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Clinical Medicine 2 > Exam 2: Asthma > Flashcards

Exam 2: Asthma Flashcards

1
Q

What is the preferred position for spirometry and why?

A

Sitting because there is less liklihood of syncope

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2
Q

What are the basic PFTs?

A

1) Airflow spirometry
2) Lung volumes
3) Diffuse capacity of lungs for CO (DLCO)

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3
Q

How is spirometry performed?

A

1) relax and breath normally
2) take a deep breath in
3) forcefully expire all the air
4) Take another deep breath in

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4
Q

What is forced vital capacity (FVC)?

A

Taking a deep breath in and blowing air out as fast as possible.
FVC is the total volume of air blown out with maximal effort

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5
Q

Is FVC or FEV1 more useful for obstruction?

A

FEV1

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6
Q

What is the FEV1/FVC ratio and what is it useful for?

A

The percentage of FVC in one second.

-Defines the severity of obstruction and assists in differentiating between obstructive and restrictive

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7
Q

What number indicates an obstructive pattern on the FEV1/FVC ratio?

A

<0.7

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8
Q

There is reversibility on Bronchodilator testing if the FEV1 increases by **% and **mL.

A

12% and 200mL

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9
Q

What is a positive bronchoprovocation test?

A

FEV1 decreases by 20%

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10
Q

What does DLCO test?

A

It measures the ability of the lungs to transfer gas and saturate the hemoglobin (may be misleading if person is anemic and this must be adjusted for hemoglobin level)

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11
Q

What is used as a surrogate for oxygen transfer in DLCO?

A

CO

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12
Q

What is the technique for DLCO?

A

The patient inhales a single breath of gas consisting of helium/CO, then expires, and a measurement of the exhalation is taken

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13
Q

What is the result of DLCO when the lungs are healthy?

A

Little CO is collected during exhalation

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14
Q

What is the result of DLCO when the lungs are diseased?

A

Less CO diffuses into lungs, higher levels are measuring in exhaled gas

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15
Q 
How does obstructive lung disease affect the following:
TCL
FVC
RV
FEV1
FEV1/FVC
A 
TCL: increased
FVC: Normal
RV: Increased
FEV1: decreased
FEV1/FVC: decreased
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16
Q 
How does restrictive lung disease affect the following:
TCL
FVC
RV
FEV1
FEV1/FVC
A 
TCL: decreased
FVC: decreased
RV: decreased
FEV1: Decreased
FEV1/FVC: normal or increased
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17
Q

What is the normal percentage for Forced Expiratory Flow (FEF)

A

25-75%

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18
Q

What are the 5 steps to PFT interpretation?

A

1) Examine the flow-volume curve
2) Examine the FEV1 value
3) examine the FEV1/FVC ratio
4) examine response to bronchodilator
5) examine the DLCO

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19
Q

Why is bronchodilator testing performed?

A

To test for reversibility and if positive, aids in diagnosis and provides treatment options

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20
Q

What is indicated when the curve of the flow volume curve has a scooped out appearance?

A

Obstructive pulmonary disease

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21
Q

What is indicated when the slope of a flow/volume curve has an increased slope?

A

Restrictive lung disease

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22
Q

If the FEV-1 valve is decreased by more than 15-20%, what should you be suspicious of?

A

Obstructive pulmonary disease

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23
Q

If TLC is increased by 15-20% what should you be suspicious of?

A

Obstructive disease

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24
Q

If the FEV-1/FVC ratio is decreased to 70% or less, what should you be suspicious of?

A

Obstructive process

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25
Q

What does it mean if the FEV1-FVC ratio is normal or increased?

A

There is possibly a restrictive disorder

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26
Q

If FEV-1 increases by 12%/200mL of a bronchodilator, what does this suggest?

A

Hyperreactive, reversible airways

27
Q

How frequently should you take lung function measurements?

A
  • At diagnosis
  • after 3-6 months of controller treatment (FEV1)
  • Periodic assessments at least every 1-2 years
28
Q

What is the hallmark symptom with asthma?

A

Inspiratory and expiratory wheezing

29
Q

What are some of the characteristic triggers of asthma?

A

URI, exercise, weather, stress, irritant exposures, medications (beta blockers!)

30
Q

When is wheezing most commonly heard in asthmatics?

A

Forced expiratory phase

31
Q

What are the signs of severe obstruction?

A

Tachypnea, tachycardia, tripod positioning, accessory muscle use, and pulsus paradoxes

32
Q

What is the ASA triad (Samters triad)?

A

Sinus disease with nasal polyps, ASA sensitivity, and severe asthma

33
Q

People who develop upper and lower respiratory reactions to ASA should avoid what medications?

70% of these people also have respiratory reactions to what other substance?

A

They should avoid NSAIDs

Alcohol

34
Q

What is the atopic triad?

