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Lung diseases Flashcards

1
Q

where does Asthma obstruction occur

A

bronchi (3-4)

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2
Q

where does Asthma obstruction occur

A

bronchi (3-4)

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3
Q

Extrinsic vs Intrinsic asthma

A

extrinsic is allergic IgE mediated; intrinsic is non-allergic post viral

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4
Q

Asthma pathophysiology

A

inflammation with increased Mast, Th2 and PMns that release histamine, luekotrienes, prostaglandins and cyotkines (IL4, 5, 9, 13) to cause bronchospasm, mucus secretion, structural changes

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5
Q

structural changes in asthma

A

SMC hypertrophy and hyperplasia
mucus hypersecrtion due to submusosal hyperplasia
angiogenesis
epithelial desquamanation

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6
Q

Lung volumes in obstructive disease

A

increase RV and FRC, but decreased IC due to high RV

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7
Q

intermittent asthma

A

less than 2 times per week and asymptomatic in between and less than 2x at night per month

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8
Q

mild persistent asthma

A

more than 2x per week or less than 1 time daily with more than 2x per night monthly

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9
Q

moderate persistent asthma

A

daily symptoms with some recovery, more than once per week at night

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10
Q

severe persistent asthma

A

continual symptoms with frequent night symptoms

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11
Q

what is well controlled asthma?

A
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12
Q

not well controlled

A

> 2 days/wk; 1-3 nights/wk; SABA >2 wk; FEV1 60-80% personal best

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13
Q

poorly controlled asthma

A

throughout day symptoms, >4 nights/wk, SABA several times a day,

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14
Q

Step ups in Asthma treatment

A

ICS before LABA, but also use omalizumab for severe and oral CS for very severe

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15
Q

LABA vs SABA

A

SABA: Albuterol is 4-6 hour duration and rapid action
LABA: salmeterol and forometerol is 12 hr sustained duration.
Should not be used along with asthma since they are not antiinflammatory!

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16
Q

Systemic Vs. Inhalted Glucocorticosteroids

A

Systemic: prednisone. Oral that lasts for 36-48 hours - causes growth inhibition!
Inhaled: beclomethasone dipropionate with faster onset and 8 hrs effectivity.

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17
Q

Leukotriene Modifiers

A

Oral D4 antagonists, 5-lipoxygenase inhibitor,
Duration of 12-24 hours and used to block leukotriene path for bronchodilation and anti-inflammatory.
attenuates exercise induced asthma

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18
Q

Omalizumab

A

Immune modulator tx for asthma. Anti-IgE

Used for severe asthma treatment given SC

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19
Q

Mepolizumab

A

immune modulator, anti IL-5

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20
Q

Atropine

A

Anticholinergic used in COPD but not asthma!
Causes bronchodilation via SM reflex and inhibits respiratory secretions by acting on cholinergic receptors.
Ipratrapium - 6 hour anticholinergic
Tiotropium: 12 hours anticholinergic

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21
Q

Tiotropium

A

long term anti-cholinergic used in >12 yo asthma patients

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22
Q

Theophylline

A

oral or IV - no longer used in asthma
Inhibits phosphodiesterase for bronchodilation and some antiinflammatory.
Not used due to narrow therapeutic window, seizures, neurologic damage and DDI

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23
Q

Cromolyn and Nedocronil

A

inhalted to inhibit mast cell release - preventative for exercise induced Asthma and prevents allergen induced asthma.

