Chapter 6- COPD/ASTHMA Flashcards
What’s the aim of asthma management
No daytime symptoms No nighttime awakening No rescue medication No asthma attacks No limitations on activity Normal lung function (FEV1 and/or PEF>80%) Minimal side effects
Should you use a spacer for MDI ?
Yes
What does the acronym SIMPLE stand for in asthma management
S=stop smoking I= inhaler technique M=monitoring (PEF) P=pharmacotherapy L=lifestyle E=education
What vaccines should you recommend to asthmatics
Pneumococcal vaccination and annual flu vaccination
Symptoms of asthma
SoB
Wheeze
Chest tightness
Dry irritating cough
Pathology of asthma
Airflow obstruction
Bronchohyperresponsiveness
Inflammation
Eosinophils high in asthma?
Yeh
What medication is good for airway inflammation
Inhaled corticosteroid
What medication is good for smooth muscle dysfunction
long acting beta agonist (formoterol, salmeterol)
Smoking history is most like to be asthma or COPD?
COPD
The asthma control test refers to the past how many weeks?
4 weeks
A score of <20 on the asthma control test indicates what?
Further recommendations regarding management of asthma
Life threatening asthma attack has a PEF of what?
<33%
Person have an acute severe asthma attack has a PEF of what
33-50%
Person Having a moderate asthma attack has a PEF of what?
50-75%
What’s target oxygen sats in asthma
94-98%
In acute asthma attack due you use driven by oxygen or air?
Oxygen
What is bronchiectasis
Abnormal widening of airways, fluid fills gap making prone to infection
What is omalizumab
Anti-immunoglobulin E for treating severe persistent allergic asthma in people aged 6 and over
Are asthma symptoms often bad at night
Yeh
List effects of long term oral corticosteroids
Adrenal suppression Glucose intolerance Decreased bone mineral density Cataracts and glaucoma Growth failure
How does omalizumab work
Monoclonal antibody that binds to IgE
Omalizumab should only be considered for what patients
Patients with convincing IgE mediated asthma
Anti-IgE (omalizumab) licensing criteria
Step4/5 asthma FEV1<80% >2 severe exacerbation \+ve skin prick test or +ve RAST to common aeroallergen IgE>50 and <700lu/ml
What can the dose of omalizumab be from? What dose it depend on?
75-375mg
Depends on patients body weight and baseline serum IgE concentration
Name four drugs that can be used for (steroid sparring effects) in difficult to treat asthma
Cyclosporin
MTX
Gold
Terbutaline
T-cell profiling can classify asthma patients into two groups
Th2 high
Th2 low
Patients with Th2 high asthma have airway eosinophilia which is promoted by what?
IL-5
What is mepolizumab
Monoclonal antibody against IL-5 licensed as add on treatment for use in severe refractory eosinophilic asthma
Mepolizumab is approved for patients who have an eosinophil count of at least what?
150 cells per microlitre
What is reslizumab
Monoclonal antibody for treating eosinophilic asthma inadequately controlled by ICS
How long are immunosuppressants given for initially in difficult to treat asthma
Three month trial
Name three cardinal symptoms of COPD
Dyspnea
Chronic cough
Sputum production
List risk factors for COPD
Smoking Air pollution Low birth weight Recurrent lung infection Cannabis smoking Low socioeconomic status Alpha-1 antitrypsin deficiency
Key features of blue bloaters ‘chronic bronchitis’
Inflammation change= mucocillary dysfunction
And increase goblet cell secretions (excess mucous)
What’s the FEV1 values for each of the stages of COPD
1= FEV1 >80% 2= FEV1 50-80% 3= FEV1 30-50% 4= FEV1 <30 or <50+ chronic respiratory failure
How is staging/assessment of severity in COPD determined?
Severity of symptoms
Spirometry
Risk of exacerbation
List the treatments for COPD
Smoking cessation Vaccination Bronchodilators Corticosteroids Pulmonary rehab Oxygen therapy Surgical interventions Carbocysteine
Less that what value is pO2 life threatening
<8kPa
What is magnesium?
Smooth muscle relaxant can be put in saline or glucose
What’s the oxygen target in COPD
88-92% (don’t want too much oxygen as won’t get rid of CO2)
