Pulm/crit care key points Flashcards
What FEV1/FVC ratio is c/w airflow obstruction?
Less than 70%
What test is helpful in patients w/ dyspnea or cough of uncertain cause when spirometry results are normal?
Bronchial challenge testing w/ a controlled stimulus
Describe fiberoptic bronchoscopy
Encoscopic technique that allows visualization of tracheobronchial lumen and sampling of suspected areas of disease, including endobronchial mucosa, lung parenchyma, and accessible lymph nodes.
Describe fiberoptic bronchoscopy
Encoscopic technique that allows visualization of tracheobronchial lumen and sampling of suspected areas of disease, including endobronchial mucosa, lung parenchyma, and accessible lymph nodes.
What test is helpful in patients w/ dyspnea or cough of uncertain cause when spirometry results are normal?
Bronchial challenge testing w/ a controlled stimulus
Classic presentation of asthma is episodes of what 4 symptoms?
SOB
Chest tightness
Cough
Wheezing
Describe fiberoptic bronchoscopy
Encoscopic technique that allows visualization of tracheobronchial lumen and sampling of suspected areas of disease, including endobronchial mucosa, lung parenchyma, and accessible lymph nodes.
2 major things you’re looking for when assessing potential asthma with spirometry?
Obstruction (reduced FEV1/FVC ratio)
Reversibility (12% or more improvement in FEV1 s/p bronchodilator)
Name 3 major exposures that can predispose to asthma
Indoor environmental allergens
Environmental tobacco smoke
Viruses
Classic presentation of asthma is episodes of what 4 symptoms?
SOB
Chest tightness
Cough
Wheezing
First step in eval of suspected asthma?
Spirometry
Name 3 major groups of occupations that are at risk for occupational asthma
Farmers
Factory workers
Hair dressers
Management of exercise-induced bronchospasm that only occurs a few times a week?
Inhaled SABA 5-20 min before exercise
When giving a patient w/ exercise-induced bronchospasm a SABA before exercise, how long should they expect it to be protective?
2-4 hours
What percent of workers exposed to known sensitizing agents have asthma?
10%
Name 2 main SABA inhalers
Albuterol, salbutamol
3 major features characterizing vocal cord dysfunction
Mid-chest tightness w/ exposure to triggers
Difficulty breathing in
Partial response to asthma medications
What is vocal cord dysfunction commonly mis-diagnosed as?
Severe asthma
Omalizumab reduces ED visits and is cost-effective in patients with what 3 characteristics?
Sx inadequately controlled with inhaled steroids
Allergies to perennial aeroallergens
Serum IgE levels btwn 30-700 U/mL
Name 2 main SABA inhalers
Albuterol, salbutamol
What procedure is FDA approved for asthma not controlled with optimization of medications?
Bronchial thermoplasty
When is the appropriate time to add LABA inhalers into asthma therapy?
When inhaled steroids alone don’t achieve control
Omalizumab reduces ED visits and is cost-effective in patients with what 3 characteristics?
Sx inadequately controlled with inhaled steroids
Allergies to perennial aeroallergens
Serum IgE levels btwn 30-700 U/mL
Name 3 non-pharm management tips for asthma
Avoidance of triggers w/ allergen management
Reduced exposure to environmental tobacco smoke
Healthy diet and exercise program
What procedure is FDA approved for asthma not controlled with optimization of medications?
Bronchial thermoplasty
4 groups of patients considered to have severe refractory asthma?
Multiple exacerbations per year
Need for high-dose inhaled or PO steroids
Inability to step down therapy w/o compromising asthma control
Hx of multiple hospitalizations or intubations
Safety of inhaled steroids for asthma during pregnancy?
Safe- abundant long-term safety evidence for budesonide
Single most clinically efficacious and cost-effective way to prevent COPD, slow progression of established disease, and improve survival?
Smoking cessation (duh)
What are the recommendations on screening for COPD in ASx patients?
Don’t do it (at least no spirometry)
What’s the major difference seen on spirometry in COPD vs asthma?
COPD will have post-bronchodilator fixed FEV1/FVC ratio of less than 70%, while asthma shows reversible obstruction. Note: this finding is diagnostic of COPD in the correct clinical setting.
Name 3 general components of monitoring COPD patients
Ongoing review of Sx
Evaluation for Cpx of COPD
Assessment of freq and severity of exacerbations
What should you check in suboptimally controlled COPD patients before changing meds?
Inhaler technique
What group of meds in mainstay of therapy in COPD?
Bronchodilators
All COPD patients with long-acting bronchodilators should also have what other med?
A short-acting bronchodilator for rescue use
How do long-acting bronchodilators affect course of COPD (4)?
- Improve FEV1
- Improve health status
- Significantly reduce frequency of exacerbations
- NO change in mortality
Would you ever use inhaled steroids as primary therapy or monotherapy in COPD?
Nope
When is it appropriate to use Abx in COPD?
Infectious exacerbations
What is roflumilast, and when should you use it in COPD?
Oral selective PDE-4 inhibitor. Use only as add-on therapy in severe COPD a/w chronic bronchitis and a history of recurrent exacerbations. Not shown to be effective in any other groups of COPD pts.
Which groups of COPD patients benefit from exercise maintenance?
All of them
While all groups of COPD patients could potentially benefit from pulmonary rehab, which 2 major groups is it specifically recommended for?
- All symptomatic patients with FEV1 less than 50% expected.
- COPD patients hospitalized 2/2 acute exacerbation.
