Miller Asthma and COPD Flashcards
Asthma epidemiology?
- Boys>girls
- Women >men
- men achieve remission more often
Prenatal risk factors for asthma?
- Ethnicity
- Low SES
- Stress
- C. section
- Maternal smoking
-
Prematurity
- largest epidemiological risk factor
Postnatal risk factors for asthma development?
- Levels of endotoxins and allergens
- Viral/bacterial infection
- Air pollution
- Abx use
- Acetaminophen exposure
- Obesity
Clinical presentation of asthma?
- Cough
- Recurrent wheeze
- chest tightness
- sob
Someone with mild intermittent asthma, what is the treatment?
- Short acting beta agonist as needed
For a person with persistent asthma, neeeding rescue inhaler more than twice a week, what is the next step?
- Add inhaled corticosteroid
- if moderate or severe persistent add LABA
Complications to asthma?
- Poor QOL
- pneumonia
- pneumothroax
- asthma exacerbation
- triggered by benign viral infections an allergens
- resp failure
- airway remodeling → COPD
How do you treat asthma exacerbation/
- Bronchodilators
- systemic glucocorticoids
- Oxyge
How do you prevent asthma?
- Breast feeding
- Avoid active/passive tobacco smoke
- Target obesity
- balanced diet
- Vaccination
COPD epidemiology?
- persistent airflow limitation
- irreversible
- 3rd leading COD worldwide
- mortality higher in men than women
- poverty is strongest association with mortality in COPD
Most common risks for COPD?
- smoking/exposure to smoke
- TB history
- potentially outdoor air pollution
Main pathological features of COPD?
- obstructive bronchiolitits
- emphysema
- mucus hypersecretion
Describe the chronic inflammation seen in COPD. (3 things)
- Increases as diseases progresses
- amplified in exacerbations
- chronic bacterial colonization
What are symptoms of COPD exacerbations?
- Increase dyspnea
- Increased sputum purulence
- Increased cough
- Increased wheezing
- Beyond normal day to day variation
How do you diagnose COPD?
- Spirometry
- FEV1/FVC <0.7
- Low FEV1
- Given a bronchodilator there is a less than 12% change in FEV1
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Describe the GOLD classification of COPD
- GOLD1:
- FEV1 > 80% predicted
- GOLD2:
- Moderate 50% 1 , <80% predicted
- GOLD 3:
- Severe, 30% < FEV1, <50% predicted
- GOLD 4:
- very severe FEV1 <30% predicted
What are the two nonpharmacological treatments for COPD?
- 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
How do you manage COPD with medications
- Bronchodilators are the mainstay
- use long acting beta and muscarinic agonists together
- doubles lung function but doesn’t 2x sx improvement
- use long acting beta and muscarinic agonists together
- Inhaled corticosteroids for high risk of exacerbations
- oxygen, this reduces mortality
Initital management for COPD?
- smoking cessation
- vaccinations
- active lifestyle
- manage comorbidities
When does a patient need to be put on an inhaled corticosteroid?
- frequent exacerbations or reactive airway component
When is an ICS contraindicated?
- repeated pneumonia
- blood eosinophils <100
- Hx of mycobacterial infection
