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Clin Med II- Exam 2 > PFT and Asthma > Flashcards

PFT and Asthma Flashcards

1
Q

Basic PFTs

A
  1. Airflow spirometry
  2. Lung Volumes
  3. Diffusion Capacity of the lungs for Carbon Monoxide (DLCO)
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2
Q

How many times should you do spirometry

A

repeat at least 3X

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3
Q

FVC

A

total volume of air expelled with maximal effort (full inspiration + blow air out as fast as possible)

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4
Q

Most useful value for obstruction

A

FEV1

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5
Q

FEV1/FVC ratio

A

determines obstructive vs. restrictive

<0.7 = OBSTRUCTIVE (<5th percentile LLN)

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6
Q

FEF 25-75%

A

forced expiratory flow;
airflow measurement during middle 1/2 of forced expiration

nonspecific for small airway obstruction but may be an early indicator of disease

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7
Q

Bronchodilator testing

A

2-4 puffs; hold med in lungs for 5-10 sec; spirometry completed 15 min after med provided

3-8 rouds of testing and possible repeated during flare

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8
Q

(+) bronchodilator test

A

FEV1 increases by 12% AND 200 mL

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9
Q

Bronchoprovocation (methacholine challenge)

A
  1. diluted methacholine given via nebulizer
  2. spirometry @ 30 and 90 seconds
  3. concentration increases
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10
Q

(+) bronchoprovocation test

A

FEV1 decreases by 20% (may have false positive)

***** closely monitor!

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11
Q

Quality of curves

A

volume-time curve plateaus
expiration > 6 sec
2 best efforts w/i 0.2L
flow volume loop free of artifact

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12
Q

obstructive curve

A

peaks the drops (expiration)

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13
Q

Restrictive curve

A

normal, but less volume (smaller)

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14
Q

TLC

A

volume of air in lungs after max inhalation

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15
Q

Vital capacity

A

volume of air we breathe out following max inhalation

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16
Q

Residual volume

A

volume of air remaining in lungs following max exhalation

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17
Q

TLC equation

A

TLC = RV + VC

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18
Q

DLCO test

A

used to measure ability of lungs to transfer gas and saturate Hgb (alveolar-capillary membrane)

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19
Q

False DLCO test

A

anemia (must be adjusted for Hgb level)

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20
Q

Results of DLCO

A

inhale helium/CO and expire:

  • health lungs: little CO collected during exhalation
  • diseased lungs, less CO diffuses into lungs, higher levels measures in exhaled gas
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21
Q

What is obstructive

A

airway narrowing
limits airflow w/ expiration
reduced airflow w/ high lung volumes
inspiration likely normal

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22
Q

Values for obstructive

A 
TLC: increased
FVC: Normal
RV: increased
FEV1: decreased
FEV1/FVC: decreased
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23
Q

What is restrictive

A

reduction in LUNG VOLUME
reduced lung expansion
inspiration & expiration look normal but flow & volume are reduced

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24
Q

Values for restrictive

A 
TLC: decreased
FVC: decreased
RV: decreased
FEV1: Decreased
FEV1/FVC: normal or increased
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25
Q

Obstructive disorders

A 
asthma
asthmatic bronchitis
bronchitis
COPD
CF
emphysema
Upper airway obstruction
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26
Q

Restrictive disorders

A 
pulmonary fibrosis
infectious lung disease
thoracic deformity
PE
tumor
NM disease
Obesity
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27
Q

increased slope

A

restrictivww

28
Q

scooped out

A

obstructive

29
Q

FEV1 examination

A

normal: r/o obstruction/restriction

dec. >15-20%: obstruction (FEV1 <80%)
- correlate w/ TLC: if this increases by 15-20% = favors obstructive

30
Q

FEV1/FVC ratio determination

A

<70%: obstructive
70%-LLN: mild obstruction cannot be excluded (asthma?)
Normal or increased: restrictive

31
Q

DLCO in asthma

A

increased

32
Q

Frequency of lung function measurements

A

at diagnosis
after 3-6 mo of tx (FEV1)
periodically every 1-2 yrs

33
Q

Definition of asthma

A
  1. chronic airway inflammation
  2. intermittent and reversible airway obstruction
  3. bronchial hyperresponsiveness
34
Q

Sx of asthma

A

usually before 5 YO:

  • coughing: NOCTURNAL, >3 weeks
  • Wheezing*** (inspiration and expiration)
  • CP, presure, dyspnea, SOB
35
Q

Meds that trigger asthma sx

A

BB, ASA, NSAIDS

36
Q

risk factors for asthma

A 
atopy
med intolerance (ASA/NSAID)
food allergy
GERD
RSV
\+FMH
maternal smoking
obesity
37
Q

