Pulmonary disorders, Gout, and Adult Immunizations Flashcards
What are the 5 steps therapy for Asthma?
Step 1 –> Low dose ICS + formoterol PRN, SABA PRN
Step 2 –> Low dose ICS daily or low dose ICS + Formoterol
Step 3 –> Low dose ICS + LABA
Step 4 –> Medium dose ICS + LABA
Step 5 –> High dose ICS + LABA and add on tiotropium (history of exacerbation), omalizumab (allergic asthma), or IL-5 antagonist (eosinophilic asthma).
What are the cutoffs for intermittent asthma?
<2 X per week. Daily is moderate persistent (except night awakenings is >once/week but not nightly) and mild is in between with severe being the worst.
What is the only LAMA for use in Asthma?
Respimat, recommended add on in step 4, preferred add on in step 5.
Can LABAs be used in adults alone?
NO. Use alone is CI’d. Only as add on therapy on ICS.
What is ACO treatment?
If 3 or more features favor each you treat it as that disease. If similar number you use ICS and add LABA or LAMA. No LABA monotherapy if any features of Asthma and no ICS monotherapy if potential diagnosis of COPD.
How to treat EIB?
Pretreatment with low dose ICS/formoterol (and PRN)
How to treat the 4 COPD groups?
Group A is short or long acting for breathlessness
Group B is long acting. No preference for LABA or LAMA.
Group C is LAMA for initial monotherapy
Group D is individualized –> LAMA for most
When can an ICS be added in COPD?
Group C or Group D. Group C you can see ICS + LABA when eosinophils >300. Group d you may see triple therapy (eosinophils >100) or LABA + ICS ( if eosinophils >300).
What places a patient in group A?
Few symptoms (CAT <10) no hospitalizations, <1 exacerbation in the past year.
Treatment is Bronchodilator (short or long acting)
What places a patient in group B?
Many symptoms (CAT>10), no hospitalizations, <1 exacerbation in past year
treatment is LABA or LAMA (can intensify to LABA + LAMA)
What place a patient in group C?
CAT score <10, > 1 copd-related hospitalizations, >2 exacerbations in the past year.
Treatment is LAMA
What places a patient in group D?
CAT score >10, >1 COPD related hospitalization or >2 exacerbations
Treatment is LAMA or LAMA + LABA (If highly symptomatic CAT >20) or LABA + ICS (if eosinophils >300) OR triple therapy (if eosinophils >100)
Can add roflumilast if eosinophils <100 +/- azithromycin if eosinophils <100 and former smoker
What are the cutoffs for GOLD 1,2,3,4?
Gold 1 >80, Gold 2 50-79, Gold 3 30- 49, Gold 4 <30
When to give antibiotics in an exacerbation?
with all 3 cardinal symptoms (increased dyspnea, increased sputum volume and purulence), in 2 cardinal symptoms where one is increased purulence, mechanical ventilation
Which antibiotics can you used in uncomplicated COPD?
Amoxicillin + clavulanate, macrolide (azithromycin), tetracycline
