PULMONARY DISEASES (AB) Flashcards
Which hormone is responsible for pulmonary changes during pregnancy, especially in the first trimester?
Progesterone
What happens to vital capacity during pregnancy?
It increases by approximately 20% by late pregnancy.
What is vital capacity?
The total amount of exhaled air after a forced expiration.
What happens to expiratory reserve volume during pregnancy?
It decreases from 1300 mL to approximately 1100 mL.
Why does tidal volume increase by approximately 40% during pregnancy?
Due to respiratory stimulation by progesterone.
Why is lung compliance reduced in pregnancy?
Because the enlarged uterus pushes the diaphragm, reducing lung expansion.
How much does minute ventilation increase during pregnancy?
By 30 to 40% due to increased tidal volume.
What happens to arterial PO2 during pregnancy?
It increases from 100 to 105 mmHg.
Why does arterial PCO2 decrease from 40 to 32 mmHg in pregnancy?
Due to increased metabolic demands and hyperventilation.
What happens to residual volume in pregnancy?
It decreases by approximately 20% from 1500 mL to 1200 mL.
Why is chest wall compliance reduced during pregnancy?
Due to the expanding uterus and increased intra-abdominal pressure.
What pulmonary function change begins at 14-16 weeks AOG?
Forced vital capacity and peak expiratory flow progressively increase.
What is total lung capacity (TLC)?
The entirety of gas in the lungs at any given time.
What are the components of total lung capacity?
Vital capacity (VC) and residual volume (RV).
What is tidal volume (TV)?
The volume of air that goes in and out of the lungs in a normal, relaxed breathing.
What is inspiratory reserve volume (IRV)?
The amount of air inhaled beyond the tidal volume.
What is expiratory reserve volume (ERV)?
The amount of air exhaled beyond the tidal volume.
What is residual volume (RV)?
The air that remains in the alveoli after a forceful expiration.
What lung capacities cannot be measured directly?
Those that involve residual volume (RV), such as functional residual capacity (FRC) and total lung capacity (TLC).
What are common risk factors for asthma exacerbations in pregnancy?
Respiratory viral infections, discontinuation of treatment, smoking, psychological stress, GERD, allergic rhinitis.
How does pregnancy affect asthma severity?
1/3 of cases improve, 1/3 remain the same, 1/3 worsen.
What weeks of gestation are asthma exacerbations most common?
Between 17-34 weeks (mean 25 weeks).
What are the potential maternal complications of asthma in pregnancy?
Maternal hypoxia, preeclampsia, preterm labor, low birth weight, need for cesarean delivery.
What are the fetal effects of maternal asthma?
Oligohydramnios, low birth weight, premature delivery, fetal demise, meconium staining.
What are signs of severe asthma exacerbation in pregnancy?
Tachypnea, retractions, agitation, cyanosis, altered consciousness, pulsus paradoxus.
What is the hallmark of bronchial asthma?
Reversible airway obstruction
Bronchial smooth muscle contraction
Vascular congestion
Tenacious mucus
Mucosal edema
What causes bronchial obstruction in asthma?
Bronchial smooth muscle contraction, vascular congestion, tenacious mucus, mucosal edema.
What happens in early asthma exacerbation?
Mild respiratory alkalosis due to hyperventilation.
What happens if asthma exacerbation worsens?
Progresses to respiratory failure with CO2 retention and impaired ventilation.
What is the best way to monitor maternal lung function in pregnancy?
Symptoms, spirometry, peak expiratory flow.
What is the importance of fetal heart monitoring in maternal asthma?
It helps assess fetal well-being and oxygen status.
What maternal condition increases perinatal mortality and neonatal hypoxemia?
Severe asthma exacerbation with respiratory distress.
Why should asthma in pregnancy be aggressively managed?
Because fetal oxygenation is directly affected by maternal respiratory status.
What are common symptoms of asthma in pregnancy?
Cough, shortness of breath, chest tightness, nocturnal awakenings, wheezing.
Why do some pregnant women stop asthma medication?
Fear of teratogenic effects, lack of education.
What fetal complication can arise from maternal hypoxemia due to asthma?
Reduced umbilical blood flow, increased pulmonary vascular resistance, decreased cardiac output.
What is the primary mechanism behind asthma-related fetal distress?
Maternal hypoxia leading to inadequate oxygen supply to the fetus.
What are the three possible asthma outcomes during pregnancy?
Improvement, no change, worsening.
Why is cesarean delivery often preferred for asthmatic mothers?
To avoid respiratory distress during labor and ensure controlled oxygenation.
How does progesterone contribute to increased tidal volume?
By stimulating respiratory centers in the brain.
Why does increased metabolic demand in pregnancy not lead to CO2 retention?
