Obstructive Lung Disease Flashcards
Indication for abx in AECOPD patient that is intubated
Routinely give them
Frequency of sputum culture in patients with CF
Every 3 months
Preferred treatment for new pseudomonas infection in CF
Inhaled tobramycin for 28 days
First line therapy for destroyed lung syndrome
Hypertonic saline and chest physiotherapy
Biologic for steroid dependent asthma regardless of phenotype
Dupilumab
Dupliumab mechanism
Inhibits alpha subunit of IL-4
Omalizumab mechanism
Inhibits free IgE
Reslizumab mechanism
Monoclonal antibody against IL-5, a cytokine responsible for eosinophil differentiation, activation, and recruitment
Mepolizumab mechanism
Monoclonal antibody against IL-5, a cytokine responsible for eosinophil differentiation, activation, and recruitment
Indication for mepolizumab
Poorly controlled asthma with eosinophil >150
Indication for roflumilast
Chronic bronchitis AND two exacerbations in a year or 1 hospitalization
Roflumilast mechanism
PDE-4 inhibitor
Criteria for a positive bronchoprovocation test?
> 15% fall in FEV1 with indirect stimulus (mannitol) and >20% fall in FEV1 with direct stimulus (methacholine)
Patients excluded in bronchial thermoplasty trials
FEV <60%, <18 years old, sinus disease, >3 exacerbations per year
COPD ppulation with greatest supplemental oxygen supplementation
Severe desaturation with activity or desaturation at rest
New therapy for attacks of hereditary angioedema
Icatibant
Benefit of pulmonary rehab after discharge for AECOPD
Reduction in all cause mortality
Benefits of endobronchial valves in COPD
Improved quality of life, improved dyspnea, improved lung function, and reduced exacerbations
Most common cause non-CF bronchiectasis
Post-infectious and idiopathic
CF bronchiectasis upper or lower lobe predominant?
Upper lobe
Non-CF bronchiectasis upper or lower lobe predominant?
Lower lobe
Is dornase alpha effective in CF? Non-CF bronchiectasis
Effective on in CF bronchiectasis
Test for primary ciliary dyskinesia
Nasal nitric oxide test
Contraindications to allergen immunotherapy in asthma management
Poorly controlled asthma, unstable cardiac disease, pregnancy (can continue in preg but can’t start)
Benefit of endobronchial valve insertion in COPD
Improved lung function and quality of life that persist after 12 months. No mortality benefit.
Most common adverse effect of endobronchial valves
Pneumothorax
Gene that confers macrolide resistance in M abscessus infection
erm
Gene that confers ethambutol resistance in mycobacterial infection
emb
Gene that confers rifampin resistance in mycobacterial infection
rpoB
Difference in using FEV1/FVC <70% and using LLN
<0.7 provides discrimination of COPD-related hospitalization and mortality that is more accurate than using the LLN
Does a fixed threshold for obstruction diagnosis based on FEV1/FVC lead to over or underdiagnosis?
Over diagnosis
How does sensitivity and specificity compare for LLN and <70% for FEV1/FVC?
LLN is more specific. Fixed threshold <70% is more sensitive.
Difference in ICS/LABA/LAMA vs LABA/LAMA
ICS/LABA/LAMA has been shown to improve lung function & symptoms, & to reduce exacerbations and all-cause mortality
When should NIV be started after AECOPD in patient with hypercapnia?
2 to 4 weeks following discharge.
ATS pCO2 cutoff for starting NIV in patients with COPD
> 45
Effects of influenza vaccination in COPD
Reduced number of exacerbations and hospitalizations
Brensocatib mechanism and use
Inhibitor of DPP1 that reduces neutrophil serine protein activity in patients with non–CF bronchiectasis
Major side effects of Brensocatib
Periodontal disease and skin lesions
Consequence of de-escalating triple therapy to ICS/LABA in patient with COPD and few exacerbations
Reduced lung function
Patients should be checked for ______ if baseline absolute eosinophil count is >300
Strongyloides
Treatment for bronchopulmonary sequestration
Surgical resection
