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CRRAB II- Week 5 > Johns: Shortness of Breath > Flashcards

Johns: Shortness of Breath Flashcards

1
Q

What is COPD?

A

Airflow limitation that is NOT fully reversible.

Associated w/ abnormal INFLAMMATORY response of the lungs.

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2
Q

What is the most important lung disease in the US and the 4th ranked cause of death?

A

COPD

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3
Q

What is chronic bronchitis?

A

Chronic PRODUCTIVE COUGH for THREE months in TWO successive years

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4
Q

What is emphysema?

A

Enlargement of airspaces w/ destruction of bronchiole walls

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5
Q

What is asthma?

A

INFLAMMATORY disease of airways w/ significantly REVERSIBLE narrowing

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6
Q

What are the clinical features of COPD?

A

LONG TERM PROCESS

Pts have SMOKED at least 20 cigarettes per day for 20 or more years.

Starts w/ CHRONIC COUGH.

DYSPNEA doesn’t occur until 10-20 years later.

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7
Q

A pt presents with chronic cough, chronic sputum production, and dyspnea. they are also a smoker. What may they have?

A

COPD

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8
Q

How do you differentiate asthma from COPD?

A

Asthma- completely reversible w/ bronchodilators

COPD- completely irreversible

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9
Q

What are clinical features as COPD progresses?

A 
Chronic clear sputum production
Weight loss
Morning HA (caused by hypoxemia)
Hypercapnia w/ hypoxemia
Cor pulmonale (RHF)
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10
Q

What is the clinical course of airway function in COPD vs. Asthma?

A

FEV1 decreases w/ Age/Asthma

FEV1 drops off DRAMATICALLY

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11
Q

On physical examination, a pt has prolonged expiration, hyperinflation of the lungs (increased AP diameter d/t trapped air), hyperresonent to percussion (sound like a drum), depressed diaphragm, decreased breath sounds, and wheezes. What does this suggest?

A

COPD

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12
Q

What is indicative of end stage COPD?

A 
Accessory muscles
pursed lips
cyanosis
enlarged liver
asterixis (tremor of the hand when wrist is extended)
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13
Q

How do you diagnose COPD?

A

CXRAY
Chest CT
Pulmonary function tests

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14
Q

What is seen on pulmonary function tests in a pt w/ COPD?

A

Decreased FEV1
Decreased FEV1/FVC
Increased TLC
Absence of bronchodilator response

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15
Q

What is seen on a CXRAY of a pt w/ obstructive lung disease?

A

Hyperlucent lung fields
Flat diaphragm
Little lung tissue

Lateral- increased AP diameter from air trapping over time (also seen in a pt w/ bad asthma)

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16
Q

What is seen on spirometry of a pt w/ COPD?

A

Significantly decreased FEV1– can’t blow out as much air in the fist second

FVC- is fairly normal or larger than normal

17
Q

*How do you tell the difference between COPD and asthma?

A

Spirometry test

Give bronchodilator and repeat spirometry test again. If there is significant change that it’s Asthma.

18
Q

How do you manage stable COPD?

A

SMOKING CESSATION–> will cause FEV1 to decline

19
Q

What is a beta 2 agonist bronchodilator?

A

Albuterol metered dose inhaler

20
Q

What anticholinergic agents are used to treat COPD?

A

Inhaled ipratropium

21
Q

What’s in most inhalers?

A

Anticholinergics and beta agonists

*these are also the MOST EFFECTIVE

22
Q

Why don’t we use theophylline much anymore?

A

Toxicity

23
Q

When do we use corticosteroids to treat COPD?

A

Mainly short term for exacerbations and only if all other meds are at maximal therapy

May slow rate of decline of FEV1

24
Q

When is supplemental O2 used to treat COPD?

A

If O2 sat is below 88% or if room air falls below 85%

If cor pulmonale is present

*O2 helps sxs and prevents cor pulmonale

25
Q

What are the three types of COPD?

A

Chronic asthma, emphysema and chronic bronchitis

26
Q

What is asthma?

A

Chronic INFLAMMATORY disorder of the airways that can cause RECURRENT episodes of WHEEZING, COUGH and CHEST TIGHTNESS.

Partly reversible spontaneously or w/ treatment.

27
Q

What is the classic triad of sxs for asthma?

A

Persistent wheeze
chronic cough
dyspnea

28
Q

On physical exam you hear high pitched wheezes and see that the pt is using accessory muscles and a pulses pardoxus. What do they have?

A

Asthma

29
Q

What is pulsus paradoxus?

A

Greater than 10 mmHg fall in systolic pressure during INSPIRATION.

30
Q

If a pt is monitoring themselves w/ a spirometer and notices that they’re feeling bad, what increase should you see in FEV-1 after using a bronchodilator?

A

Increase of more than 12% is considered responsive

31
Q

What is the treatment for asthma?

A

Stepwise approach based on sxs

  1. SABA (albuterol)
  2. ICS
  3. Long acting beta agonist to steroid inhaler/increase dose of inhaler
32
Q

What is Omalizumab?

A

Anti-IgE monoclonal Ab
Binds free IgE in circulation and decreases receptors on basophils

Sub q injection

COSTS A BUTTLOAD

33
Q

What is the classic triad for asthma?

A

wheeze
cough
dyspnea

34
Q

How does asthma differ from COPD?

A

Asthma is generally reversible

*COPD isn’t necessarily more severe than asthma and eosinophils are related to asthma

CRRAB II- Week 5 (3 decks)

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