Obstructive Pulmonary Diseases

Question 1

3 characteristic components of Asthma

Answer 1

1. Obstruction of Airflow
2. Bronchial hyperreactivity
3. Inflammation of airway

Question 2

A disease of chronic inflammation leading to airway narrowing and increased mucus production.

Chronic inflammation is associated with bronchospasms that lead to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing.

Often reversible airflow obstruction.

Answer 2

Asthma

Question 3

3rd leading cause of death in US

Answer 3

COPD

Question 4

A common, preventable, treatable disease that is not reversible. It is usually progressive and associated with enhanced chronic inflammatory response in the airway and lung to noxious particles or gas.

Answer 4

COPD

Question 5

A chronic inflammatory condition of the small airways that results in a chronic productive cough
cough must last for 3 months in each of 2 successive years
other causes of cough (bronchiectasis, malignancy etc) must be ruled out

Answer 5

Chronic Bronchitis

Question 6

Abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles due to chronic inflammation.
Destruction of airspace walls but no overt fibrosis.

Answer 6

Emphysema

Question 7

Asthma classification and diagnosis

Answer 7

Classified according to

1. frequency of symptoms
2. PFT (pulmonary function testing)

Question 8

Asthmatic symptoms appear 2 or less days / week, does not interfere w daily activities.
Nighttime symptoms 2 or fewer times per month.

Answer 8

Mild / Intermittent

Question 9

Asthmatic symptoms appear more than 2 days / week but not daily. Minor limitation.
Nighttime symptoms 3-4 times / month

Answer 9

Mild persistent

Question 10

Asthmatic symptoms appear daily. Some limitation in daily activity.
Nighttime symptoms more than 1x / week but not nightly
Daily use of medication

Answer 10

Moderate persistent

Question 11

Asthmatic symptoms are continuous. Extremely limited physical activities. Nighttime symptoms often every night.
Medication use several times / day

Answer 11

Severe persistent

Question 12

FEV1 > 80% predicted

PEFR variability < 20%

Answer 12

Mild intermittent

Question 13

FEV1 > 80% predicted

PEFR variability 20 - 30 %

Answer 13

Mild persistant

Question 14

FEV1 > 60% , < 80%

PEFR variability > 30%

Answer 14

Moderate persistent

Question 15

FEV 1 < 60%

PEFR variability >60%

Answer 15

Severe persistent

Question 16

How is the diagnosis of asthma confirmed?

Answer 16

Demonstrating reversibility of airflow obstruction with use of short-acting bronchodilator.

Reversibility = improve FEV1 by 12% and 200mL

Question 17

Using PEFR to confirmed asthma diagnosis

Answer 17

Peek Expiratory Flow Rate, to measure diurnal variability
( {highest daily PEFR - lowest daily PEFR} / {highest daily PEFR} )

Diagnosis of asthma if PEFR varies by at least 20%, for 3 days in a week over several weeks
OR
PEFR increases by at least 20% in response to treatment

Question 18

Treatment for Intermittent asthma

Answer 18

Step 1

SABA (inhaled short acting beta2 agonists) PRN

up to 3 treatments at 20 minute intervals, as needed

Question 19

Indication of inadequate control of symptoms and need to “step up”

Answer 19

use of SABA >2x / week for symptom relief

not including EIB prevention

Question 20

Treatment for persistent asthma, step 2

Answer 20

Low-dose ICS (inhaled corticosteroid)

Question 21

Tx persistant asthma, step 3

Answer 21

Low dose ICS + LABA (long-acting inhaled beta 2 agonist)

OR

Medium-dose ICS

Question 22

Tx persistant asthma, step 4

Answer 22

Medium dose ICS + LABA

Question 23

Tx persistant asthma, step 5

Answer 23

High-dose ICS + LABA

AND

allergy treatment (Omalizumab)

Question 24

Tx persistant asthma, step 6

Answer 24

High-dose ICS + LABA + Oral corticosteroid

AND

allergy treatment (omalizumab)

Question 25

Necessary components for each step of asthma treatment

Answer 25

Patient education Environmental control Management of comorbidities

Question 26

Special treatment considerations for steps 2-4

Answer 26

Consider subcutaneous allergen immunotherapy for patients with allergic asthma - especially children

Question 27

When to consider consultation with asthma specialist

Answer 27

Consider at step 3, definitely consult if need to step tup to 4

Question 28

Abnormal, permanent dilation of the bronchi and destruction of bronchial walls.

Answer 28

Bronchiectasis

Question 29

What can lead to bronchiectasis?

Answer 29

1. Congenital cystic fibrosis ** half of all cases here ** 2. Recurrent inflammation and infections (TB, fungal, abscess) 3. Tumor obstruction

Question 30

Indication of recurrent pulmonary infections and chronic, purulent, foul-smelling sputum?

Answer 30

Bronchiectasis transmural inflammation, mucosal edema, cratering, ulceration, and neovascularization in the airways. The result is permanent abnormal dilatation and destruction of the major bronchi and bronchiole walls.

Question 31

Test of choice for bronchiectasis

Answer 31

High-resolution chest CT - reveals dilated, tortuous airways "SIGNET-RING SIGN}

Question 32

Treatment for bronchiectasis

Answer 32

10-14 days or longterm antibiotics (augmenting, bacterium, or ciproflox) Bronchodilators Chest physiotherapy - airway clearance **consider lung transplant**

Question 33

Rule-out tests for bronchiectasis

Answer 33

1. Sweat chloride - rule out cystic fibrosis | 2. alpha 1 anti trypsin deficiency (serum)

Question 34

Signet-ring sign in chest CT classic feature of what?

Answer 34

Bronchiectasis

Question 35

Pathophysiological / clinical syndrome that includes emphysema and chronic bronchitis

Answer 35

COPD

Question 36

Condition in which the air spaces are enlarged as a consequence of destruction of alveolar space

Answer 36

Emphysema

Question 37

Disease characterized by a chronic cough that is productive of phlegm occurring on most days for **3 months of the year for 2 or more consecutive years** without an others-defined acute cause

Answer 37

Chronic bronchitis

Question 38

Causes of COPD other than smoking

Answer 38

``` Environmental pollutants Recurrent URI Eosinophilia Bronchial hyper-responsiveness Alpha-1 Antitrypsin deficiency ```

Question 39

Clinical features of emphysematous COPD

Answer 39

Progressive SOB Excessive DRY cough Weight loss Advanced stage: Pursed lip breathing Grunting expirations

Question 40

Chest examination of COPD patient

Answer 40

Hyperinflation, increased AP dimensions Increased resonance w percussion Decreased breath sounds Early Inspiratory crackles Prolonged duration of expiration

Question 41

First test for diagnosing and monitoring COPD

Answer 41

Spirometry and PFTs FEV1 <70%, nonreversible with bronchodilator - *for both chronic bronchitis and emphysema

Question 42

Definitive test to determine presence of emphysema

Answer 42

Chest CT