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24
Q

Particles >5 um are deposited

A

in pharynx and large airways

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25
Particles
small airways;
26
Tx of COPD
LABA over SABA
27
Pathogenesis of Chronic Bronchitis
hypertrophy and mucosal gand hyperplasia, increased bronchial wall thickness, squamous metaplasia transition to cause excessive mucus and inflammation.
28
Pathogenesis of Emphysema
loss of alveolar space due to destruction of alveolar septa without fibrosis. Increased compliance, increase protease activity and decrease repair
29
Centriacinar
cigarette smoking related, with central airways more inflated
30
Panacinar
due to alpha-1antitrypsin def over entire respiratory bronchioles and alveoli.
31
DLCO in emphysema vs. Chronic Bronchitis
emphysema has decreased but normal Bronchitis due to aveolar sparing
32
Pink puffer vs Blue Bloater response to hypoxia
Pink: poor - hyperventilation Blue: can tolerate
33
CO in Pink puffer vs. Blue Bloater
Decreased CO compared to Blue Bloater
34
Blood gas for Pink puffer vs blue bloater
pink: normal blood gas Blue: low O2 sat
35
Cor Pulmonale Pink puffer vs. blue bloater
more common in blue bloater, can occur with pink puffer but is end stage.
36
Gold rating of COPD
Mild Ratio is 80 | Mod ratio is 70 with FEV
37
Tx of COPD
smoking cessation, increase physical activity, overall health preseveration. GOLd 1-2 that are low risk with low-mod symptoms have SAMB/SABA PRN or LAMA/LABA Gold 3-4 with high risk and low-high symptoms: ICS with LABA
38
Bronchiectasis:
abnormal dilation of proximal bronchi due to muscular and elsatic components to decrease mucociliary clearance and increase colonization and infection. Due to frequent bacterial infection in recurrent Px, CF, Cuases foul smelling sputum, wheeze, hemoptysis, airflow limitation. Airways are dialted but collapsed. tx: airway clearance, Antibiotic
39
Extrinsic vs Intrinsic asthma
extrinsic is allergic IgE mediated; intrinsic is non-allergic post viral
40
Asthma pathophysiology
inflammation with increased Mast, Th2 and PMns that release histamine, luekotrienes, prostaglandins and cyotkines (IL4, 5, 9, 13) to cause bronchospasm, mucus secretion, structural changes
41
structural changes in asthma
SMC hypertrophy and hyperplasia mucus hypersecrtion due to submusosal hyperplasia angiogenesis epithelial desquamanation
42
Lung volumes in obstructive disease
increase RV and FRC, but decreased IC due to high RV
43
intermittent asthma
less than 2 times per week and asymptomatic in between and less than 2x at night per month
44
mild persistent asthma
more than 2x per week or less than 1 time daily with more than 2x per night monthly
45
moderate persistent asthma
daily symptoms with some recovery, more than once per week at night
46
severe persistent asthma
continual symptoms with frequent night symptoms
47
what is well controlled asthma?
Given
48
not well controlled
>2 days/wk; 1-3 nights/wk; SABA >2 wk; FEV1 60-80% personal best
49
poorly controlled asthma
throughout day symptoms, >4 nights/wk, SABA several times a day,
50
Step ups in Asthma treatment
ICS before LABA, but also use omalizumab for severe and oral CS for very severe
51
LABA vs SABA
SABA: Albuterol is 4-6 hour duration and rapid action LABA: salmeterol and forometerol is 12 hr sustained duration. Should not be used along with asthma since they are not antiinflammatory!
52
Systemic Vs. Inhalted Glucocorticosteroids
Systemic: prednisone. Oral that lasts for 36-48 hours - causes growth inhibition! Inhaled: beclomethasone dipropionate with faster onset and 8 hrs effectivity.
53
Leukotriene Modifiers
Oral D4 antagonists, 5-lipoxygenase inhibitor, Duration of 12-24 hours and used to block leukotriene path for bronchodilation and anti-inflammatory. attenuates exercise induced asthma
54
Omalizumab
Immune modulator tx for asthma. Anti-IgE | Used for severe asthma treatment given SC
55
Mepolizumab
immune modulator, anti IL-5
56
Atropine
Anticholinergic used in COPD but not asthma! Causes bronchodilation via SM reflex and inhibits respiratory secretions by acting on cholinergic receptors. Ipratrapium - 6 hour anticholinergic Tiotropium: 12 hours anticholinergic
57
Tiotropium
long term anti-cholinergic used in >12 yo asthma patients
58
Theophylline
oral or IV - no longer used in asthma Inhibits phosphodiesterase for bronchodilation and some antiinflammatory. Not used due to narrow therapeutic window, seizures, neurologic damage and DDI
59
Cromolyn and Nedocronil
inhalted to inhibit mast cell release - preventative for exercise induced Asthma and prevents allergen induced asthma.
60
Particles >5 um are deposited
in pharynx and large airways
61
Particles
small airways;
62
Tx of COPD
LABA over SABA
63
Pathogenesis of Chronic Bronchitis
hypertrophy and mucosal gand hyperplasia, increased bronchial wall thickness, squamous metaplasia transition to cause excessive mucus and inflammation.
64
Pathogenesis of Emphysema
loss of alveolar space due to destruction of alveolar septa without fibrosis. Increased compliance, increase protease activity and decrease repair
65
Centriacinar
cigarette smoking related, with central airways more inflated
66
Panacinar
due to alpha-1antitrypsin def over entire respiratory bronchioles and alveoli.
67
DLCO in emphysema vs. Chronic Bronchitis
emphysema has decreased but normal Bronchitis due to aveolar sparing
68
Pink puffer vs Blue Bloater response to hypoxia
Pink: poor - hyperventilation Blue: can tolerate
69
CO in Pink puffer vs. Blue Bloater
Decreased CO compared to Blue Bloater
70
Blood gas for Pink puffer vs blue bloater
pink: normal blood gas Blue: low O2 sat
71
Cor Pulmonale Pink puffer vs. blue bloater
more common in blue bloater, can occur with pink puffer but is end stage.
72
Gold rating of COPD
Mild Ratio is 80 | Mod ratio is 70 with FEV
73
Tx of COPD
smoking cessation, increase physical activity, overall health preseveration. GOLd 1-2 that are low risk with low-mod symptoms have SAMB/SABA PRN or LAMA/LABA Gold 3-4 with high risk and low-high symptoms: ICS with LABA
74
Bronchiectasis:
abnormal dilation of proximal bronchi due to muscular and elsatic components to decrease mucociliary clearance and increase colonization and infection. Due to frequent bacterial infection in recurrent Px, CF, Cuases foul smelling sputum, wheeze, hemoptysis, airflow limitation. Airways are dialted but collapsed. tx: airway clearance, Antibiotic

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