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Clinical Med II > PFTs and Asthma > Flashcards

PFTs and Asthma Flashcards

1
Q

What are the basic PFTs?

A
  • Airflow spirometry
  • Lung volumes
  • Diffusion Capacity of the lungs for carbon monoxide (DLCO)
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2
Q

What can be measured with airflow spirometry?

A
  • Forced Vital Capacity (FVC)
  • Forced Expiratory Volume in first second of expiration (FEV-1)
  • FEV-1/FVC Ratio
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3
Q

What PFT aspect is the most useful information for obstruction?

A

FEV-1

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4
Q

How many times should spirometry be performed?

A

Repeat testing at least 3 times

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5
Q

What classifies an airway disease as reversible?

If there is reversibility, what disease are you most likely dealing with?

A

If FEV-1 increases by 12% AND 200 mL

Asthma

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6
Q

How is bronchodilator testing performed?

A

Patient inhales 2-4 puffs of medication and hold it in lungs for 5-10 seconds. Spirometry is then completed 15 minutes later.

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7
Q

What constitutes a positive Methacholine Challenge Test (Bronchoprovocation)?

A

FEV-1 decreases by 20%

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8
Q

What are examples of obstructive diseases?

Are there issues with expiration or inspiration?

A

COPD, asthma, bronchitis

Expiration

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9
Q

What are examples of restrictive diseases?

Are there issues with expiration or inspiration?

A

Fibrosis, infectious lung disease, pleural effusion

Inspiration

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10
Q

Define Total Lung Capacity (TLC)?

A

Volume of air within the lung after maximal inhalation

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11
Q

Define Vital Capacity (VC)?

A

Volume of air we breath out following maximal inhalation

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12
Q

Define Residual Volume (RV)?

A

Volume of air remaining in the lungs following maximal exhalation

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13
Q

What does DLCO measure?

When can this be misleading?

A

Measures the ability of the lungs to transfer gas and saturate the hemoglobin (alveolar-capillary membrane)

Can be misleading in anemia and must be adjusted for hemoglobin level

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14
Q

In DLCO testing, what will occur in healthy versus diseased lungs?

A

In healthy lungs, little CO is collected during exhalation

In disease lungs, less CO diffuses into lungs and higher levels are measured in exhaled gas

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15
Q

Is the following seen in obstructive or restrictive lung disease:

Inspiration and expiration will overall look normal, but flow and volume are reduced

A

Restrictive

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16
Q

Is the following seen in obstructive or restrictive lung disease:

Reduction in lung volume

A

Restrictive

17
Q

Is the following seen in obstructive or restrictive lung disease:

TLC: Increased 
FVC: Normal
RV: Increased 
FEV-1: Decreased 
FEV-1/FVC: Decreased
A

Obstructive

18
Q

Is the following seen in obstructive or restrictive lung disease:

TLC: Decreased 
FVC: Decreased 
RV: Decreased 
FEV-1: Decreased 
FEV-1/FVC: Normal or increased
A

Restrictive

19
Q

What must the FEV-1/FVC ratio decrease to to classify it as an obstructive process?

A

Decreased to 70% or less

20
Q

What is the hallmark symptom of asthma?

A

Wheezing

21
Q

What are symptoms typically associated with asthma?

A
  • Nocturnal coughing with duration longer than 3 weeks

- Wheezing

22
Q

What physical exam findings are associated with asthma?

A
  • Increased AP diameter (air trapping)
  • Wheezing with prolonged expiratory phase (mostly heard on forced expiration)
  • Associated signs of rhinitis, sinusitis, URI, atopic dermatitis
23
Q

What are signs of severe obstruction in asthma?

A
  • Tachypnea
  • Tachycardia
  • “Tripod positioning”
  • Accessory muscle use
  • Pulsus paradoxus (different pulses during inspiration vs. expiration)
24
Q

What is included in the ASA Triad/Samter’s Triad?

