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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
what can cause bronchiectasis
airway obstruction - foreign body, tumors congenital anatomic defects immunodeficiency hereditary recurrent lung infections asthma resistant to treatment COPD and smoking idiopathic
26
what are symptoms of bronchiectasis
chronic cough fatigue dyspnea/SOB fever/chills pleuritic chest pain
27
what are signs of bronchiectasis
crackles - -
28
what are the diagnostic studies to determine bronchiectasis
persisent or recurrent cough with mucopurulent sputum labs (CBC, immunoglobulin, sputum smear, rh factor, etc) CXR CT scan PFTs bronchoscopy
29
what is the treatment/management for bronchiectasis
treat and control recurrent infections treat underlying disease bronchodilators chest physiotherapy surgery (severe)
30
what are exacerbation treatments for bronchiectasis
antibiotics (oral - outpatient; parental - inpatient)
31
What is bronchiolitis
inflammation of the bronchioles acute (M/C), bronchiolitis obliterans (constrictive), proliferative, follicular
32
what is acute bronchiolitis
most commonly seen in pediatric patients caused by: RSV, mycoplasma pneumoniae, influenza, pertussis, parainflenza and adenovirus
33
what is bronchiolitis obliterans (constrictive)
toxic fumes: diacetyl (found in popcorn) is the most common - "popcorn lung" lung transplant patients (about 50% within 5 years)
34
what are risk factors for bronchiolitis
viral illness (children < 2 yo) exposure to toxic fumes connective tissue disease rheumatological disease organ transplantation
35
what are signs and symptoms of bronchiolitis
upper respiratory symptoms fever wheezing tachypnea shallow respirations poor appetite all signs of viral infection
36
how is bronchiolitis diagnosed
clinical context and medical history CXR can be equivocal nasal viral panel (RSV/flu) PFT results biopsy (constrictive, proliferative and follicular)
37
what is the treatment for acute bornchiolitis
supportive therapy severe - admission with supportive care, respiratory support, may trial one time bronchodilator, +/- glucocorticoids,
38
What is COPD
chronic airway and expiratory obstruction progressive disease chronic damage is irreversible
39
what are the major conditions with COPD
Chronic Bronchitis (blue bloaters) Emphysema (pink puffer) Chronic obstructive asthma
40
What are risk factors for COPD
smoking (1st and 2nd hand) air pollutants genetic factors respiratory infections atopy and asthma
41
what are the signs and symptoms of COPD
cough persistent, progressive dyspnea (worse with exertion) CO2 retention weight loss (emphysema) tachycardia hypertension wheezes/crackles on auscultation prolonged expiratory phase Barrel chest
42
What type of patient do you see malodorous thick and mucopurulent productive cough with
bronchoiectasis
43
what is seen on CXR with COPD
hyper-inflated lungs plat diaphragm
44
what is the pathways to diagnosis of COPD
Symptoms: SOB, chronic cough, sputum Risk Factors: Host factors, tobacco, occupation, pollution Spirometry: required to establish diagnosis
45
what test is required for the diagnosis of COPD
spirometry
46
What is chronic bronchitis
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
What is emphysema
permanent enlargement of alveoli - causes impairment in gas exchange weight loss hunched over, tripoding dyspneic with prolonged expiration PINK PUFFER
48
what are the GOLD Guidelines
Global Initiative for Chronic Obstructive Lung Disease 1. classification grade 2. stability 3. history of exacerbations
49
What are COPD medcations
SABA SABA LAMA LABA combination inhalers
50
What are the GOLD classifications for treatment
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
What is cystic fibrosis
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
what channel transports chloride
CRTF
53
what occurs with CF
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
what are the respiratory signs and symptoms of CF
persistent, productive cough wheezing dyspnea hemoptysis apical crackles bronchiectasis barrel chest in some patients respiratory distress/failure digital clubbing
55
What is the cold standard for diagnosing CF
sweat chloride test
56
what is the definitive test for diagnosing CF
genetic testing
57
what is the sweat choloride test
gold standard for diagnosis procedure produces sweat on forearm or thigh sweat collected and weighed/analyzed for chloride
58
what is the results of sweat chloride test that are indivative of CF
> or equal to 60 mmol/L
59
What is seen on CF imaging
peri-cronchial cuffing tram lines fibrosis recurrent infiltrates pulmonary blebs and bullae
60
What is the treatment of CF
CFTR modulators - require diet high in fats to maximize absorption newest agent Trikafta
61
What are the chronic treatments of CF
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
what is treatment for acute exacerbation of CF
oral glucocorticoids (brief) - prednisone respiratory support antivirals antibiotics

Clin Med2: Pulmonology (13 decks)

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