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Clin Med2: Pulmonology > Asthma and COPD - fiore > Flashcards

Asthma and COPD - fiore Flashcards

1
Q

What is Ventilation

A

process of air movement into and out of the lungs

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2
Q

What is perfusion

A

Q - absorption IN of oxygen into the blood through alveoli into capillary beds and removal OUT of CO2

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3
Q

what are bronchioles

A

non-cartilaginous airways with diameter < 2mm (become microscopic before becoming alveoli)

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4
Q

whate are subjective PMH questions for pulmonary patients

A

smoking history
exposure to noxious gases/products
vaccination status
hospitalizations
history of intubation
Noninvasive positive pressure ventilation (NPPV)

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5
Q

what is a adventitious breath sounds

A

abnormal breath sounds

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6
Q

what is the pathophysiology of asthma

A

bronchial wall hyperresponsiveness and airway inflammation

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7
Q

what is extrinsic asthma

A

allergic
Most common
environmental vs animal allergens

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8
Q

what is intrinsic asthma

A

non allergic
occupational/pollution
cold/humidity
stress
medications: ASA or NSAIDs
exercise

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9
Q

what is the atopic triad

A

eczema (atopic dermatitis)
asthma
hay fever

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10
Q

what are risk factors for asthma

A

atopy
environmental/occupational exposures
childhood asthma or symptoms (many are not diagnosed)
family history
HISTORY, HISTORY, HISTORY

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11
Q

what are symptoms of asthma

A

SOB
cough
atopic dermatitis/eczema
chest tightness
wheezing

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12
Q

what are signs of asthma

A

expiratory wheezes
diminished breath sounds
accessory muscle use
tripoding (severe exacerbation)

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13
Q

what evaluations/diagnostics are used to diagnose asthma

A

clinical findings and HISTORY
PFTs
bronchoprovocation testing

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14
Q

what are the classifications of asthma

A

intermittent
persistent (mild, moderate, severe)

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15
Q

what is the pathophysiology of extrinsic asthma

A

IgE mediated
history of atopy
history of seasonal allergies with rashes as a child

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16
Q

what are the must ask questions for asthma patients

A

“how often do you have your symptoms?”
“Do you have nocturnal (nighttime) symptoms?” or “do your symptoms wake you up at night?”
“do you use a rescue inhaler, how often?”
“do your symptoms interfere with normal activities?”
“how often do you have exacerbations (acute worsening) of your asthma that requires oral systemic corticosteroids?”

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17
Q

what are the primary asthma treatment options

A

SABA
ICS
Combo inhalers
Leukotriene modifiers
Immunomodulators

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18
Q

what are the SABA medications

A

Albuterol
Levabuterol
Metoproterenol

used as needed

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19
Q

what are the ICS

A

fluticasone (flovent)
beclomethasone (Qvar)
Budesonide (pulmicort)
Mometasone (asmanex)
methylprednisolone/prednisone

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20
Q

what are the combination inhalers

A

budesonide/formoterol (symbicort)
fluticasone/salmeterol (advair)
mometasone/formoterol (dulera)
albuterol/ipratropoium (combivent)

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21
Q

what are the leukotrienes

A

montelukast (singulair)
zafirlukast
zileuton

used primarily for allergy asthma but may help with intrinsic as well

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22
Q

what is the immunomodulator

A

omalizmab (Xolair)

only used for SEVERE asthma and only for allergy asthma

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23
Q

how do you reduce risk for asthma

A

avoid triggers
allergens (allergy medications, immunotherapy, air filters, washing face/hands)
medication management
Asthma action plan

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24
Q

what is bronchiectasis

A

irreversibly inflamed and easily collapsible airway
affects medium sized bronchi and bronchioles
airway becomes dilated (wide) causing excess mucus
induced by an infectious insult and impaired host defense

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25
Q

what can cause bronchiectasis

A

airway obstruction - foreign body, tumors
congenital anatomic defects
immunodeficiency
hereditary
recurrent lung infections
asthma resistant to treatment
COPD and smoking
idiopathic

26
Q

what are symptoms of bronchiectasis

A

chronic cough
fatigue
dyspnea/SOB
fever/chills
pleuritic chest pain

27
Q

what are signs of bronchiectasis

A

-

28
Q

what are the diagnostic studies to determine bronchiectasis

A

persisent or recurrent cough with mucopurulent sputum
labs (CBC, immunoglobulin, sputum smear, rh factor, etc)
CXR
CT scan
PFTs
bronchoscopy

29
Q

what is the treatment/management for bronchiectasis

A

treat and control recurrent infections
treat underlying disease
bronchodilators
chest physiotherapy
surgery (severe)

30
Q

what are exacerbation treatments for bronchiectasis

A

antibiotics (oral - outpatient; parental - inpatient)

31
Q

What is bronchiolitis

A

inflammation of the bronchioles
acute (M/C), bronchiolitis obliterans (constrictive), proliferative, follicular

32
Q

what is acute bronchiolitis

A

most commonly seen in pediatric patients
caused by: RSV, mycoplasma pneumoniae, influenza, pertussis, parainflenza and adenovirus

