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

PFT and Asthma Flashcards

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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
Obstructive disorders
``` asthma asthmatic bronchitis bronchitis COPD CF emphysema Upper airway obstruction ```
26
Restrictive disorders
``` pulmonary fibrosis infectious lung disease thoracic deformity PE tumor NM disease Obesity ```
27
increased slope
restrictivww
28
scooped out
obstructive
29
FEV1 examination
normal: r/o obstruction/restriction dec. >15-20%: obstruction (FEV1 <80%) - correlate w/ TLC: if this increases by 15-20% = favors obstructive
30
FEV1/FVC ratio determination
<70%: obstructive 70%-LLN: mild obstruction cannot be excluded (asthma?) Normal or increased: restrictive
31
DLCO in asthma
increased
32
Frequency of lung function measurements
at diagnosis after 3-6 mo of tx (FEV1) periodically every 1-2 yrs
33
Definition of asthma
1. chronic airway inflammation 2. intermittent and reversible airway obstruction 3. bronchial hyperresponsiveness
34
Sx of asthma
usually before 5 YO: - coughing: NOCTURNAL, >3 weeks - Wheezing*** (inspiration and expiration) - CP, presure, dyspnea, SOB
35
Meds that trigger asthma sx
BB, ASA, NSAIDS
36
risk factors for asthma
``` atopy med intolerance (ASA/NSAID) food allergy GERD RSV +FMH maternal smoking obesity ```
37
PE for asthma
increased AP diameter wheezing w/ prolonged expiratory phase (most often expiratory) associated signs of rhinitis, sinusitis, conjunctivitis, URI, atopic derm
38
Signs of severe asthma obstruction
tachy tripod positioning accessory mm. use pulsus paradoxs
39
Aspirin-exacerbated respiratory disease (ASA Triad/Samter's Triad)
nasal polyps ASA sensitivity severe asthma
40
Upper and lower respiratory rxns to ASA
avoid NSAIDs | 75% have respiratory response to alcohol
41
Atopic Triad
allergic rhinitus atopic dermatitis asthma
42
Atopic March
allergic rhinitis atopic dermatitis asthma food allergy
43
Dx of asthma
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
Intermittent asthma (step 1)
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
Mild-persistent asthma (step 2)
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
Mod-persistent asthma (step 3)
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
Severe persistent asthma (step 4)
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
LTRA
leukotriene receptor antagonist (Montelukast)
49
Montelukast use
ages 0-4
50
Monoclonal antibodies
omalizumab (anti-IgG) | benralizumab (anti-IL5 receptor a)
51
Methlxanthine
theophyline
52
Tx for step 1
SABA PRN* (+/- ICS)
53
Tx for step 2
low dose ICS daily* OR LTRA or cromolyn (+ SABA)
54
Tx for step 3
refer to specialist medium dose ICS* OR low dose ICS + LABA
55
Tx for step 4
medium dose ICS & LABA (or LTRA in 0-4 yo)
56
Tx for step 5
high dose ICS & LABA (or LTRA ages 0-11)
57
Tx for step 6
high dose ICS & LABA (or LTRA) & oral steorid
58
Consideration for steps 5 & 6
consider omalizumab (Xolair) for ages >!2 w/ allergies
59
Rule of 2's to know if asthma is under control
sx >2x/week awaken more than 2x/month refill inhaler >2x/yr does your peak flow meter measure < 2x10 (20%) from baseline?
60
F/u for asthma
initially 1-3 mo, then every 3-12 months depending on severity
61
Well controlled asthma
sx <2 days/week awaken <1x/month (0-11 yo), or <2x/month (>12) FEV1: >80% FEV1/FVC: >80%
62
Dx for acute exacerbatiton
PEFR (peak expiratory flow rate)
63
Values for PEFR
>80%: GREEN: good control 50-80%: YELLOW: caution - SABA & Med <50%: RED: emergency dep.
64
ABG for acute exacerbation
respiratory alkalosis initially (hyperventilation) - if PaCO2 normal, considering patient getting tired/breathless
65
CXR for acute exacerbation
only if r/o infection or obstruction | may show hyperinflation
66
Tx for exacerbation
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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