Pulmonary 1 (Asthma) - Jaynstein Final Flashcards
What are examples of Obstructive Diseases?
- Asthma
- COPD (Chronic Bronchitis and Emphysema)
- Bronchiectasis
What are examples of Restrictive Diseases/ Interstitial Lung Diseases
- Pulmonary fibrosis
- Idiopathic Interstitial Pneumonia (IIP)
- Pneumoconiosis
- Sarcoidosis
What is a disorder of pulmonary circulation?
Pulmonary HTN
Obstructive lung diseases are caused by the inability to ____ ____ due to airway obstruction (inflammation or collapsed airways)
Obstructive lung diseases are caused by the inability to fully exhale due to airway obstruction (inflammation or collapsed airways)
Obstructive lung diseases are:
A. Diseases of the lung parenchyma
B. Diseases of the airways
C. Described as the inability to get air out of the lungs
D. Described as the inability to get air into the lungs
E. B and C
E. B and C
B. Disease of the airways
C. Described as the inability to get air out of the lungs
Restrictive lung diseases are caused by restriction or limitation of the lungs to expand and therefore ____ ____
fully inhale
Restrictive diseases are disease of the?
lung parenchyma
Pulmonary function tests (PFTs) are a group of tests that measure what?
- How well the lungs take in and release air
- How well they move gases from the atmosphere into the body’s circulation
The most common type of PFT is?
Spirometry
Forced Vital Capacity (FVC)
The maximum volume of air one can exhale
What is Forced Vital Capacity determined by?
The volume of air after full inspiration (Total Lung Capacity TLC) and the volume of air remaining in the lungs after exhalation (Residual Volume RV)
FVC = TLC - RV
What does Forced Vital Capacity help evaluate?
Issues of inhalation (Restrictive Disease)
Forced Expiratory Volume (FEV1)
The amount of air exhaled in one second
Forced Expiratory Volume FEV1 measures?
- The velocity of flow of exhalation
- Obstructive lung process evaluation
What do you use to calculate PFTs for restrictive disease?
Measured FVC / Predicted FVC
If > 80% of predictive = normal
If < 80% of predictive = restrictive process
What do you use to calculate PFTs for Obstructive disease?
Measured FEV1 / Measured FVC
If > 70% = normal
If < 70% = obstructive process
What are peak flow meters and what do they help measure?
They are used at home by patiens for monitoring (obstructive processes)
Used for daily and acute monitoring (PRN symptoms, response to acute tx) - should be obtained when pt is well
Pt has known “best”
100-80% of best = green
79-50% of best = yellow
< 49% of best = red
PFTs are for ____ and long-term ____
PFTs are for diagnosing and long-term monitoring
- At dx
- 3-6 post dx
- Q 1-2 yrs thereafter
Asthma is characterized by chronic inflammation of the ___ ___, bronchial hyperactivity, and ___ airway obstruction
Asthma is characterized by chronic inflammation of the small airways, bronchial hyperactivity, and reversible airway obstruction
*remember asthma by definition is reversible aka pradoxical (ie intermittent)
What is the atopic triad of asthma?
- Eczema
- Allergic rhinitis
- Asthma (hypersensitivity response)
T/F: Symptoms of asthma can be cured
False - symptoms can be managed but not cured
What are the 3 pathological features of asthma?
- Spasm/constriction of smooth muscle
- Wall edema (stimulated by histamine)
- Increased mucus produciton
What are the 3 main types of asthma?
- Extrinsic (allergen triggered)
- IgE mediated
- Allergic factors
- Intrinsic
- Irritant mediated
- Environment
- Mixed intrinsic and extrinsic
When obtaining a PMH for a patient with asthma what are important things to ask/determine?
- What medications the patient has been on for their asthma
- Any recent medication changes
- Compliant?
- Known trigger?
- Ever been hospitalized
- Ever been intubated
What are some clinical presentations of asthma?
- Cough (often dry)
- Symptoms usually worse at night
- Hx of seasonal allergies
- Episodic wheezing (expiratory sound)
- Chest tightening
What would you find during the PE of an asthma patient?
- Samter’s Triad
- asthma
- nasal polyps
- NSAID sensitivity
- Expiratory wheeze
What would you expect the PFTs to show for an asthma patient? What other work up would you want to do?
PFTs = obstructive pattern
Decreased FEV1/FVC ratio (<0.7)
If PFTs are normal –> perform provoking tests
- Methacholine Challenge
- Aspirin Challenge
CXR = would be normal or show hyperinflation
VBG/ABG
Treatment for asthma?
- Minimize symptoms that interfere with daily activity
- Prevent recurrent exacerbations
- Decrease ER visits and hospitalizations
- Maintain near normal pulmonary function
What are the medication classes used to treat asthma and what do each do?
- Bronchodilators - ALL get this
* relax smooth muscle and dilate bronchiole walls - Coricosteroids, Leukotriene modifiers, Mast Cell Stabilizers
* decrease inflammation/wall edema - Anticolinergics
* decrease mucus production
What are specific bronchodilators prescribed? Which ones are for rescue purposes?
Beta2 Agonists
- Short acting (SABA) = Ventolin, ProAir (Albuterol)
- for rescue purposes
- Long acting (LABA) = Salmeterol (Serevent)
Theophylline
- narrow therapeutic window - high toxicity
- rarely initiated
What are specific corticoidsteroids that could be prescribed?
- Inhaled Corticosteroids (ICS)
- Beclomethason (QVAR), Fluticasone (Flovent), Budesonide (Pulmicort)
- Maximize steroid dose before adding other agents (such as a LABA)
- Systemic (PO or IV) - use precaution and limit!
* Methylprednisolone, Prednisone - Leukotriene modifiers
* Montelukast (Singular) - Mast Cell Stabilizers
* Cromolyn Sodium and Nedocromil
What are specific anticolinergics that could be prescribed?
- Ipratropium Bromide (Atrovent)
2 .Tiotropium (Spiriva)
What are some combination therapies for asthma?
LABA + ICS
- Flucticasone/Salmeterol –> Advair
- Budesonide/Formoterol –> Symbicort
What is the progression of asthma medication prescribed?
- All patients get an Albuterol INH
- Add on ICS (start low dose)
- Increase ICS dose OR add a LABA (but increase ICS first!)
What are some medications that may precipitate asthma?
- Beta blockers
- NSAIDs, ASA
- Histamine
- Acetylcystine (used for acetaminophen overdose)
What are the 4 classifications of asthma?
- Intermittent - exercise or cold induced (symptoms < 2x/wk)
- Mild (symptoms > 2x/wk, not daily)
- Moderate persistent (daily symptoms)
- Severe persistent (symptoms throughout the day)
What would you expect to see for the VGB/ABG for a patient with asthma?
Mild = normal or resp alkalosis, hyperventilation (blow off CO2)
Mod/Severe = resp acidosis - muscle fatigue, CO2 retained
