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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
COPD FEV
Acceleration in decline of FEV1
26
COPD SX
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
COPD TX
1. ABs 2. Steroids = lower inflammation 3. Bronchodilators 4. Pulmonary rehabilitation = increase pulmonary function
28
Pink puffers
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
Blue Bloaters
``` 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
How to DX COPD
SPIROMETRY : 1. FEV1/FEV < 0.7 2. FEV1 LOW (classified by GOLD) 3. <12% reversibility
31
GOLD classification
Classify COPD 1-4 (4 being worse FEV1 <30%)
32
GOLD 1
FEV 1 > 80% + FEV1/FVC < 0.7
33
GOLD 2-4
FEV1 = <80% + FEV1/FCV = <0.7
34
No pharmacology TX COPD
- pulmonary rehab : exercise, breathlessness, mental and physical health - lung volume reduction surgery + transplant :
35
TX COPD pharm
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
Group A - D COPD
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
Acute exacerbation TX in COPD
1. Oral corticosteroids ** | 2. ABs + O2
38
Some things that can improve COPD SX
1. Opiates = air hunger improvement 2. Fans and O2 blowing 3. Nutrition supplements 4. Pulmonary rehabilitation
39
When to use ICS in COPD
****frequent exacerbations + reactive airway component (Eosinophils >300 cells)
40
When to definitely not use ICS in COPD
1. Repeated pneumonia 2. E < 100 cells 3. Mycobacterium infection history
41
Normal FEV1/FVC
Above 0.70
42
Asthma with bronchodilator should do what
Increase FEV1 more then 200ml + increase FEV1/FVC
43
Long-acting B- Agonist should always be used with
ICS
44
When do you not do spirometry
Unstable acute patients
45
GOLD 2 and GOLD 3
GOLD 2 : 50%-80% FEV1 predicted | GOLD 3 : 30% - 50% FEV1 predicted
46
Acute COPD TX | Managements COPD TX
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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