Miller Asthma and COPD

Question 1

Asthma epidemiology?

Answer 1

• Boys>girls
• Women >men
  
  • men achieve remission more often

Question 2

Prenatal risk factors for asthma?

Answer 2

• Ethnicity
• Low SES
• Stress
• C. section
• Maternal smoking
• Prematurity
  
  • largest epidemiological risk factor

Question 3

Postnatal risk factors for asthma development?

Answer 3

• Levels of endotoxins and allergens
• Viral/bacterial infection
• Air pollution
• Abx use
• Acetaminophen exposure
• Obesity

Question 4

Clinical presentation of asthma?

Answer 4

• Cough
• Recurrent wheeze
• chest tightness
• sob

Question 5

Someone with mild intermittent asthma, what is the treatment?

Answer 5

• Short acting beta agonist as needed

Question 6

For a person with persistent asthma, neeeding rescue inhaler more than twice a week, what is the next step?

Answer 6

• Add inhaled corticosteroid
• if moderate or severe persistent add LABA

Question 7

Complications to asthma?

Answer 7

• Poor QOL
• pneumonia
• pneumothroax
• asthma exacerbation
  
  • triggered by benign viral infections an allergens
• resp failure
• airway remodeling → COPD

Question 8

How do you treat asthma exacerbation/

Answer 8

• Bronchodilators
• systemic glucocorticoids
• Oxyge

Question 9

How do you prevent asthma?

Answer 9

• Breast feeding
• Avoid active/passive tobacco smoke
• Target obesity
• balanced diet
• Vaccination

Question 10

COPD epidemiology?

Answer 10

• persistent airflow limitation
  
  • irreversible
• 3rd leading COD worldwide
  
  • mortality higher in men than women
  • poverty is strongest association with mortality in COPD

Question 11

Most common risks for COPD?

Answer 11

• smoking/exposure to smoke
• TB history
• potentially outdoor air pollution

Question 12

Main pathological features of COPD?

Answer 12

• obstructive bronchiolitits
• emphysema
• mucus hypersecretion

Question 13

Describe the chronic inflammation seen in COPD. (3 things)

Answer 13

• Increases as diseases progresses
• amplified in exacerbations
• chronic bacterial colonization

Question 14

What are symptoms of COPD exacerbations?

Answer 14

• Increase dyspnea
• Increased sputum purulence
• Increased cough
• Increased wheezing
• Beyond normal day to day variation

Question 15

How do you diagnose COPD?

Answer 15

• Spirometry
• FEV1/FVC <0.7
• Low FEV1
• Given a bronchodilator there is a less than 12% change in FEV1
  *

Question 16

Describe the GOLD classification of COPD

Answer 16

• GOLD1:
  
  • FEV₁ > 80% predicted
• GOLD2:
  
  • Moderate 50% 1 , <80% predicted
• GOLD 3:
  
  • Severe, 30% < FEV1, <50% predicted
• GOLD 4:
  
  • very severe FEV1 <30% predicted

Question 17

What are the two nonpharmacological treatments for COPD?

Answer 17

• Pulmonary rehab, this improves exercise capacity, breathlessness, health status and daily living
• Lung volume reduction surgery and transplantation
  
  • improve survival and QOL in select patients with very severe disease

Question 18

How do you manage COPD with medications

Answer 18

• Bronchodilators are the mainstay
  
  • use long acting beta and muscarinic agonists together
    
    • doubles lung function but doesn’t 2x sx improvement
• Inhaled corticosteroids for high risk of exacerbations
• oxygen, this reduces mortality

Question 19

Initital management for COPD?

Answer 19

• smoking cessation
• vaccinations
• active lifestyle
• manage comorbidities

Question 20

When does a patient need to be put on an inhaled corticosteroid?

Answer 20

• frequent exacerbations or reactive airway component

Question 21

When is an ICS contraindicated?

Answer 21

• repeated pneumonia
• blood eosinophils <100
• Hx of mycobacterial infection