Pulmonary Disorders Flashcards
One in __ children have asthma
14
What are some precipitating or aggravating factors for asthma?
URIs exercise drugs (ASA, BB) weather changes allergens emotional expression food additives exposure to allergens or irritants
What are the four pathophysiological characteristics of asthma acutely?
- bronchoconstriction
- airway hyperresponsiveness
- airway edema
- increased mucous secretion
(and inflammation from all three)
What are the 5 pathophysiological characteristics of asthma chronically?
- fibrosis
- mucous hypersecretion
- smooth muscle hypertrophy
- angiogenesis
- loss of reversibility
What are the 5 questions generally included in the Asthma Control Test?
- How often does your asthma keep you from getting things done?
- How often do you have SOB?
- How often do you symptoms wake you up at night?
- How often do you use your rescue inhaler?
- How would you rate your asthma control in the past 4 weeks?
Describe the typical PFT findings for a diagnosis of asthma.
Obstructive picture (decreased FEV1)
12% of 200 mL improvement in FEV1 with a bronchodilator
What is the FEV1 in mild asthma?
> 80%
What is the FEV1 range for moderate asthma?
60-80%
What is the FEV1 range for severe asthma?
What are the three general things we base asthma severity classification on?
- frequency of symptoms (ACT)
- FEV1
- # of exacerbations
What are the classification rules based on symptoms?
intermittent: less than 2 days/week
mild: more than 2 days/week
moderate: daily
severe: throughout the day
What are the classification rules based on how often they use their inhaler?
intermittent: less than 2x/month
mild: 3-4x/mo
moderate: >1x/wk but not daily
severe: often 7x/week
What are the classification rules based on interference with normal activity?
intermittent: none
mild: minor limitation
moderate: some limitation
severe: extremely limited
What are the classification rules based on number of exacerbations?
if only 0-1/yr, then it’s only intermittent
anything 2 or more can be mild, moderate or severe depending on other categories
What is the main rescue medication for asthma?
short acting beta2 agonists (SABA)
albuterol or levalbuterol
What are the three main classes of controller medications for asthma?
inhaled corticosteroids
leukotriene modifiers
long acting beta2 agonists
What are the examples of leukotriene modifiers?
montelukast (singulair)
zafirlukast
zileuton
What are the examples of LABAs?
salmeterol
formoterol
vilanterol
True or false: you cannot use LABAS as monotherapy in asthma.
true
What are the four main combination ICS/LABA inhalers?
advair (fluticasone/salmeterol)
sumbicort (budesonide/formoterol)
Dulera (mometasone/formoterol)
Breo (fluticasone/vilanterol)
What is the immunomodulator that can be used for asthma (dose/frequency determined by IgE levels)?
omalizumab (xolair)
How do mepolizumab and reslizumab work?
interleukin-5 antagonists
can be used as add-on maintenance therapy in severe asthma in adults and adolescents with eosinophilic phenotype
What is the management strategy for intermittent asthma?
SABA prn
What is the preferred step 2 management for asthma (for mild persistent)?
SABA prn and low dose ICS
What is the preferred step 3 management for moderate persistent asthma?
SABA prn
low dose ICS
+ LABA or Medium dose ICS
What is the preferred step 4 management for moderate or severe persistent asthma?
SABA prn
moderate dose ICS
+LABA
What is step 5 for severe persistent asthma?
SABA prn
Higher dose ICS
LABA
+ consider omalizumab if allergic
What is step 6?
SABA prn
High dose LABA
oral corticosteroids
+consider omalizumab
COPD is the ___ leading cause of death.
5th
What aren
SMOKING occupation dust and chemicals second hand smoke indoor\outdoor pollution family history low socioeconomic status
What are the three main symptoms of COPD?
dyspnea
chronic cough
chronic sputum production
The CAT is the main questionnaire to assess COPD symptoms. What score would make you worried for more COPD symptoms?
> 10
What diagnostic test is required to make the diagnosis of COPD?
PFTs
What is the spirometry result for a COPD diagnosis?
post-bronchodilator FEV1/FVC
What is the FEV1 cutoff for mild COPD?
> or equal to 80%
What range of FEV1 for moderate COPD?
50 to 80%
What range for severe COPD?
30 to 50%
What range for very severe?
less than 30%
What are the three things that would make a patient at high risk for COPD exacerbation?
hx of 2+ exacerbations in the past year
FEV1
True or false; medication management has been shown to improve mortality and slow the long-term decline in lung function.
false - they don’t :(
they just provide symptomatic treatment
What is the initial treatment in COPD? (unlike asthma…)
LABAs or LAMA or a combination
short acting is only prn
In moderate to severe COPD, which is preferred: SABAs or SAMAs?
SAMA
and SAMA?SABA combo is preferred over SABA alone
What is the main oral phosphodiesterase-4 inhibitor for COPD?
roflumilast
What COPD patients will have the most benefit from roflumilast?
those with a major chronic bronchitis component
Which antibiotic has been found to be useful for prevention of COPD exacerbations?
Azithromycin
What is the typical management for COPD exacerbations when they occur/
short-acting albuterol nebulizer every 1-4 hours (or short acting ipratropium…or duoneb to make it easy)
with systemic corticosteroids (40 mg prednisone qd for 5 days)
and sometimes antibiotics
When should antibiotics be used for exacerbation?
when you have all three cardinal symptoms (increased dyspnea, sputum increase, or sputum purulence)
or with only two if one of them is increased sputum purulence
or if exacerbation is so severe that it requires mechanical ventilation
What antibiotics are preferred for uncomplicated COPD?
azithro clarithro doxy bactrim amoxicillin
What antibiotic is preferred for complicated COPD with risk factors?
amox/clav
levo
moxi
What antibiotic should you use if you’re worried about pseudomonas infection?
high dose levo or cipro
If someone has the asthma, COPD combo, what is the best treatment?
ICS and LABA combo
But if there are any features more consistent with asthma, what don’t you use?
LABA monotherapy
What don’t you use if there are features more consistent with COPD?
no ICS monotherapy
