copd asthma Flashcards
Risk factors for COPD
Smoking cigarrette pipe, cigar marjana
2nd hand smoke
genetic factors
Environment
Respiratory infections can have what affect on COPD
exacerbation increase airway inflammation
Environmental pollutants (dust fumes, chemicals)can have what affect on COPD
Causes increased hyperinflation, gas trapping and reduced expiratory flow
Pneumonia, PE, and Heart Failure can mimic exacerbation
COPD
What is required to establish Diagnosis of COPD
spirometry
Mild Classification of severity airflow limitation in COPD (based on post-bronchodilator FEV1
Gold 1- FEV1 > 80%
Moderate Classification of severity airflow limitation in COPD (based on post-bronchodilator FEV1
Gold2 50%< FEV1 < 80
severe Classification of severity airflow limitation in COPD (based on post-bronchodilator FEV1
Gold3
30< FEV1 <50
very severe Classification of severity airflow limitation in COPD (based on post-bronchodilator FEV1
Gold4
FEV1<30
Medicare spo2 has to drop to what for coverate
30
Labs required for COPD
ABG, CMP, CBC BNP Alpha 1 testing
Why is CBC tested for COPD
Polycythemia
Why is CBC tested for COPD
Polycythemia
Chest xray done for COPD what will be seen
increased bronhco vascular markings and cardiomegaly
Chest xray done for COPD and you see small heart hyperinflation, bullous changes
Emphysema
Chest xray done and you see cardiomegaly and broncho vascular markings
COPD
Patient comes in with COPD and depression what would be best treatment
wellbutrin
What vaccinations are best for COPD to prevent infectoin
flu and pneumo vac
What guidelines must be met before placing chronic o2 for home use
medicare
Group A treatment
Short or long bronchodilator
Group B Treatment copd
LABA ro LAMA
if symptoms persist then combo LABA/LAMA
Group C (exacerbation)
start with lama
if exacerbation continue go to laba/lama or laba/ics
Group D (> exacerbation and persistant symptom)
LABA/LAMA/ICS
if worsen add Daliresp
if FEV1 <50
Group d and former smoker what should be added for chronic bronchitis
azithromycin or erythromycin
Pharmo Treatment used for moderate to severe copd
ics/laba
Pharmo Treatment used for low rate exacerbation copd
laba/lama to increase bronchodilatin
what is alpha 1 antitrypsin augmentaion used for
people wiht alpha 1 genetic defect must have weekly treatemnt to preserve lung function
is oxygen a pharmacological treatment
no
Supplemental o2 indicated for pao2 of or sao2 of
pao2 <55
sa02 <88
Supplemental o2 indicated for pao2 of or sao2 of
pao2 less than 55
sa02 less than 88
Supplemental o2 indicated for pao2 of or sao2 of
pao2 less than 55
sa02 less than 88
how many calories are needed for copd patients
3000 per day
What are the benefits of Lung volume reduction surgery
parts are resected to reduce hyperinflation respiratory muscles can be more effectiv and incre mech effication
What can Brethine be used for
Terbutaline
bronchodilator
used for bronchospams
Can asthma be transfered throght genetic
yes
What happens during asthma? (how is asthma discribed)
inflamations which casues edema, increase fluid leakage (mucus secreation)and smooth muscle thickening
leads to intermittent airflow abstruction
Hyperresponsiveness of airway
CBC during asthma attack would show increase of what wbc
eosinophillia, serum igE sputum eosinophils
Nonpharm strategies for asthma
smoking cessation
avoid NSAIDS
Remove sensitizer
encourage regular activity (advise to to use inhalier first)
Treatment in special populations should asthma treatment be given to pregnancy
yes benefit out weigh risk
Daily Controller Medications for step1
None needed SABA prn ( no more than 3-4 x day)
Daily Controller Medications for step2
low dose ICS
also Theophyline or cromone or leukotriene mods
Daily Controller Medications for step3
low to medium ICS and LABA
Daily Controller Medications for step4
High ICS plus LABA plus one or more of the following:
- SR theophylline
- Leukotriene modifier
- Long acting oral beta2-agonist (brethine)
- Oral glucocorticosteroid
—indicates what % of the total FVC was expelled from the lungs during the first second of forced exhalation
FEV1/FVC
Measures if treatment is effective in improving airway diseases such as COPD.
