Pulmonology Flashcards
If FEV1 improves by more than ____ % after administration of a beta-agonist it is considered diagnostic of Asthma.
12%
Cough in Asthma is generally Productive or non-productive? Is it throughout the day?
Non-productive (productive is generally with COPD) Generally the cough is worse at night and in the early morning with asthma, throughout the day with COPD
Classification of Asthma Severity by Frequency of Symptoms (all ages)
Intermittent: < or = to 2 days/week
Mild Persistent >2 days/week but not daily
Moderate Persistent: Daily
Severe Persistant: Throughout the day
Classification of Asthma Severity by Nighttime Awakening (age category 5-11 & >12 y/o)
Intermittent: < or = to 2 days/month
Mild Persistent: 3 or 4 times/month
Moderate Persistent: more than once weekly but not nightly
Severe Persistant: Often 7 times/week
Classification of Asthma Severity by Nighttime Awakening (Age 0-4)
Intermittent: 0 times
Mild Persistent: 1 or 2 times/month
Moderate Persistent: : 3 or 4 times/month
Severe Persistant: more than once weekly
Classification of Asthma Severity by SABA use (all ages)
Intermittent: < or = to 2 days/week
Mild Persistent >2 days/week but not daily
Moderate Persistent: Daily
Severe Persistant: Throughout the day/several times/day
Classification of Asthma Severity by FEV1/FVC (age over 12 y/o)
Intermittent: Normal
Mild Persistent: Normal
Moderate Persistent: : Reduced 5%
Severe Persistant: Reduced > 5%
Normal FEV1/FVC values
age 8-19 y/o: 85%
age 20-39 y/o: 80%
age 40-59 y/o: 75%
age 60-80 y/o: 70%
Classification of Asthma Severity by FEV1 (age over 12 y/o)
Intermittent: >80%
Mild Persistent: >80%
Moderate Persistent: : >60-<60%
Classification of Asthma Severity by Exacerbations requiring oral steroids (age over 12 y/o)
Intermittent: 0-1 /year
Mild Persistent: > or = 2 /year
Moderate Persistent: > or = 2 /year
Severe Persistant: > or = 2 /year
Recommended Steps for Treatment Initiation based on Asthma Severity
Intermittent: Step 1
Mild Persistent: Step 2
Moderate Persistent & Severe Persistant: Step 3 and consider short course of oral steroids.
FEV1
Volume of air exhaled forcefully in the first second of maximal expiration.
Normally greater than 80% of predicted value, asthma reversibility is shown by an increase in FEV1 > or = to 12% after SABA
FVC
The maximum volume of air that can be exhaled after full inspiration. normal lungs can empty 80% of air in < 6 seconds.
FEV1/FVC Ratio
Differentiates between obstructive and restrictive disease.
Decreased in obstructive disease (asthma/COPD)
Normal/high in restrictive disease (ex. pulmonary fibrosis)
Assessing Asthma Control in Adults >12 y/o based on SX
Well Controlled:< or = to 2 days/week
Not Well Controlled: >2 days/week
Very Poorly Controlled: Throughout the day
Assessing Asthma Control in Adults >12 y/o based on Nighttime Awakenings
Well Controlled: < or = 2 times/month
Not Well Controlled: 1-3 times/week
Very Poorly Controlled: > or = to 4 times/week
Assessing Asthma Control in Adults >12 y/o based on Interference with Normal Activities
Well Controlled: None
Not Well Controlled: Some limitation
Very Poorly Controlled: Extremely Limited
Assessing Asthma Control in Adults >12 y/o based on Short-acting B2 agonist use for Sx control
Well Controlled:< or = to 2 days/week
Not Well Controlled: >2 days/week
Very Poorly Controlled: Several times/day
Assessing Asthma Control in Adults >12 y/o based on FEV1 or peak flow
Well Controlled: 80% of predicted/personal best
Not Well Controlled: 60-80% of predicted
Very Poorly Controlled: <60% of predicted
Assessing Asthma Control in Adults >12 y/o based on ACT
Well Controlled: > or = to 20
Not Well Controlled: 16-19
Very Poorly Controlled: < or = to 15
Assessing Asthma Control in Adults >12 y/o based on Exacerbations requiring oral steroids
Well Controlled: 0 or 1 per year
Not Well Controlled: > or = to 2 per year
Very Poorly Controlled: > or = to 2 per year
Recommended Action for treatment based on Asthma Assessment
Well Controlled: Maintain current step, regular follow-up every 1-6 months, consider step-down if well controlled >3 months
Not Well Controlled: Step up 1 step, re-evaluate in 2-6 weeks
Very Poorly Controlled: Consider short course of oral steroids, step up 1 or 2 steps. Reevaluate in 2 weeks.
