Asthma/COPD

Question 1

Essentials of diagnosis of Asthma

Answer 1

• Episodic or chronic symptoms of wheezing, dyspnea, or cough
• Symptoms frequently worse at night or in the early AM
• Prolonged expiration and diffuse wheezes on physical exam
• Limitation of airflow on pulmonary function resting or positive bronchoprovocation challenge
• Reversibility of airflow obstruction either spontaneous or following bronchodilator therapy.

Question 2

Essentials of diagnosis of COPD

Answer 2

• Hx of cigarette smoking or other chronic inhalation exposure
• Chronic cough, dyspnea, and sputum production
• Rhonchi, decreased intensity of breath sounds, and prolonged expiration on PE
• Airflow limitation on pulmonary function testing that is not fully reversible and is more often progressive

Question 3

Stepped treatment/diagnostic algorithms step 1:

Answer 3

SABA prn

Question 4

Stepped treatment/diagnostic algorithms step 2:

Answer 4

• Low dose ICS

- Alt: cromolyn, LTRA (montelukast), theophylline

Question 5

Stepped treatment/diagnostic algorithms step 3:

Answer 5

• Low dose ICS + LABA (salmeterol) OR medium-dose ICS

- Alt: low dose ICS + LRTA (montelukast) or theophylline, or zileuton

Question 6

Stepped treatment/diagnostic algorithms step 4:

Answer 6

• Medium dose ICS + LABA (salmeterol)

- Alt: low dose ICS + LRTA (montelukast) or theophylline

Question 7

Stepped treatment/diagnostic algorithms step 5:

Answer 7

• High dose ICS + LABA (salmeterol) AND Omalizumab for pts with allergies

Question 8

Stepped treatment/diagnostic algorithms step 6:

Answer 8

• High dose ICS + LABA (salmeterol)+ oral corticosteroids AND Omalizumab for pts with allergies

Question 9

When do you refer to asthma?

Answer 9

• Atypical presentation of uncertain dx of uncertain particularly if additional dx testing is required
• Complicating comorbid problems such as rhinosinusitis, tobaccos use, multiple environmental allergies, suspected allergic bronchopulmonary mycosis
• Uncontrolled symptoms despite LABA and high dose inhaled corticosteroids
• PTs is not meeting goals of asthma therapy after 3-6 mos of tx
• More than 2 courses of oral prednisone therapy in the past 12 mos
• Any life-threatening asthma exacerbation of exacerbation requiring hospitalizing in the past 12 mos
• Presence of social or psychological issues interfering with asthma management.

Question 10

When do you refer for COPD

Answer 10

• Occurs before age 40
• Frequent exacerbations (2+ a yr) despite optimal tx
• Severe or rapid progressive COPD
• Symptoms disproportionate to the severity of airflow obstruction
• Need to long term oxygen therapy
• The onset of comorbid illness

Question 11

When do you admit for COPD

Answer 11

• Sever symptoms or acute worsening that fails to respond to outpatient management
• Acute or worsening hypoxemia, hypercapnia, peripheral edema, or change in mental status
• Inadequate home care or inability to sleep or maintaining nutrition/hydration d/t sxs
• The presence of high risk comorbid conditions