33
Q

what is bronchiolitis obliterans (constrictive)

A

toxic fumes: diacetyl (found in popcorn) is the most common - “popcorn lung”
lung transplant patients (about 50% within 5 years)

34
Q

what are risk factors for bronchiolitis

A

viral illness (children < 2 yo)
exposure to toxic fumes
connective tissue disease
rheumatological disease
organ transplantation

35
Q

what are signs and symptoms of bronchiolitis

A

upper respiratory symptoms
fever
wheezing
tachypnea
shallow respirations
poor appetite

all signs of viral infection

36
Q

how is bronchiolitis diagnosed

A

clinical context and medical history
CXR can be equivocal
nasal viral panel (RSV/flu)
PFT results
biopsy (constrictive, proliferative and follicular)

37
Q

what is the treatment for acute bornchiolitis

A

supportive therapy
severe - admission with supportive care, respiratory support, may trial one time bronchodilator, +/- glucocorticoids,

38
Q

What is COPD

A

chronic airway and expiratory obstruction
progressive disease
chronic damage is irreversible

39
Q

what are the major conditions with COPD

A

Chronic Bronchitis (blue bloaters)
Emphysema (pink puffer)
Chronic obstructive asthma

40
Q

What are risk factors for COPD

A

smoking (1st and 2nd hand)
air pollutants
genetic factors
respiratory infections
atopy and asthma

41
Q

what are the signs and symptoms of COPD

A

cough
persistent, progressive dyspnea (worse with exertion)
CO2 retention
weight loss (emphysema)
tachycardia
hypertension
wheezes/crackles on auscultation
prolonged expiratory phase
Barrel chest

42
Q

What type of patient do you see malodorous thick and mucopurulent productive cough with

A

bronchoiectasis

43
Q

what is seen on CXR with COPD

A

hyper-inflated lungs
plat diaphragm

44
Q

what is the pathways to diagnosis of COPD

A

Symptoms: SOB, chronic cough, sputum
Risk Factors: Host factors, tobacco, occupation, pollution
Spirometry: required to establish diagnosis

45
Q

what test is required for the diagnosis of COPD

A

spirometry

46
Q

What is chronic bronchitis

A

chronic productive cough for 3 or more months in 2 or more successive years
CO2 retention
more likely to be obese
BLUE BLOATER: cyanotic, reduced respiratory drive and hypoxic

47
Q

What is emphysema

A

permanent enlargement of alveoli - causes impairment in gas exchange
weight loss
hunched over, tripoding
dyspneic with prolonged expiration
PINK PUFFER

48
Q

what are the GOLD Guidelines

A

Global Initiative for Chronic Obstructive Lung Disease
1. classification grade
2. stability
3. history of exacerbations

49
Q

What are COPD medcations

A

SABA
SABA
LAMA
LABA
combination inhalers

50
Q

What are the GOLD classifications for treatment

A

group A: SBA or LABA - continue if benefit
group B: LABA - consider SABA and LABA
group C: add LAMA
group D: most started on LAMA - combination LABA/LAMA or LABA/ICS (hx of asthma/atopy)

51
Q

What is cystic fibrosis

A

autosomal recessive inherited disorder
mutation in the CFTR gene
thick mucous builds up i organs that contain mucus membranes (lungs, pancreas, liver, intestines, reproductive tract)

52
Q

what channel transports chloride

A

CRTF

53
Q

what occurs with CF

A

meconium ileus in newborns
male infertility
young patient with bronchiectasis
pancreatic insufficiency
growth delays
recurrent sinusitis and nasal polyps
chronic abdominal pain/diarrhea
unintentional weight loss
recurrent infections

54
Q

what are the respiratory signs and symptoms of CF

A

persistent, productive cough
wheezing
dyspnea
hemoptysis
apical crackles
bronchiectasis
barrel chest in some patients
respiratory distress/failure
digital clubbing

55
Q

What is the cold standard for diagnosing CF

A

sweat chloride test

56
Q

what is the definitive test for diagnosing CF

A

genetic testing

57
Q

what is the sweat choloride test

A

gold standard for diagnosis
procedure produces sweat on forearm or thigh
sweat collected and weighed/analyzed for chloride

58
Q

what is the results of sweat chloride test that are indivative of CF

A

> or equal to 60 mmol/L

59
Q

What is seen on CF imaging

A

peri-cronchial cuffing
tram lines
fibrosis
recurrent infiltrates
pulmonary blebs and bullae

60
Q

What is the treatment of CF

A

CFTR modulators
- require diet high in fats to maximize absorption
newest agent Trikafta

61
Q

What are the chronic treatments of CF

A

airway clearance therapies (inhaled dnase, hypertonic saline and/or mannitol), chest physiotherapy, percussive vests, exercise
prevention of infection (vaccines)
bronchodilators
anti-inflammatory therapy/bacterial prophylaxis

62
Q

what is treatment for acute exacerbation of CF

A

oral glucocorticoids (brief) - prednisone
respiratory support
antivirals
antibiotics

Clin Med2: Pulmonology (13 decks)

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