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X Clin Med II Exam 2 > PFTs and Asthma > Flashcards

PFTs and Asthma Flashcards

1
Q

What are the indications for PFTs?

A

Diagnose and classify severity of pulmonary dysfunction
Distinguish between obstructive, restrictive and mixed disease
Monitor response to therapeutic interventions and progression of disease
Determine pulmonary risk prior to surgery

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2
Q

What are the basic PFTs?

A

Airflow spirometry
Lung volumes
Diffusion capacity for lungs for CO (DLCO)

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3
Q

Why is sitting preferred in spirometry?

A

Less likelihood of syncope

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4
Q

What is forced vital capacity?

A

Deep breath in and blow the air out as fast as possible with a forced expiration–total volume of air with maximal effort

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5
Q

What is FEF (forced expiratory flow) 25-75%?

A

Airflow measurement during middle half of forced expiration (nonspecific for small airway obstruction but may be an early indicator of disease)

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6
Q

Why is bronchodilator testing used?

A

Used to test reversibility

Take 2-4 puffs with chamber and hold for 5-10 sec and then spirometry completd 15 min after

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7
Q

When does bronchodilator testing show reversibility?

A

If FEV1 increased by 12% and 200 ml

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8
Q

What is the methacholine challenge test?

A

For bronchoprovocation
Dilute solution of methacholine in nebulizer
Spirometry conducted at 30 and 90 sec
Concentration increases
Positive test: FEV1 decreased by 20% (may be false +)

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9
Q

What do you have to confirm was achieved with PFTs?

A

Volume-time curve plateaus
Expiration lasts > 6 sec
2 best efforts are within .2 L
Flow vol loops are free of artifact

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10
Q

What is the diffusion capacity?

A

Measures the ability of the lungs to transfer gas and saturate Hb (alveolar-capillary membrane)
*can be misleading if person is anemia (false reduction) and must adjust for Hb level
CO used for surrogate for O2 transfer

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11
Q

Technique for DLCO

A

Pt inhales single breath of gas with helium/CO, then expires and measurement of exhalation taken

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12
Q

How to infer results for DLCO

A

Lungs are healthy- little CO collected during exhalation

Lungs diseased- less CO diffuses into lungs so higher levels are measured in exhaled gas

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13
Q

Results indicating obstructive disease

A 
TLC: increased
FVC: normal
RV: increased
FEV1: decreased
FEV1/FVC: decreased
Airway narrowing, limit airflow with expiration, reduced airflow with high lung vols, inspiration probs normal
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14
Q

Results indicating restrictive disease

A 
TLC: decreased
FVC: decreased
RV: decreased
FEV1: decreased
FEV1/FVC: normal or increased
Reduction in lung vol, reduced lung expansion, inspiration and expiration look normal with reduced flow and vol
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15
Q

Types of obstructive diseases

A

Asthma, asthmatic bronchitis, bronchitis, COPD, cystic fibrosis, emphysema, upper airway obstruction

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16
Q

Types of restrictive diseases

A

Pulmonary fibrosis, infectious lung disease, thoracic deformities, pleural effusion, tumors, neuromuscular diseases, obesity

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17
Q

How to examine a flow-volume curve (step 1)

A

If looks normal
Is the curve scooped out (obstructive)
Is the slope increased/peaked (restrictive)

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18
Q

How to examine FEV-1 value and lung vols (step 2)

A

Normal- r/o obstruction and restriction

Decreased by more than 15-20% of predicted– obstruction

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19
Q

How to examine FEV1/FVC ratio (step 3)

A

If decreased to less than 70%–obstructive
If 70% to LLN then mild obstruction cannot be excluded so look at FEV-1 and FEF 25-75% for asthma consideration
If normal to increased–maybe restrictive

20
Q

How to examine response to bronchodilator (step 4)

A

If FEV-1 increases by 12%/200 ml–hyperreactive, reversible airways

21
Q

How often do you need to get PFTs?

A

After 3-6 mos of controller tx (FEV1)

Periodic assessments every 1-2 yrs

22
Q

Characteristics of asthma

A

Chronic airway inflammation, intermittent and reversible airway obstruction, bronchial hyper-responsiveness

23
Q

Sxs that might indicate asthma

A

Coughing (nocturnal, seasonal, specific exposures, longer than 3 wks)
Wheezing (hallmark- may be inspiration or expiration)
Maybe CP, chest pressure, dyspnea, SOB

24
Q

Risk factors for asthma

A

Atopy, medication intolerance, food allergies, GERD, RSV, positive FH, maternal smoking, obesity

25
Q

Physical exam findings

A

Increased AP diameter
Wheezing with prolonged expiration
Associated signs of rhinitis, sinusitis, conjunctivitis, URI, atopic dermatitis

26
Q

What are signs of severe obstruction?

