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CPR 2 Pulm Section > DSA 1 Asthma & COPD > Flashcards

DSA 1 Asthma & COPD Flashcards

1
Q

In childhood, which sex has a higher rate of asthma?

A

boys

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2
Q

In adulthood, which sex has a higher rate of asthma?

A

women, because men have higher rates of remission

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3
Q

What are prenatal risk factors for the child developing asthma?

A
  • low socioeconomic status
  • stress
  • Cesarean section
  • tobacco use
  • prematurity (most significant risk factor)
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4
Q

What are postnatal risk factors for developing asthma?

A
  • endotoxins and allergens in the home
  • viral and bacterial infxns (ex: RSV, adenovirus)
  • air pollution
  • abx use
  • acetaminophen exposure
  • obesity
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5
Q

What type of airway inflammation is present in asthma?

A

T2-type inflammation

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6
Q

What kinds of cells are in the inflammatory infiltrate of asthma?

A
  • eosinophils

- mast cells

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7
Q

What happens as a result of defective resolution of the asthma process?

A

airway remodeling

  • increased smooth muscle
  • increased mucus cells
  • increased mucus production
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8
Q

What is the clinical presentation of asthma?

A
  • cough
  • wheezing
  • chest tightness
  • shortness of breath

(worse at night, w/ exercise, infxns, irritants, laughing)

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9
Q

What is seen on spirometry of asthma?

A
  • FEV1 < 80% predicted
  • FEV1/FVC < 75%

-reversibility (12% improvement in FEV1 and absolute volume increase of 200 mL after bronchodilator)

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10
Q

True or False: normal spirometry rules out asthma

A

False; it just means the airways were fxning normally at time of the test

-if you’re still suspicious of asthma, try doing a methacholine challenge

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11
Q

What is the main goal of asthma?

A

-reduce acute exacerbations b/c they’re the riskiest complication

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12
Q

What qualifications are needed to diagnose mild persistent asthma over intermittent asthma?

A
  • symptoms >2 days/wk (but not daily)
  • awaken at night > 2 days/wk
  • use of rescue inhaler w/ SABA > 2 days/wk
  • 2+ exacerbations in 6mos
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13
Q

What is the major difference between mild persistent asthma and moderate persistent asthma?

A
  • daily symptoms

- daily use of rescue inhaler w/SABA

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14
Q

What is the major difference between moderate persistent asthma and severe persistent asthma?

A
  • symptoms throughout the day

- use of rescue inhaler w/ SABA multiple times daily

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15
Q

What is a concern for patients and their use of inhalers?

A

-they need to be using it correctly

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16
Q

What is the major goal of creating an asthma action plan with the patient?

A
  • individualized approach
  • provide the best quality of life
  • minimize symptoms
  • minimize exacerbations
17
Q

What piece of equipment can asthmatics use to assess their condition?

A

peak flow meter

-take a deep breath, blow out hard and fast

18
Q

What test can be given to assess whether the patient’s asthma is well-controlled?

A

Asthma Control Test (ACT)

  • 5 questions
  • patient self administers
  • score < 19 means asthma may not be controlled
19
Q

What are complications of asthma?

A
  • poor quality of life
  • PNA
  • PTX
  • exacerbations
  • respiratory failure
20
Q

What measures can be taken to prevent asthma?

A
  • being breastfed
  • avoid tobacco smoke exposure
  • prevent obesity
  • adequate vitamin D
  • vaccinations
21
Q

Risk of death from COPD is higher in which sex?

A

men

22
Q

What risk factor has the strongest association with mortality from COPD?

A

poverty

23
Q

What are the risk factors for COPD?

A
  • smoking (most common cause)

- Hx of TB

24
Q

What are the main pathological features of COPD?

A
  • obstructive bronchiolitis
  • emphysems
  • mucus hypersecretion
25
Q

What are the symptoms of a COPD exacerbation?

A
  • increased dyspnea
  • increased sputum purulence
  • increased cough
  • increased wheezing
26
Q

What test is used to diagnose COPD?

A

spirometry

  • FEV1/FVC < 0.7
  • <12% reversibility
27
Q

What are the goals of Tx in COPD?

A
  • reduce symptoms
  • improve exercise tolerance
  • improve health status
  • prevent Dz progression
  • prevent/treat exacerbations
28
Q

What are types of non-pharmacological treatment that can be done in COPD patients?

A
  • pulmonary rehab
  • -reduces breathlessness, improves physical activity

-lung volume reduction surgery and transplantation

29
Q

What is the main form of treatment for COPD?

A
  • bronchodilators
  • -LABA (long-acting beta agonist)
  • -LAMA (long-acting muscarinic antagonist)

-together = 2x lung fxn (not 2x symptom improvement)

30
Q

What typed of medication would be provided to COPD patients at high risk of exacerbations?

A

inhaled corticosteroids
-improves lung fxn, decreases breathlessness

(benefits:adverse effects ratio isn’t high enough to justify ICS for all COPD patients)

31
Q

What are possible adverse side effects of inhaled corticosteroids?

A
  • PNA
  • oral thrush
  • hoarseness
  • osteoporosis
32
Q

When and how is supplemental oxygen beneficial for COPD patients?

A

-if O2 sat is < 88%, supplemental oxygen for at least 15hrs daily reduces mortality

33
Q

How is COPD initially managed in addition to LABA and LAMA?

A
  • smoking cessation
  • vaccination
  • active lifestyle and exercise
  • manage comorbidities
34
Q

What is the Tx for COPD exacerbation?

A
  • -early Rx (prevents hospitalization, shortens recovery)
  • -oral abx in the case of increased sputum purulence
  • -ORAL CORTICOSTEROIDS
  • -O2 or non-invasive mechanical vent if resp acidosis
35
Q

How do you prevent COPD exacerbations?

A
  • -flu vaccines (decreases hospitalization risk by 27%)
  • -pneumococcal vaccine
  • -long-acting bronchodilators and ICS
36
Q

What can be used in end of life care for COPD patients?

A
  • opiates and fans blowing air on face relieves breathlessness
  • nutritional supplementation

CPR 2 Pulm Section (9 decks)

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