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Family Medicine Clerkship > Pulmonary Disorders > Flashcards

Pulmonary Disorders Flashcards

1
Q

One in __ children have asthma

A

14

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2
Q

What are some precipitating or aggravating factors for asthma?

A 
URIs
exercise
drugs (ASA, BB)
weather changes
allergens
emotional expression
food additives
exposure to allergens or irritants
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3
Q

What are the four pathophysiological characteristics of asthma acutely?

A
  1. bronchoconstriction
  2. airway hyperresponsiveness
  3. airway edema
  4. increased mucous secretion

(and inflammation from all three)

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4
Q

What are the 5 pathophysiological characteristics of asthma chronically?

A
  1. fibrosis
  2. mucous hypersecretion
  3. smooth muscle hypertrophy
  4. angiogenesis
  5. loss of reversibility
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5
Q

What are the 5 questions generally included in the Asthma Control Test?

A
  1. How often does your asthma keep you from getting things done?
  2. How often do you have SOB?
  3. How often do you symptoms wake you up at night?
  4. How often do you use your rescue inhaler?
  5. How would you rate your asthma control in the past 4 weeks?
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6
Q

Describe the typical PFT findings for a diagnosis of asthma.

A

Obstructive picture (decreased FEV1)

12% of 200 mL improvement in FEV1 with a bronchodilator

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7
Q

What is the FEV1 in mild asthma?

A

> 80%

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8
Q

What is the FEV1 range for moderate asthma?

A

60-80%

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9
Q

What is the FEV1 range for severe asthma?

A
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10
Q

What are the three general things we base asthma severity classification on?

A
  1. frequency of symptoms (ACT)
  2. FEV1
  3. # of exacerbations
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11
Q

What are the classification rules based on symptoms?

A

intermittent: less than 2 days/week
mild: more than 2 days/week
moderate: daily
severe: throughout the day

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12
Q

What are the classification rules based on how often they use their inhaler?

A

intermittent: less than 2x/month
mild: 3-4x/mo
moderate: >1x/wk but not daily
severe: often 7x/week

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13
Q

What are the classification rules based on interference with normal activity?

A

intermittent: none
mild: minor limitation
moderate: some limitation
severe: extremely limited

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14
Q

What are the classification rules based on number of exacerbations?

A

if only 0-1/yr, then it’s only intermittent

anything 2 or more can be mild, moderate or severe depending on other categories

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15
Q

What is the main rescue medication for asthma?

A

short acting beta2 agonists (SABA)

albuterol or levalbuterol

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16
Q

What are the three main classes of controller medications for asthma?

A

inhaled corticosteroids

leukotriene modifiers

long acting beta2 agonists

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17
Q

What are the examples of leukotriene modifiers?

A

montelukast (singulair)
zafirlukast
zileuton

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18
Q

What are the examples of LABAs?

A

salmeterol
formoterol
vilanterol

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19
Q

True or false: you cannot use LABAS as monotherapy in asthma.

A

true

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20
Q

What are the four main combination ICS/LABA inhalers?

A

advair (fluticasone/salmeterol)

sumbicort (budesonide/formoterol)

Dulera (mometasone/formoterol)

Breo (fluticasone/vilanterol)

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21
Q

What is the immunomodulator that can be used for asthma (dose/frequency determined by IgE levels)?

A

omalizumab (xolair)

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22
Q

How do mepolizumab and reslizumab work?

A

interleukin-5 antagonists

can be used as add-on maintenance therapy in severe asthma in adults and adolescents with eosinophilic phenotype

23
Q

What is the management strategy for intermittent asthma?

A

SABA prn

24
Q

What is the preferred step 2 management for asthma (for mild persistent)?

A

SABA prn and low dose ICS

25
Q

What is the preferred step 3 management for moderate persistent asthma?

A

SABA prn
low dose ICS
+ LABA or Medium dose ICS

26
Q

What is the preferred step 4 management for moderate or severe persistent asthma?

A

SABA prn
moderate dose ICS
+LABA

27
Q

What is step 5 for severe persistent asthma?

A

SABA prn
Higher dose ICS
LABA
+ consider omalizumab if allergic

28
Q

What is step 6?

A

SABA prn
High dose LABA
oral corticosteroids
+consider omalizumab

29
Q

COPD is the ___ leading cause of death.

A

5th

30
Q

What aren

A 
SMOKING
occupation dust and chemicals
second hand smoke
indoor\outdoor pollution
family history
low socioeconomic status
31
Q

What are the three main symptoms of COPD?

A

dyspnea
chronic cough
chronic sputum production

32
Q

The CAT is the main questionnaire to assess COPD symptoms. What score would make you worried for more COPD symptoms?

A

> 10

33
Q

What diagnostic test is required to make the diagnosis of COPD?

A

PFTs

34
Q

What is the spirometry result for a COPD diagnosis?

A

post-bronchodilator FEV1/FVC

35
Q

What is the FEV1 cutoff for mild COPD?

A

> or equal to 80%

36
Q

What range of FEV1 for moderate COPD?

A

50 to 80%

37
Q

What range for severe COPD?

A

30 to 50%

38
Q

What range for very severe?

A

less than 30%

39
Q

What are the three things that would make a patient at high risk for COPD exacerbation?

A

hx of 2+ exacerbations in the past year

FEV1

40
Q

True or false; medication management has been shown to improve mortality and slow the long-term decline in lung function.

A

false - they don’t :(

they just provide symptomatic treatment

41
Q

What is the initial treatment in COPD? (unlike asthma…)

A

LABAs or LAMA or a combination

short acting is only prn

42
Q

In moderate to severe COPD, which is preferred: SABAs or SAMAs?

A

SAMA

and SAMA?SABA combo is preferred over SABA alone

43
Q

What is the main oral phosphodiesterase-4 inhibitor for COPD?

A

roflumilast

44
Q

What COPD patients will have the most benefit from roflumilast?

A

those with a major chronic bronchitis component

45
Q

Which antibiotic has been found to be useful for prevention of COPD exacerbations?

A

Azithromycin

46
Q

What is the typical management for COPD exacerbations when they occur/

A

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

47
Q

When should antibiotics be used for exacerbation?

A

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

48
Q

What antibiotics are preferred for uncomplicated COPD?

A 
azithro
clarithro
doxy
bactrim
amoxicillin
49
Q

What antibiotic is preferred for complicated COPD with risk factors?

A

amox/clav
levo
moxi

50
Q

What antibiotic should you use if you’re worried about pseudomonas infection?

A

high dose levo or cipro

51
Q

If someone has the asthma, COPD combo, what is the best treatment?

A

ICS and LABA combo

52
Q

But if there are any features more consistent with asthma, what don’t you use?

A

LABA monotherapy

53
Q

What don’t you use if there are features more consistent with COPD?

A

no ICS monotherapy

Family Medicine Clerkship (9 decks)

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