A

Atopic dermatitis, allergic rhinitis, and asthma

35
Q

What is the atopic march?

A

Atopic dermatitis, food allergy, allergic rhinitis, asthma

36
Q

What are the spirometry findings that support diagnosis of asthma?

A
  • FEV1 <80%
  • FEV1/FVC is normal to decreased relative to predicted values
  • Reversibility >12% in FEV1 with bronchodilator
37
Q

What FEV1/FVC ratio is the gold standard for COPD diagnosis?

A

<70%

38
Q

What symptoms are classified as intermittent asthma?

A
  • Symptoms less than 2 days per week
  • No nighttime awakenings if aged 0-4
  • If 5 or older, less than 2 nighttime awakening per month
39
Q

What PFT findings are consistent with intermittent asthma?

A
  • Normal PFTs in between exacerbations
  • FEV1 >80%
  • Normal FEV1/FVC ratio
  • normal activity
  • <2 days/weeks SABA use to control symptoms
40
Q

What symptoms classify mild persistent asthma?

A
  • Symptoms more than 2 days/week but not daily
  • 1-2 nighttime awakenings per month if aged -4
  • 3-4 nighttime awakenings per month if 5 and older
41
Q

What are the PFT findings consistent with mild persistent asthma?

A
  • FEV1>80%
  • FEV1/FVC normal
  • Minor activity limitation
  • > 2 days per week SABA use to control symptoms
42
Q

What FEV1/FVC value is normal for 5-19 year olds?

A

> 80%

43
Q

What symptoms classify moderate persistent asthma?

A
  • daily symptoms
  • 3-4 nighttime awakenings per month if aged 0-4
  • more than once a week nighttime awakenings if 5 and older
44
Q

What are the PFT findings consistent with moderate persistent asthma?

A
  • FEV1 60-80%
  • FEV1/FVC reduced by 5%
  • some activity limitation
  • daily SABA use to control symptoms
45
Q

What symptoms classify severe persistent asthma?

A

Symptoms throughout the day

  • greater than once weekly nighttime awakenings for those aged 0-4
  • Nightly awakenings for those 5 and older
46
Q

What are the PFT findings with severe persistent asthma?

A
  • FEV1< 60%
  • FEV1/FVC reduced by >5%
  • Extreme physical activity limitation
  • SABA used several times daily
47
Q

What are the medication options for asthma treatment? (8)

A

SABA, LABA, ICS, LTRA, monoclonal antibodies, methylxanthines, mast cell stabilizers, and anticholinergics

48
Q

What LTRA is used in patients aged 0-4?

A

Montelukast

49
Q

What are the two monoclonal antibodies used to treat asthma?

A

Omalizumab (anti-IgG) and Benralizumab (anti-IL5 receptor a)

50
Q

What kind of drug is theophylline?

A

Methylxanthines

51
Q

What is Step one in treatment of asthma?

A

SABA PRN (used in all stages)

52
Q

What is Step 2 in treatment of asthma?

A

Low dose ICS daily

OR

LRTA or Cromolyn

53
Q

What is Step 3 in treatment of asthma?

A

-medium dose ICS (all stages)

OR

Low dose ICS and LABA (if >5yo) or LTRA

54
Q

What is Step 4 in treatment of asthma?

A

-medium dose ICS and LABA (Or LTRA in 0-4yo)

OR

Medium dose ICS and LTRA

55
Q

What is Step 5 in treatment of asthma?

A

-High dose ICS and LABA (or LRTA in 0-4yo)

56
Q

What is Step 6 in treatment of asthma?

A

-high dose ICS and LABA(or LRTA in 0-4yo) and oral steroids

57
Q

What should you consider adding to step 5 and 6 in asthma treatment in patients older than 12 with allergies?

A

Omalizumab

58
Q

What should you consider adding in asthma treatment in patients older than 12 with severe eosinophilia asthma?

A

Benralizumab

59
Q

What drug may be used on conjunction with ICS in aged older than 5, but serum levels must be monitored closely?

A

Theophylline

60
Q

What does green mean on a peak flow meter?

A

Peak flow rate is >80 with means asthma is in good control

61
Q

What does yellow mean on a peak flow meter?

A

Peak flow rate is 50-80% and patient should take SABA and medications

62
Q

What does red mean on a peal flow meter?

A

Peak flow rate is <50% and patient needs to go to the ED

63
Q

What may be initial finding on ABGs in a patient with asthma?

A

Respiratory Alkalosis because they are hyperventilating and blowing off CO2

64
Q

What are the 3 main treatment options of asthma exacerbation?

A

1) O2
2) SABA/SVN: Albuterol and ipratropium bromide (repeat PEF and SVN may be repeated or continuous)
- Systemic corticosteroids (prenisolone)

Clinical Medicine 2 (22 decks)

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