Because of increased diffusion capacity and hyperventilation.
What are common triggers for asthma exacerbations?
Allergens, viral infections, smoke exposure, GERD, stress.
What is the preferred approach to identify reversible airflow obstruction?
Spirometry
Why are asthmatic pregnant patients advised to undergo baseline spirometry?
To guide medication adjustments
What is an obstructive pattern in spirometry characterized by?
Increase in forced expiratory volume
What does Peak Expiratory Flow (PEF) indicate?
The severity of an asthma crisis
What is the normal PEF for a woman?
450 L/min
What FEV1 increase after bronchodilator administration indicates asthma?
> 12% from baseline
What should be routinely measured for asthma management?
Sequential FEV1 or PEFR
What is the advantage of PEFR measurement?
It correlates well with FEV1 and can be measured with portable meters
Why is bronchoprovocation testing avoided in pregnancy?
It can trigger preterm labor (PTL)
What are the key components of chronic bronchial asthma management?
Patient education, environmental control, pulmonary function monitoring, pharmacologic therapy
What is the primary goal of pharmacologic therapy for asthma?
Provide baseline control and treat exacerbations
How often should women with moderate to severe asthma measure their FEV1 or PEFR?
Twice daily
What is the goal FEV1 for asthma control?
> 80% of predicted
What are the predicted PEFR values for women?
380 to 550 L/min
What is the stepwise approach for asthma management in pregnancy?
Use beta-agonists for bronchospasm and corticosteroids for inflammation
What is the first-line treatment for mild intermittent asthma?
Beta-agonists
When are inhaled corticosteroids (ICS) required in asthma?
For persistent asthma
What is the preferred beta-agonist for pregnant patients?
Albuterol
Why are leukotriene receptor antagonists not used for acute exacerbations?
They prevent leukotriene production but do not address muscle contractions or bronchospasms
What is the association between vitamin D and asthma severity?
Vitamin D insufficiency is linked to more severe asthma
What are the FDA pregnancy risk categories for drugs?
Category A: No risk, Category B: No risk in animals, Category C: Fetal harm in animals, Category D: Risk but benefits > risk, Category X: Contraindicated
What is the goal oxygen saturation in acute bronchial asthma?
90-95%
What is the preferred IV corticosteroid for acute asthma?
Methylprednisolone
What is the preferred oral corticosteroid for asthma?
Prednisone
What should be avoided in labor for asthmatic patients?
Prostaglandin F2α (Carboprost) and Ergotamine derivatives
What is the preferred induction agent for labor in asthmatics?
Oxytocin
What is status asthmaticus?
Severe asthma not responding to therapy within 30-60 minutes
What are indications for mechanical ventilation in status asthmaticus?
Fatigue, CO2 retention, hypoxemia
What is the management of a laboring asthmatic patient?
Continue maintenance medications and administer stress-dose corticosteroids if needed
What is the recommended treatment for mild intermittent asthma in pregnancy?
Short-acting β2-agonist as required for symptom relief
What is the treatment for mild persistent asthma in pregnancy?
Short-acting β2-agonist as required for symptom relief + Low-dose inhaled corticosteroid (ICS)
What is the recommended treatment for moderate persistent asthma in pregnancy?
Short-acting β2-agonist as required for symptom relief + Low-dose ICS (combination inhaler) + LABA
What is the recommended treatment for severe persistent asthma in pregnancy?
Short-acting β2-agonist as required for symptom relief + High-dose ICS or add-on therapy (Theophylline, Anti-leukotriene, Oral Beta2-agonist, Anticholinergic) + LABA
What is the recommended treatment for very severe persistent asthma in pregnancy?
Short-acting β2-agonist as required for symptom relief + High-dose ICS + Add-on therapy (Anti-IgE, Immunosuppressants) + LABA
What is the primary manifestation of acute bronchitis?
Cough without pneumonitis.
What is the most common cause of acute bronchitis?
Viruses such as Influenza A and B, parainfluenza, respiratory syncytial virus, coronavirus, adenovirus, and rhinovirus.
How long does cough typically persist in acute bronchitis?
10 to 20 days, occasionally lasting a month or longer.
What is the role of antimicrobials in acute bronchitis?
Limited evidence supports antimicrobial therapy.
What cough medications are considered safe in pregnancy for acute bronchitis?
Cough suppressants with dextromethorphan and expectorants with guaifenesin.
What is pneumonia?
An infection in one or both lungs, causing alveolar inflammation.
What are the two types of pneumonia based on the affected area?
Lobar pneumonia (affecting a lung lobe) and bronchopneumonia (affecting patches throughout both lungs).
What is community-acquired pneumonia?
Pneumonia acquired outside of a hospital, often in pregnant patients visiting outpatient clinics.
