Chronic Cough/Asthma Flashcards
Chronic cough in a smoker vs non smoker (Ddx)?
COPD or bronchogenic carcinoma versus postnasal drip, GERD, asthma
Acute cough? Most common cause? Other causes?
Call for less than three weeks. Usually by upper respiratory infection. Also caused by CHF, pneumonia, PE.
Asthma?
Bronchial hyperactivity and smooth muscle hypertrophy leading to chronic inflammatory condition with widespread bronchospasm
Cobblestone appearance of the oropharynx may represent?
Lymphoid hyperplasia
End expiratory wheezing versus localized wheezing?
Active bronchospasm versus foreign body/bronchogenic tumor
Suspect postnasal drip, asthma, or GERD if?
Negative chest x-ray in immunocompetent non-smoker
Initial treatment for nonallergic postnasal drip Versus allergic rhinitis?
First generation antihistamine decongestant for three weeks
Vs new generation antihistamine and nasal corticosteroid
Patients postnasal drip does not improve with treatment, How to examine for sinusitis? Tx?
Sinus radiographs. Look for opacification, air-fluid levels, or mucosal thickening. Treat with antibiotics
Cough variant asthma?
Presents with dry cough occurs throughout the day and night – worsened by URIs, allergies, cold or exercise
Confirmatory test results for asthma?
- Reduced FEV1 and FEV1/FVC
- Increased FEV1 after Beta agonist inhalation
- Methacholine challenge
PFT changes after albuterol vs Methacholine challenge?
Increase in FEV1 of 12+ percent after bronchodilator treatment
Decrease in FEV1 of 20+ percent after methacholine
Treatment for asthma?
Bronchodilators and inhaled/oral corticosteroids
GERD lifestyle changes?
Low-fat diet Elevation of head in bed Avoid caffeine, alcohol, peppermint, chocolate Weight-loss Smoking cessation
If GERD cough does not resolve with lifestyle changes, treatment?
H2 receptor antagonists (famotidine) or PPI
If acid suppression does not resolve GERD, treatment?
Metoclopramide to increase gastric motility
Types of asthma?
- mild intermittent (Less than twice a week)
- Mild persistent (More than twice a week but less than once a day)
- Moderate persistent (Daily)
- Severe persistent (Continual)
Daily medications for mild intermittent asthma?
None
Daily medications for mild persistent asthma?
Low-dose steroids (preferred) or from cromolyn, leukotriene modifiers, sustained release theophylline, nedocromil
Daily medications for moderate persistent asthma?
Preferred – long-acting Beta two agonist or low to medium dose inhaled steroids
Steroids and leukotriene modifiers/theophylline
Daily medications for severe persistent asthma?
High-dose inhaled steroids and long-acting inhaled beta two agonist
Patients with GERD who remain symptomatic after maximal medical treatment should get?
- 24-hour esophageal pH monitoring
2. Endoscopy to show esophagitis or reflux
Quick relief medications for all classes of asthma?
Short acting inhaled beta two agonist and oral steroids
Intrinsic vs extrinsic asthma?
Not atopic (cold, stress, cough-variant )
Vs
Due to environmental triggers - Produce IgE, associated with eczema and hay fever
Dz with wheezing?
- CHF - edema
- COPD - inflamed airways
- Cardiomyopathies - edema around bronchi
- Lung cancer
Montelukast - MoA? Use?
Leukotriene modifiers. Prophylaxis for asthma.
Associated findings in patients with asthma?
#Symptoms worse at night #Polyps and sensitivity to aspirin #Eczema/atopic dermatitis
Exploratory phase in asthma?
Increased
Best initial diagnostic test in acute asthma exacerbation?
Most accurate diagnostic test in pt with no symptoms?
Peak expiratory flow or atrial blood gas
Methacholine challenge
Role of CXRs in asthma exacerbation?
#Exclude pneumonia #Exclude pneumothorax #Exclude CHF
CBC finding in asthma?
Increased eosinophils
Increased IGE levels in asthmatic suggests? Treatment?
Increased IGE levels in non-asthmatic pulmonary patient?
Allergic etiology; omalizumab
Allergic bronchopulmonary aspergillosis
Cromolyn/nedocromil MoA? Use in asthma?
Inhibits mast cell mediator release and eosinophil recruitment
Asthma ppx
Adverse effects of systemic corticosteroids?
#Osteoporosis #cataracts #Adrenal suppression #thinning skin, striae, easy bruising #Hyperlipidemia, hyperglycemia, acne, hirsutism
Role of ipratropium in:
general asthma management?
Acute exacerbation?
Unclear (effective in COPD)
Useful (But slower than albuterol)
Gave which vaccines to asthma patients?
Influenza and pneumococcal vaccine
Best indication of severity of acute asthma exacerbation?
Respiratory rate > accessory muscle use
Peak expiratory flow based on? Approximation for?
Height and age
FVC
Drugs of last resort in acute asthma exacerbation?
Epinephrine and Mg (bronchodilation)
