COPD and asthma Flashcards
What is the most common PFT
spirometry
What kind of flow volume loop is seen with obstructive emphysema
scooped out curve
What are some extrinsic factors for asthma
allergic (most common)
environmental
animal
What are some intrinsic factors of asthma
occupation/pollution
cold/humidity
stress
medications (ASA or NSAIDs)
Exercise
What is the immune response for an extrinsic asthma attack
IgE mediated
What is the atopic triad
eczema (atopic dermatitis)
Asthma
Hay fever
What are risk factors for asthma
atopy
environmental/occupational exposures
childhood asthma / symptoms
Family history
What is used for evaluating and diagnosing asthma
PFT
Bronchoprovocation test
What are the classifications of asthma
intermittent
persistent (Mild, moderate, severe)
What are the different forms of asthma treatment
SABA
ICS
Leukotriene modifiers
Immunomodulators
Combos (SABA or LABA w/ ICS)
When are SABAs used
PRN
When are leukotriene modifiers used
primarily for extrinsic allergy but may help with intrinsic
When are immunomodulators used
Severe asthma and ONLY extrinsic
What is a sign you have to watch out for with leukotriene modifiers
Mood / behavioral changes
sleep changes in kids
suicidality in adults
How do you treat intermittent asthma
all ages: SABA PRN
<4 y/o: associated with URIs, use as short course at beginning of infection
How do you treat mild persistent asthma
All ages: Continue SABA PRN
<11y/o: low dose ICS or Montelukast
>12y/o: Daily ICS, Daily combo inhaler or montelukast
What is the risk of giving children ICS for asthma
risk of growth suppression with regular use
How do you treat moderate persistent asthma
All ages: SABA PRN
<4y/o: Combo inhaler, Montelukast, or medium dose ICS
> 4y/o: Daily combo inhaler and PRN, daily ICS, or low dose ICS and montelukast
How do you treat severe persistent asthma
Daily combo inhaler (medium ICS w/ LABA) or daily ICS with montelukast
*may consider omalizumab
What treatment may severe asthmatics need to be treated with during exacerbations
Oral corticosteroids
predisone
methylprednisolone
prednisolone
What are ways asthmatics can reduce allergen exposure
2nd gen antihistamines
Flonase
1st gen antihistamines PRN
Immunotherapy
Air filters
Washing face/hands after environmental exposure
When should patients be referred to pulmonologists
Difficulty diagnosing
Life threatening exacerbations
Hospitalizations
frequent oral glucocorticoids (>2/year)
Step 5 or higher
poor control
What population is at high risk for bronchiectasis
Older Women in underserved populations
What is occurring in bronchiectasis
irreversible, inflamed and easily collapsable airway that is induced by infectious insult and impaired host defense
What are the symptoms of bronchiectasis
`chronic cough (productive)
Fatigue
dyspnea
fever/chills
pleuritic chest pain
What are the signs of bronchiectasis
Crackles
Wheezing
Digital clubbing
What is pathogneumonic for bronchiectasis
persistent or recurrent cough with mucopurulent sputum
What can be used to diagnose bronchiectasis
Labs
CXR
CT
PFT
Bronchoscopy
How do you treat bronchiectasis
Treat / control recurrent infections
treat underlying disease
bronchodilators (Duoneb or SABA/Combo)
Chest physiotherapy
Surgery (severe cases)
If a patient has a bronchiectasis exacerbation, how do you treat it
Antibiotics
If someone with bronchiectasis is outpatient, how will you treat
Fluoroquinolone (Levofloxacin) - pseudomonas coverage
Amoxicillin or augmentin
Macrolids
If someone has bronchiectasis is inpatient, how should they be treated
Ampicillin
Piperacillin/Tazobactam (Zosyn) -Pseudamonas coverage
Vanco for MRSA
What are the types of bronchiolitis
Acute (most common)
Bronchiolitis obliterans (constrictive)
Proliferative
Follicular
What causes acute bronchiolitis
Mycoplasma pneumonia
RSV
Influenza
Pertussis
Which patients are most effected from acute bronchiolitis
Pediatric patients
What are the causes of bronchiolitis obliterans
Toxic fumes (popcorn lung)
Lung transplant patients
What causes proliferative bronchiolitis
Cryptogenic
What causes follicular bronchiolitis
Rheumatic diseases (RA & Sjogrens)
What are the risk factors for bronchiolitis
viral illness
exposure to toxic fumes
CT disorders
Rheumatologic disorders
organ transplant
How do you diagnose bronchiolitis
Nasal viral panel
biopsy
Which forms of bronchiolitis do you preform a biopsy for
Constrictive
proliferative
follicular
How do you treat acute bronchiolitis
Supportive therapy (will peak in 3-5 days)
how do you treat severe bronchiolitis
admission
respiratory support
+/- glucocorticoids
CPAP
ET tube for respiratory failure
What is the diagnostic criteria for chronic bronchitis
Chronic productive cough for 3 or more months in 2 or more successive years
How do you treat group A COPD patients
SABA or LABA
How do you treat group B COPD patients
LABA
How do you treat group C COPD patients
Add LAMA to LABA
Which patients will get oxygen therapy with COPD
PaO2<55
PaO2>55 with Cor pulmonale
Hypoxia with exercise
SPO2 at or below 88%
Erythrocytosis
What population is primarily effected by cystic fibrosis
Caucasian
What is the current median of life expectancy with cystic fibrosis
50 years
What type of disease os cystic fibrosis
Autosomal recessive
Mutation in CFTR gene
What occurs with CF in the body
Thick mucus builds up in organs that contain mucus membranes
-lungs
-pancreas
-liver
-intestines
-reproductive tract
What are some respiratory signs and symptoms of cystic fibrosis
persistent, productive cough
hemoptysis
apical crackles
bronchiectasis
digital clubbing
How can you diagnose cystic fibrosis
Newborn screening
Genetic testing
Sweat chloride test
What is the gold standard for diagnosing cystic fibrosis
Sweat chloride test
How is the sweat choline test done
Sweat is produced on forearm or thigh and collected and weighed/analyzed for chloride
What may cause a false positive on a sweat chloride test
Addisons disease
medium ileus
renal failure
hypothyroidism
G6PD deficiency
What will you see on imaging with cystic fibrosis
Pre-bronchial cuffing
Tram lines
Recurrent infiltrates
Pulmonary blebs and bullae
How do you treat CF
CFTR modulators to return part of the function of the chloride channel
What are chronic treatments for cystic fibrosis
Airway clearance therapies
Prevention of infection
bronchodilators
anti-inflammatory therapy/bacterial prophylaxis
How do you treat an acute exacerbation of CF
Oral glucocorticoids
respiratory support
Antivirals
Antibiotics