PE for asthma

A

increased AP diameter
wheezing w/ prolonged expiratory phase (most often expiratory)
associated signs of rhinitis, sinusitis, conjunctivitis, URI, atopic derm

38
Q

Signs of severe asthma obstruction

A

tachy
tripod positioning
accessory mm. use
pulsus paradoxs

39
Q

Aspirin-exacerbated respiratory disease (ASA Triad/Samter’s Triad)

A

nasal polyps
ASA sensitivity
severe asthma

40
Q

Upper and lower respiratory rxns to ASA

A

avoid NSAIDs

75% have respiratory response to alcohol

41
Q

Atopic Triad

A

allergic rhinitus
atopic dermatitis
asthma

42
Q

Atopic March

A

allergic rhinitis
atopic dermatitis
asthma
food allergy

43
Q

Dx of asthma

A

spirometry >5 YO (may need repeated):

  1. FEV1 <80%
  2. FEV1/FVC ratio: normal or decreased (70-85%)
  3. Reversibility: >12% and 200 mL w/ bronchodilator (>8% in young children)
44
Q

Intermittent asthma (step 1)

A

sx <2 days/week
Nighttime awakening: age 0-4 - none; >5: <2 nights/month

normal PFTs in between exacerbation
FEV1 >80%
FEV1/FVC: normal (>85% ages 5-19)
Normal activity
<2 days/week SABA
45
Q

Mild-persistent asthma (step 2)

A

sx >2 days/week
Nighttime: age 0-4: 1-2 nights/month; >5 yo: 3-4 nights/month

FEV1 >80%
FEV1/FVC: normal (>80%)
minor limitation in activity

> 2 days/week SABA (not daily)

46
Q

Mod-persistent asthma (step 3)

A

daily symptoms
nighttime: age 0-4: 3-4x/month; >5: 1x/week (not nightly)

FEV1: 60-80%
FEV1/FVC reduced by 5%
some activity limitations

daily use of SABA

47
Q

Severe persistent asthma (step 4)

A

Sx throughout the day
nighttime: 0-4: 1x/week; >5 yo: nightly

FEV1: <60%
FEV1/FVC reduced >5%
Extremely limitied activity

SABA several times a day

48
Q

LTRA

A

leukotriene receptor antagonist (Montelukast)

49
Q

Montelukast use

A

ages 0-4

50
Q

Monoclonal antibodies

A

omalizumab (anti-IgG)

benralizumab (anti-IL5 receptor a)

51
Q

Methlxanthine

A

theophyline

52
Q

Tx for step 1

A

SABA PRN* (+/- ICS)

53
Q

Tx for step 2

A

low dose ICS daily* OR
LTRA or cromolyn

(+ SABA)

54
Q

Tx for step 3

A

refer to specialist

medium dose ICS* OR low dose ICS + LABA

55
Q

Tx for step 4

A

medium dose ICS & LABA (or LTRA in 0-4 yo)

56
Q

Tx for step 5

A

high dose ICS & LABA (or LTRA ages 0-11)

57
Q

Tx for step 6

A

high dose ICS & LABA (or LTRA) & oral steorid

58
Q

Consideration for steps 5 & 6

A

consider omalizumab (Xolair) for ages >!2 w/ allergies

59
Q

Rule of 2’s to know if asthma is under control

A

sx >2x/week
awaken more than 2x/month
refill inhaler >2x/yr
does your peak flow meter measure < 2x10 (20%) from baseline?

60
Q

F/u for asthma

A

initially 1-3 mo, then every 3-12 months depending on severity

61
Q

Well controlled asthma

A

sx <2 days/week
awaken <1x/month (0-11 yo), or <2x/month (>12)
FEV1: >80%
FEV1/FVC: >80%

62
Q

Dx for acute exacerbatiton

A

PEFR (peak expiratory flow rate)

63
Q

Values for PEFR

A

> 80%: GREEN: good control
50-80%: YELLOW: caution - SABA & Med
<50%: RED: emergency dep.

64
Q

ABG for acute exacerbation

A

respiratory alkalosis initially (hyperventilation) - if PaCO2 normal, considering patient getting tired/breathless

65
Q

CXR for acute exacerbation

A

only if r/o infection or obstruction

may show hyperinflation

66
Q

Tx for exacerbation

A
  1. O2
  2. SABA/SVN: albuterol or xopenex +/- itraptroium (repeat PEF) - SVN may be repeated or given continuous
  3. Systemic corticosteroid (prednisolone 1 mg/kg/day); abx PRN; respiratory monitoring; severe may warrant C-PAP, BiPAP, or intubation
  • f/u in 1 week

Clin Med II- Exam 2 (7 decks)

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