worse health
29
Q

Blue Bloaters

A 
COPD less emphysema 
1. High BMI
2. More comorbidities
3. Cardiac probs 
4. Chronic bronchitis 
5. High IL6 and CRP 
6 more exacerbations + sleep apnea
30
Q

How to DX COPD

A

SPIROMETRY :

  1. FEV1/FEV < 0.7
  2. FEV1 LOW (classified by GOLD)
  3. <12% reversibility
31
Q

GOLD classification

A

Classify COPD 1-4 (4 being worse FEV1 <30%)

32
Q

GOLD 1

A

FEV 1 > 80% + FEV1/FVC < 0.7

33
Q

GOLD 2-4

A

FEV1 = <80% + FEV1/FCV = <0.7

34
Q

No pharmacology TX COPD

A
  • pulmonary rehab : exercise, breathlessness, mental and physical health
  • lung volume reduction surgery + transplant :
35
Q

TX COPD pharm

A
  1. LABA and LAMA improve sx and lung function (if both are given lung function 2x improvement only sx don’t improve x2)**
  2. Inhaled corticosteroids (ICS not always helpful) ——> exacerbation risk pts
  3. Oxygen (15hours per day) = reduced mortality **
36
Q

Group A - D COPD

A

GROUP A : bronchodilator
GROUP B : LAMA or LABA (no hospitalization)
GROUP C : LAMA ( more then 2 exacerbations hospitalized pts)
GROUP D : LAMA or LAMA + LABA or ICS + LABA

37
Q

Acute exacerbation TX in COPD

A
  1. Oral corticosteroids **

2. ABs + O2

38
Q

Some things that can improve COPD SX

A
  1. Opiates = air hunger improvement
  2. Fans and O2 blowing
  3. Nutrition supplements
  4. Pulmonary rehabilitation
39
Q

When to use ICS in COPD

A

**frequent exacerbations + reactive airway component (Eosinophils >300 cells)

40
Q

When to definitely not use ICS in COPD

A
  1. Repeated pneumonia
  2. E < 100 cells
  3. Mycobacterium infection history
41
Q

Normal FEV1/FVC

A

Above 0.70

42
Q

Asthma with bronchodilator should do what

A

Increase FEV1 more then 200ml + increase FEV1/FVC

43
Q

Long-acting B- Agonist should always be used with

A

ICS

44
Q

When do you not do spirometry

A

Unstable acute patients

45
Q

GOLD 2 and GOLD 3

A

GOLD 2 : 50%-80% FEV1 predicted

GOLD 3 : 30% - 50% FEV1 predicted

46
Q

Acute COPD TX

Managements COPD TX

A
  1. Oral Corticosteroids + O2 + bronchodilator + ABS (if sx of consolidation or type of inflammation/infection shown)
  2. LABA OR LAMA OR SABA
    + ICS (frequent exhasterbaitons only or hospitalizations)

CPR 2 Exam 2 (12 decks)

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