Peak Expiratory Flow Rate (PEFR)
A measure of how much air can be exhaled from the lungs. It is an indicator of large airway obstruction
Forced Expiratory Flow (FEF)
This value represents the amount of air that can be forcibly exhaled from the lungs in the first 25% of the total forced vital capacity test.
FEF25
This measurement represents the total amount of air expelled from the lungs during the first half (50%) of the forced vital capacity test.
FEF50
This measurement is representative of the total amount of air exhaled from the lungs during the middle half of the forced vital capacity test. Many clinicians refer to this value because of it’s indicative of an obstructive lung disease.
FEF25%-75%
Functional Vital Capacity—normal is
80% or greater
Force expiratory volume in one second FEV1%– normal
80 or greatter
the FEV1/FVC % ratio
greater than 0.7 or 70% is normal
- If 69% or less indicated of obstructive disease
PEF (peak expiratory flow)—
assesses ventilator capacity– index of the activity of the disease process (more in Asthma`
forced expiratory flow at 25–75% of FVC (FEF25–75%)
commonly cited as an indicator of small airways obstruction
complete PFTs can be ordered to assess
obstructive dysfunction
lung volumes,
air trapping,
gas exchange abnormalities
Asthma Exacerbation that come into ED what should the steps be to treat
Duonebs every 20min for 3 doses then every 3 to 4 min
- provide O2 6-8L/min
- Brethine subq for bronchspasm
- iv/oral steroid
- Heliox
- Intubation
- ECMO (status asthmaticus with no improvement and po2 decreas)
Most allergen are encountered where
indoors
Ominous asthmatic signs
fatigue
cyanosis with increased PCO2 (normal or elevated)
paradoxical chest/abdominal movement
signs of impending failure
the volume of gas contained in the lung at the end of maximal inspiration
total lung capacity
the amount of air left in the lungs after a maximal exhalation
residual volume
measurement of the lungs ability to add oxygen to the blood and extract carbon monoxide from the lungs. The lower the value, the more likely you will become SOB during exertion
Diffusing capacity of lung for carbon monoxide
With asthma Hospitalization is recommended when FEV1 is
FEV 1 is less than 30% or less than 40% after hour of vigorous therapy
Person having asthma attack comes in, peak flow is less than 60 liter/minute what should be recommended?,. After hour of treatment what should be recommend next
Hospitalization is recommended for patient with ashtma that has a peak flow less than 60 liters/min or doesnt improve over 50% after hour of treatment
initial labs of ABG showing respiratory alkalosis show
hypoxia on ABG
Asthma signs and symptoms
Distressed at rest
RR increased
PULSUS PARADOXUS >12mmHg (BP drops during respiration)
Hyperresonance (2/2 air trapping)
cant speak sentences
cough
tight chest
tacycardia
Patient having asthma attack has Pco2 of 48 you understand this means
this is an ominous sign indicates emergency situation
Patient haveing asthma attack has PCO2 of normal ranges you understand this means
indicates patient is very sick.
Chest xray for asthma would be done how often
No recommend unless ruling out other conditions.
What would chest xray should if taken during asthma
hyperinflation
Inpatient treatment of worsening asthma or status asthmaticus
1) SABA (1st line) (or Duoneb)
2) o2 humidified
3) fluids (IV D5 half NS)
4) Iv steroids (hydrocorticone 300mg)
5) Continuous monitoring Spo2
6) ABGs if spo2 less than 90
7) possibly intubate
Status asthmaticus pco2 and po2
pco2 greater than 50
po2 less than 50
ASTHMA treatment pneumonic
A- albuterol S- Steroid T- Theophylline (rare) H- humidified O2 M- magnesium ( severe) A- anticholinergids
Patient with asthma comes into clinic with exacerbations. after using inhaled bronchodilator we would expect to see general improvement of
FVC or FEV1 of 15%
or
FEF 25-75% of 25%
