Asthma and Copd tx

Question 1

Asthma DX
What doesn’t r/o asthma 
3 tests (2 fall, 1 rise)

Answer 1

Normal spirometry doesn’t r/o asthma
FEV1/FVC ^12% after Saba
Bronchial challenge test: FEV1 falls 20% w methacholine/histamine
Exercise test: fall in FEV1 10%
^Lung function after 4wks antiinflammatory

Question 2

Add ons for severe asthma despite ICS+LAMA

Answer 2

Anticholinergic
Anti-IgE’s
Leukotriene receptor antagonist
Chromones

Question 3

COPD dx

Answer 3

spirometry post bronchodilator <0.7, repeat for 0.6-0.8

typically not bronchodilator sensitive

Question 4

COPD GOLD staging 1-4
FEV1% predicted
(Poorly correlated w functional capacity/exacerbation risk)

Answer 4

stage 1- >80
stage 2- 50-80
stage 3- 30-50
stage 4- <30 or <50+chronic resp failure

Question 5

COPD tx
Group A (vRisk,vSx)
Group B (vRisk, ^Sx)
Group C (^Risk, vSx)
Group D (^Risk, ^Sx)

Answer 5

A: lama or laba, LAMA/LABA
B: same as A
C: LAMA, LAMA/LABA or LABA/IGC
D:LAMA or LAMA/LABA or IGC/LABA, LAMA/LABA/IGC
Can add roflumilast and azithromycin

Question 6

COPD exacerbation tx

Answer 6

SABA alone or w inhaled anticholinergic
systemic glucocorticoids
abx esp for smokers
Maintain o2 at 88-92%