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clinical medicine II exam 2 > pulmonary function tests and asthma > Flashcards

pulmonary function tests and asthma Flashcards

1
Q

What are the three basic pulmonary function tests

A
  1. airflow spirometry
  2. lung volumes
  3. diffusion capacity of the lungs for carbon monoxide (DLCO)
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2
Q

describe how you would coach a patient through a spirometry test

A
  1. relax and breathe normally
  2. take a deep breath in
  3. forcefully exhale all of your air
    • visualization may be provided (candles, balloons)
  4. take another deep breath in
  5. repeat testing at least 3X
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3
Q

What is forced vital capacity

A
  • deep breath in (full inspiration)
  • blow out air as fast as possible (forced expiration)
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4
Q

What is FEV-1

A
  • volume of air forcibly expelled in the first second of exhalation
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5
Q

An FEV-1/FVC ratio of is consistent with an obstructive airway disease

A

< 0.7

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6
Q

Why is bronchodilator testing done

A
  • reversibility testing
  • if positive: FEV1 is increased by 12% and 200 ml
    • aides in diagnosis
    • provides treatment options
    • improves compliance
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7
Q

how is bronchodilator testing done

A
  • nebulizer or inhaler
    • monitor technique: hold inhaled medication in lungs 5-10 sec
  • testing completed 15 min after medication provided
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8
Q

What is the Methacholine challenge test? What is a positive test?

A
  1. dilute solution of methacholine given via nebulizer
  2. spirometry conducted at 30-90 seconds
  3. concetration increases
  • Positive test: FEV1 decreases by 20%
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9
Q

this spirometry reading indicates which type of airway disease

A

obstructive disease

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10
Q

restrictive airway disease has what characteristic shape

A

peaked appearance

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11
Q

vital capacity

A

volume of air we breathe out following maximal inhalation

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12
Q

draw out lung volumes

A
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13
Q

diffusion capacity (DLCO) can be misleading in what condition

A
  • anemic
    • will give false reduction and must be adjusted for hemoglobin level
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14
Q

function of diffusion capacity (DLCO)

A
  • measures the ability of the lungs to transfer gas and saturate the hemoglobin (alveolar-capillary membrane)
  • CO is used as a surrogate for oxygen transfer
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15
Q

describe diffusion capacity (DLCO) technique

A
  • patient inhales a single breath of gas consisting of helium/CO, then expires, and measurement of exhalation is taken
    • when lungs are healthy; little CO is collected during exhalation
    • when lungs are diseased; less CO diffuses into lungs, thus higher levels are measured in exhaled gas
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16
Q

describe obstructive airway disease

A
  • aiwary narrowing
  • have high lung volumes and airflow is limited in expiration
  • inspiration is likely normal
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17
Q

Are the following lung volumes likely to be increased or decreased in obstructive airways disease?

  • TLC
  • FVC
  • RV
  • FEV1
  • FEV1/FVC
A
  • TLC: increased
  • FVC: normal
  • RV: increased
  • FEV1: decreased
  • FEV1/FVC: decreased
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18
Q

Are the following lung volumes likely to be increased or decreased in restrictive airways disease?

TLC

FVC

RV

FEV1

FEV1/FVC

A
  • TLC: decreased
  • FVC: decreased
  • RV: decreased
  • FEV1: decreased
  • FEV1/FVC: normal or increased
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19
Q

name some conditions that are classified under obstructive airway disease

A
  • asthma
  • bronchitis
  • COPD
  • cystic fibrosis
  • emphysema
  • upper airway obstruction
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20
Q

name some conditions that are classified under restrictive airway disease

A
  • pulmonary fibrosis
  • infectious lung disease
  • pleural effusion
  • tumors
  • obesity
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21
Q

name the 5 step approach to PFT interpretation

A
  1. examine flow-volume curve for shape
  2. examine FEV-1 value
  3. examine FEV-1/FVC ratio
  4. examine the response to bronchodilator
  5. examine DLCO
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22
Q

which Forced expiratory value is more sensitive for detecting early airway obstruction

A

FEF 25-75%

  • forced expiratory flow
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23
Q

if FEV-1 is < 80% of predicted value, patient likely has?

A

an obstructive airway disease

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24
Q

if the FEV-1/FVC ratio is decreased to 70% or less, what does the patient likely have?

A

obstructive process

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25
Q

if the if the FEV-1/FVC ratio is at 70% to less than normal, what does the patient likely have?

A
  • mild obstruction cannot be excluded
  • refer to FEV-1 and FEF 25-75% for asthma consideration
26
Q

if the FEV-1/FVC ratio is normal or increased, what does the patient likely have?

A

possibly a restrictive disorder

27
Q

If a patients FEV-1 increases by 12% and 200 ml after bronchodilator, this is suggestive of what

A
  • hyperactive, reversible airways
28
Q

If a patients FEV-1 remains below 0.7 after bronchodilator, this is suggestive of what

A

COPD

29
Q

a normal or increased DLCO is indicative of

A

asthma

30
Q

a decreased DLCO is indicative of

A

COPD

31
Q

define asthma

A
  • chronic airway inflammation
  • intermittent and reversible airway obstruction
  • bronchial hyper-responsiveness
32
Q

what are the hallmark symptoms of asthma

A
  • wheezing**
  • coughing
    • nocturnal
33
Q

80% of patients with asthma develop symptoms by what age

A

5 yo

34
Q

risk factors of asthma

A
  • atopy
  • med intolerance (ASA/NSAID)
  • food allergies
  • GERD
  • RSV
  • +FMH
  • maternal smoking
  • obestiy
35
Q

what history questions should you ask a patient with a known h/o asthma

A
  • medications?
  • last use of inhaler
  • how often is inhaler needed
  • number of ED visits in last month-year
  • any hospitalization needed (intubation?)
36
Q

patients with asthma typically wheeze during what phase

A

prolonged expiratory phase

  • may also be heard during inspiration
37
Q

what are signs of severe asthmatic obstruction

A
  • tachypnea
  • tachycardia
  • tripod posturing
  • accessory muscle use
  • pulsus paradoxus
38
Q