A

Sinus disease with nasal polyps, ASA sensitivity, severe asthma

25
Q

If patient has aspirin-exacerbated respiratory disease (AERD), what should you include in patient education?

A
  • Avoid NSAIDS

- Avoid alcohol (75% also have respiratory response to alcohol)

26
Q

What is included in the Atopic Triad?

A

Atopic dermatitis, allergic rhinitis, asthma

27
Q

What testing can help confirm the diagnosis of asthma?

A

Spirometry

28
Q

5 year old patient presents with the following:

  • Symptoms 2 days a week or less
  • 2 or less nighttime awakenings per month
  • FEV-1 > 80%
  • FEV-1/FVC is normal
  • Normal activity
  • SABA use to control symptoms 2 days or less per week

How would you classify this case of asthma and what would the recommended treatment be?

A

Step 1: Intermittent asthma

Treatment:
SABA PRN

29
Q

5 year old patient presents with the following:

  • Symptoms greater than 2 days a week but not daily
  • 3-4 nighttime awakenings per month
  • FEV-1 > 80%
  • FEV-1/FVC is normal
  • Minor limitation in activity
  • > 2 days per week of SABA use to control symptoms (not daily)

How would you classify this case of asthma and what would the recommended treatment be?

A

Step 2: Mild persistent asthma

Treatment: 
- SABA PRN
- Low dose ICS daily 
OR 
LTRA/Cromlyn (used in children)
30
Q

5 year old patient presents with the following:

  • Daily symptoms
  • More than 1 nighttime awakenings per week
  • FEV-1 is 60-80%
  • FEV-1/FVC is reduced by 5%
  • Some activity limitations
  • Daily use of SABA to control symptoms

How would you classify this case of asthma and what would the recommended treatment be?

A

Step 3: Moderate persistent asthma

Treatment: 
- SABA PRN
- Medium dose ICS (all ages)
OR
Low dose ICS + LABA if 5 or older (or LTRA)
31
Q

5 year old patient presents with the following:

  • Symptoms throughout the day
  • Nighttime awakenings are nightly
  • FEV-1 < 60%
  • FEV-1/FVC is reduced by 5%
  • Extremely limited physical activity
  • SABA used to control symptoms several times per day

How would you classify this case of asthma and what would the recommended treatment be?

A

Step 4: Severe persistent asthma

Treatment:

  • Refer to specialist
  • SABA PRN
  • Medium dose ICS + LABA (or LTRA in 0-4)
32
Q

What is the preferred treatment in Step 5 asthma?

A
  • SABA PRN
  • High dose ICS + LABA (or LTRA in ages 0-4)
  • Consider adding Xolair for ages > 12 with allergies
33
Q

What is the preferred treatment in Step 6 asthma?

A
  • SABA PRN
  • High dose ICS + LABA (or LTRA in ages 0-4) + oral steroids
  • Consider adding Xolair for ages > 12 with allergies
34
Q

What is considered well controlled asthma?

What should follow up look like?

A
  • Symptoms 2 days per week or less
  • Less than 2 nighttime awakenings per month
  • FEV-1 is > 80%
  • FEV-1/FVC is > 80%

Follow-up initially 1-3 months then every 3-12 months depending on severity

35
Q

When would you order an ABG for asthma symptoms?

What would you see on the ABG?

A

Order ABG is O2 levels are low

Will see respiratory alkalosis initially due to hyperventilation; if PaCO2 is normal though you should consider the patient getting tired/breathless

36
Q

How should an acute asthma exacerbation be treated?

When should the patient follow-up?

A
  1. O2
  2. SABA/SVN of Albuterol or Xopenex +/- Ipratropium Bromide
  3. Systemic corticosteroids
  • Abx PRN
  • Respiratory monitoring
  • C-PAP, BiPAP, or intubation if severe

Follow-up within 1 week

Clinical Med II (17 decks)

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