Pulmonary Clinical Medicine I: Asthma and COPD

Question 1

What sex is asthma more common in childhood?

What sex is it more common in puberty/young adulthood?

Answer 1

1) Boys

2) Women

Question 2

What are prenatal risk factors for asthma?

Which is deemed the highest risk?

Answer 2

1) Ethnicity
2) Low SES
3) C-section
4) Maternal tobacco smoking
5) Prematurity (*Highest risk factor)

Question 3

What are postnatal risk factors for asthma?

Answer 3

1) Levels of endotoxins and allergens within the home (esp. dust mites)
2) Viral and bacterial infection (RSV and adenovirus)
3) Air pollution
4) Antibiotic use
5) Acetaminophen exposure
6) Obesity

Question 4

What does the T2-type airway inflammation of asthma cause?

Answer 4

Airway remodeling

Question 5

What composes airway remodeling?

Answer 5

1) Increased airway smooth muscle
2) Thickened subepithelial reticular lamina
3) Increased mucous cells in new areas
4) Increased mucus production

Question 6

What is found on spirometry that makes an asthma diagnosis more likely?

Answer 6

1) FEV1 of <80%

2) Age adjusted FEV1/FVC of <75%

Question 7

What is the hallmark of asthma that separates it from COPD?

Answer 7

Reversibility of airway obstruction

Question 8

What classifies a patient as mild, persistent asthma in terms of days/week of symptoms experienced?

Amount of night time awakenings for 0-4 year olds in a month?

Amount of night time awakenings for 5 and up in a month?

Amount of asthma exacerbations that require oral systemic corticosteroids in a year?

Answer 8

1) More than twice a week (but not daily)
2) 1-2 a month
3) 3-4 a month
4) 2 or more a year

Question 9

What classifies a patient as moderate, persistent asthma in terms of the amount of times they need to use a short acting beta agonist to control symptoms?

What classifies a patient as severe, persistent asthma in these terms?

Answer 9

1) Daily

2) Several times a day

Question 10

What is the major goal of an individualized written asthma action plan?

Answer 10

Provide best quality of life by minimizing symptoms and stopping exacerbations

Question 11

What is the most common complication of asthma?

How is this managed?

Answer 11

1) Asthma exacerbation

2) Prevention of triggers

Question 12

What is the best asthma prevention measure?

Answer 12

Breastfeeding

Question 13

What is the hallmark of COPD that separates it from Asthma?

Answer 13

Airflow limitation in COPD is largely irreversible

Question 14

COPD mortality rates are higher in what sex?

The rates rise exponentially with?

The strongest association with mortality from COPD is with?

Answer 14

1) Men
2) Age
3) Poverty

Question 15

What is the most common cause of COPD?

What is the next common cause?

Answer 15

1) Smoking

2) TB

Question 16

What genetic factor combined with smoking causes approximately a threefold increased risk of developing COPD?

Answer 16

A patient that smokes with first-degree relatives with COPD

Question 17

What are the main pathological features of COPD?

Answer 17

1) Obstructive bronchiolitis
2) Emphysema
3) Mucus hypersecretion

Question 18

How does COPD clinically present?

Answer 18

1) Decreased capacity to exercise
2) Low muscle strength
3) Low BMI

Question 19

How is COPD diagnosed on spirometry?

Answer 19

1) FEV1/FVC <0.7
2) Low FEV1
3) <12% reversibility

Question 20

What is the mainstay treatment for COPD in order to improve lung function and reduce breathlessness?

What is used to Tx COPD for those at high risk of exacerbation?

When and why is oxygen used to Tx COPD?

Answer 20

1) Bronchodilators (LABA or LAMA)
2) Inhaled corticosteroids
3) If SaO2 < 88% because it reduces mortality

Question 21

What is given for COPD acute exacerbations if there is increased sputum purulence or volume?

Answer 21

Oral antibiotics

Question 22

What vaccinations are recommended for prevention of COPD exacerbations?

Answer 22

Influenza and Pneumococcal

Question 23

What is the initial management for COPD

Answer 23

Smoking cessation
Vaccination
Active Lifestyle/exercise
Initial pharmacotherapy
Self management education
Manage Comorbidities