Treatment Guideline Steps (age >12 y/o)
Step 1: No Controller needed/only SABA PRN
Step 2: Preferred Low dose ICS
Step 3: Preferred Low dose ICS plus LABA or medium dose ICS
Step 4: Medium dose ICS plus LABA
Step 5: High dose ICS plus LABA and consider omalizumab for patients with allergic asthma.
Step 6: High dose ICS plus LABA plus systemic corticosteriods and consider omalizumab
Inhaled Corticosteriod Daily Dosing in Adults-Budesonide
Low: 180-600 mcg/day
Med: 600-1200 mcg/day
HIgh: >1200 mcg/day
Inhaled Corticosteriod Daily Dosing in Adults-Fluticasone
Low: 88-264 mcg/day
Med: 264-440 mcg/day
HIgh: >440 mcg/day
Inhaled Corticosteriod Daily Dosing in Adults-Beclomethasone
Low: 80-240 mcg/day
Med: >240-480 mcg/day
HIgh: >480 mcg/day
Inhaled Corticosteriod Daily Dosing in Adults-Mometasone
Low: 200 mcg/day
Med: 400 mcg/day
HIgh: >400 mcg/day
Inhaled Corticosteriod Daily Dosing in Adults-Ciclesonide
Low: 160 mcg/day
Med: 320 mcg/day
HIgh: 640 mcg/day
Inhaled Corticosteriod Daily Dosing in Children-Budesonide Suspension for nebulization
Ages 0-4/Ages 5-11 (mg/day)
Low: 0.25-5 mg/0.5 mg
Med: >0.5-1 mg/1 mg
High: >1 mg/2 mg
COPD Definition
Chronic bronchitis consists of persistent cough plus sputum production for most days of 3 months in the last 2 consecutive years.
Spirometry FEV1/FVC less than 70%
Gold Guidelines Assessment of COPD Severity (A-D)
A- low risk/less symptoms. FEV1 50-80% (moderate) or >80% (mild) or = 2 exacerbations per year
D: High risk, more symptoms, same FEV1 as C, > or = 2 exacerbations per year
Questions to ask low symptoms or more symptoms
FEV1 >/= 50% A or B
FEV1 /=10 high Sx, <10 low Sx
Pharmacotherapy for COPD based on Staging
A: SA ANC PRN or SABA PRN
B: LA ANC or LABA
C & D: ICS + LABA or LA ANC
ANC= Anticholinergic
When do you use antibiotics in COPD Exacerbation?
- Should be given if all three cardinal Sx of COPD are present (dyspnea, increased sputum volume, increased sputum purulence)
- If 2 of 3 cardinal sx are present and if increased purulence is one of the symptoms
- If patients require mechanical ventilation
Treatment duration is generally 5-10 days
Duration of therapy for Nicotine Patch (Including Step-downs)
21 mg/24 hours X 4 weeks
14 mg/24 hours X 2 weeks
7 mg/24 hours X 2 weeks
Nicotine Gum Dose
1-24 cig/day= 2 mg
25+ cigarettes/day =4 mg gum up to 24 pieces/day
Can use up to 12 weeks, longer term use up to 6 months may be helpful.
True or False…Single therapy is favored over combination therapy in Smoking Cessation
False: Combination therapy is more effective, only combo to avoid is varenicline and NRT d/t higher incidence of side effects such as nausea/headache.