What is hospital-acquired pneumonia?
Pneumonia acquired in the hospital, often in postpartum patients, making it more challenging to manage.
What is the most common cause of bacterial pneumonia?
Streptococcus pneumoniae.
What is a classic sign of Streptococcus pneumoniae pneumonia?
Rust-colored sputum.
What is a classic sign of Klebsiella pneumoniae pneumonia?
Red currant-jelly sputum.
What bacterial species may cause green sputum in pneumonia?
Pseudomonas, Haemophilus, and pneumococcal species.
What are key symptoms of pneumonia?
Crackles on auscultation, productive cough, dyspnea, pleuritic chest pain, fever, chills, cyanosis, nausea, vomiting, and diarrhea.
What are risk factors for early deterioration in community-acquired pneumonia?
Respiratory rate ≥30/min, arterial O₂ saturation <90%, core temperature <36°C, hypotension, multilobar infiltrates, leukopenia <4000/μL, thrombocytopenia <100,000/μL, confusion/disorientation.
What diagnostic tests are used for pneumonia?
Chest X-ray, blood tests, sputum test, bronchoscopy, pulse oximetry, rapid PCR testing for influenza A/B and COVID-19.
What does the CURB-65 score assess?
Severity of pneumonia and need for hospitalization.
What is the CURB-65 management strategy?
0-1: Low risk, consider home treatment; 2: Possible admission or close outpatient monitoring; 3-5: Hospital admission, treat as severe.
What is the empirical inpatient antimicrobial treatment for uncomplicated community-acquired pneumonia in pregnancy?
Macrolides (clarithromycin 500 mg BID or azithromycin 500 mg daily) + oseltamivir if influenza A suspected.
What is the recommended treatment duration for pneumonia in pregnancy?
5-7 days, with antibiotics discontinued after 48-72 hours of being afebrile.
What is the first-line antimicrobial therapy for severe pneumonia in pregnancy?
Beta-lactams (ampicillin/sulbactam, ceftriaxone, ceftaroline, cefotaxime) combined with macrolides.
What additional treatment is given if community-acquired MRSA is suspected in pneumonia?
Vancomycin (15 mg/kg every 12 hrs) or linezolid (600 mg every 12 hrs).
What are common pregnancy complications associated with pneumonia?
Preterm rupture of membranes, preterm delivery, intrauterine growth restriction, preeclampsia, and increased C-section rates.
What are key prevention strategies for pneumonia in pregnancy?
Pneumococcal vaccination (PPSV23 and PCV13 for high-risk groups) and influenza vaccination.
What is the most common complication of influenza in pregnancy?
Pneumonia.
What is the first-line treatment for influenza pneumonia?
Neuraminidase inhibitors (oseltamivir 75 mg BID for 5 days).
What is the primary method of COVID-19 pneumonia prevention in pregnancy?
Airborne infection isolation and transfer to equipped facilities.
What is Pneumocystis pneumonia (PCP), and who is at risk?
A fungal lung infection primarily affecting immunocompromised individuals, such as those with HIV/AIDS.
What is the characteristic symptom triad of Pneumocystis pneumonia (PCP)?
Dry cough, tachypnea, and dyspnea.
What is the diagnostic test for Pneumocystis pneumonia (PCP)?
Bronchoscopy with lavage or biopsy.
What is the first-line treatment for Pneumocystis pneumonia (PCP) in pregnancy?
TMP-SMX (double-strength tablet daily for HIV-infected pregnant women with CD4 <200/μL).
What is tuberculosis (TB)?
A granulomatous pulmonary infection caused by Mycobacterium tuberculosis.
What are the key symptoms of active TB?
Chronic cough, hemoptysis, low-grade fever, weight loss, night sweats, chills, fatigue, and chest pain.
What are the two types of TB?
Latent TB (inactive, non-contagious) and active TB (symptomatic and contagious).
What are the key risk factors for TB worsening in pregnancy?
Late diagnosis, incomplete treatment, advanced pulmonary lesions.
What are the laboratory tests used for TB diagnosis?
Tuberculin skin test (PPD), interferon-gamma release assays (IGRAs), chest X-ray, sputum microscopy, nucleic acid amplification assay, culture and sensitivity.
What is the first-line treatment regimen for active TB in pregnancy?
Isoniazid, rifampin, ethambutol, and pyrazinamide for 2 months, followed by isoniazid and rifampin for 7 months.
What is the recommended treatment for latent TB in pregnancy?
Delay treatment until 3-6 months postpartum, except for high-risk cases (HIV-positive, recent exposure).
When is a TB patient considered non-infectious?
After 2 weeks of directly observed therapy (DOT), 3 consecutive AFB-negative sputum smears, and clinical improvement.