What is the ASA Triad/Samter’s Triad

A
  • nasal polyps, ASA intolerance, severe asthma
    • life threatening reaction to ASA
    • may be associated with chronic rhinosinusitis
39
Q

What is the atopic triad

A
  • allergic rhinitis
  • atopic dermatitis
  • asthma
40
Q

Spirometry helps confirm diagnosis of asthma, but at what age is it recommended to start using this test

A

> 5 yo

41
Q

What is needed to diagnose asthma

A
  1. FEV1 < 80%
  2. FEV1/FVC: normal or decreased relative to predicted values
  3. reversibility > 12% (>8% in young children) and 200mL in FEV1 with bronchodilator
42
Q

What parameters are needed to diagnose a patient with intermittent asthma

  • # symptoms
  • nightime awakenings
  • PFT
  • FEV1
  • FEV1/FVC
  • activity level
  • how often SABA is used
A
  • Sx < or = 2 days/week
  • nighttime awakenings
    • ages < 4yo: none
    • ages > 5yo: < or = 2 nights/month
  • normal PFTs in between exacerbation
  • FEV1>80%
  • FEV1/FVC normal (>85% ages 5-19)
  • normal activity
  • < or = 2 days/week SABA use to control sx
43
Q

What parameters are needed to diagnose a patient with mild persistent asthma

  • # symptoms
  • nightime awakenings
  • FEV1
  • FEV1/FVC
  • activity level
  • how often SABA is used to control sx
A
  • # symptoms: > 2 days/week but not daily
  • nightime awakenings
    • ages < 4 yo: 1-2 nights/month
    • ages > 5 yo: 3-4 nights/month
  • FEV1 >80%
  • FEV1/FVC normal (>80% ages 5-19%)
  • activity level: minor limitation
  • how often SABA is used to control sx: > 2 days/week (not daily)
44
Q

What parameters are needed to diagnose a patient with moderate persistent asthma

  • # symptoms
  • nightime awakenings
  • FEV1
  • FEV1/FVC
  • activity level
  • how often SABA is used to control sx
A
  • # symptoms: daily
  • nightime awakenings
    • ages < 4 yo: 3-4x/month
    • ages > 5 yo: >1x/week (not nightly)
  • FEV1: 60-80%
  • FEV1/FVC reduced by 5%
  • activity level: some limitations
  • how often SABA is used to control sx: daily
45
Q

What parameters are needed to diagnose a patient with severe persistent asthma

  • # symptoms
  • nightime awakenings
  • FEV1
  • FEV1/FVC
  • activity level
  • how often SABA is used to control sx
A
  • # symptoms: throughout the day
  • nightime awakenings
    • ages < 4 yo > 1x/week
    • ages > 5 yo: nightly
  • FEV1 < 60%
  • FEV1/FVC reduced by 5%
  • activity level: extremely limited physical activity
  • how often SABA is used to control sx: several times a day
46
Q

SABA

A

inhaled short acting beta 2 agonist

47
Q

LABA

A

long acting beta 2 agonist

48
Q

ICS

A

inhaled corticosteroid

49
Q

LTRA

A

leukotriene receptor antagonist

50
Q

treatment of Intermittent asthma

A

SABA prn

51
Q

treatment of mild persistent asthma

A
  • SABA prn
  • low dose ICS daily
    • OR: LTRA or Cromolyn
52
Q

treatment of moderate persistent asthma

A
  • refer to specialist
  • SABA prn
  • medium dose ICS (all ages)
    • OR low dose ICS + LTRA or LABA (ages > 5)
53
Q

treatment of severe persistent asthma

A
  • SABA prn
  • medium dose ICS and LABA OR LTRA in ages < 4yo
54
Q

What are other treatment options to try if patient with severe persistent asthma is not controlled

A
  1. high dose ICS and LABA or LTRA in ages < 11 yo
  2. high dose ICS and LABA and oral steroids
    1. use LTRA instead of LABA in patients < 4 yo
55
Q

What are other treatment option can you add if patient is over 12 yo with severe persistent asthma and allergies

A

Omalizumab (Xolair)

56
Q

what is the appropriate follow up time with asthma patients

A
  • initially 1-3 months then every 3-12 months depending on severity
57
Q

what is the rules of two

A
  1. do you have asthma symptoms more than 2x/week
  2. do you awaken with asthma symptoms more than 2x/month
  3. do you refill your quick relief inhaler canister more than 2x/year
  4. does your peak flow meter measure < 20% from baseline
  • if yes, then asthma is not under control
58
Q

PEFR

A

peak expiratory flow rate

59
Q

what do the colors signify in the peak flow meter

A
  • green: > 80%: good control
  • yellow: 50-80%: caution- SABA and med change
  • red: < 50%: medical alert -ED
60
Q

what is the treatment for asthma exacerbation

A
  1. O2
  2. SABA/SVN (nebulizer): albuterol or xopenex +/- Ipratropium bromide
  3. systemic corticosteroids: prednisone 1 mg/kg/day
  4. f/u within 1 week

clinical medicine II exam 2 (7 decks)

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