A

Tachypnea, tachycardia, tripod, accessory muscle use, pulse paradoxus

27
Q

What is the aspirin-exacerabted respiratory disease triad?

A

Samters (sinus disease with nasal polyps, ASA sensitivity, severe asthma)

28
Q

What is the atopic triad?

A

Atopic dermatitis, allergic rhinitis, asthma

29
Q

What is the atopic march?

A

Atopic dermatitis, food allergy, allergic rhiniits, asthma

30
Q

Spirometry results to confirm asthma

A

FEV1< 80%
FEV1/FVC normal or decreased relative to predicted values (70-85%)
Reversibility >12% in FEV1 with bronchodilator

31
Q

What is intermittent asthma (step 1)?

A 
Sxs <2 days/wks
Nighttime awakenings: none 0-4, <2 nights/month over 5 yo
Normal PFTs in between exacerbations
FEV1>80%
FEV1/FVC normal (>85% when 5-19)
Normal activity
<2 days/week SABA use to control sxs
32
Q

What is mild persistent asthma (step 2)?

A

Sxs >2 days/wks (not daily)
Nighttime awakenings: 1-2 nights/mo when 0-4, 3-4 nights/month over 5 yo
FEV1>80%
FEV1/FVC normal (>80% when 5-19)
Minor limitation in activity
>2 days/week SABA use to control sxs (not daily)

33
Q

What is moderate persistent asthma (step 3)?

A 
Daily sxs
Nighttime awakenings: 3-4x/mo when 0-4, >1/wk but not nightly over 5 yo
FEV1 60-80%
FEV1/FVC reduced by 5%
Some activity limitations
Daily SABA use to control sxs
34
Q

What is severe persistent asthma (step 4)?

A

Sxs throughout day
Nighttime awakenings: >1x/wk when 0-4, nightly over 5 yo
FEV1 <60%
FEV1/FVC reduced by >5%
Extremely activity limited
SABA use to control sxs several times a day

35
Q

Preferred tx for intermittent asthma

A

SABA PRN (but used in all stages PRN)

36
Q

Preferred tx for mild persistent asthma

A

Low dose inhaled corticosteroid daily

37
Q

Preferred tx for moderate persistent asthma

A

Medium dose inhaled corticosteroid all ages OR lose dose ICS + LABA (over 5)

38
Q

Preferred tx for severe persistent asthma

A

Medium dose ICS and LABA (or leukotriene receptor antagonist in 0-4) OR medium dose ICS + LTRA

39
Q

Preferred tx for step 5 and 6 asthma

A

5: High dose ICS and LABA (or LTRA ages 0-11)
6: high dose ICS and LABA (or LRTA ages 0-4) and oral steroids
* consider adding omalizumab (Xolair) for ages >12 with allergies

40
Q

What are the rules of 2 for asthma?

A

Do you have asthma sxs more than 2x/wk?
Do you awaken with asthma sxs more than 2x/month?
Do you refill your quick relief inhaler canister more than 2x/yr?
Does your peak flow meter measure less than 2x 10 (20%) from baseline?
If YES then asthma is not under control

41
Q

What is well controlled asthma?

A

Sx < 2days/week
Nighttime awakenings: 0-11 <1/mo, >12 <2x/mo
FEV1 >80%
FEV1/FVC: >80% (ages 5-11)

42
Q

What is not well controlled asthma?

A

Sx > 2days/week
Nighttime awakenings: 0-4 >1x/mo, 5-11 >2x/mo, >12 <1-3x/week
FEV1 60-80%
FEV1/FVC: 75-80% (ages 5-11)

43
Q

What is very poorly controlled asthma?

A

Sxs daily
Nighttime awakenings: 0-4 >1x/wk, 5-11 >2x/wk, >12 >4x/wk
FEV1 <60%
FEV1/FVC: <75% (ages 5-11)

44
Q

What are the zones one the peak expiratory flow meter?

A

Green good control (>80%)
Yellow caution-SABA and Med (50-80%)
Red medical alert (<50%)

45
Q

What results are seen on the ABG?

A

Respiratory alkalosis initially (hyperventilatory)

46
Q

What is the tx for an acute asthma exacerbation?

A

O2
SABA/SVN (albuterol or xopenex with maybe ipratropium)
Systemic corticosteroids (prednisolone-1 mg/kg/day with max dosing based on weight)
Maybe abx, respiratory monitoring and maybe CPAP or intubation
*follow up within 1 wk

47
Q

What is the goal of asthma?

A

Prevent persistent sxs and asthma progression with appropriate medication management (daily ICS)

X Clin Med II Exam 2 (6 decks)

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