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BCACP Flash Cards > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

If FEV1 improves by more than ____ % after administration of a beta-agonist it is considered diagnostic of Asthma.

A

12%

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2
Q

Cough in Asthma is generally Productive or non-productive? Is it throughout the day?

A

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

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3
Q

Classification of Asthma Severity by Frequency of Symptoms (all ages)

A

Intermittent: < or = to 2 days/week
Mild Persistent >2 days/week but not daily
Moderate Persistent: Daily
Severe Persistant: Throughout the day

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4
Q

Classification of Asthma Severity by Nighttime Awakening (age category 5-11 & >12 y/o)

A

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

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5
Q

Classification of Asthma Severity by Nighttime Awakening (Age 0-4)

A

Intermittent: 0 times
Mild Persistent: 1 or 2 times/month
Moderate Persistent: : 3 or 4 times/month
Severe Persistant: more than once weekly

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6
Q

Classification of Asthma Severity by SABA use (all ages)

A

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

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7
Q

Classification of Asthma Severity by FEV1/FVC (age over 12 y/o)

A

Intermittent: Normal
Mild Persistent: Normal
Moderate Persistent: : Reduced 5%
Severe Persistant: Reduced > 5%

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8
Q

Normal FEV1/FVC values

A

age 8-19 y/o: 85%
age 20-39 y/o: 80%
age 40-59 y/o: 75%
age 60-80 y/o: 70%

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9
Q

Classification of Asthma Severity by FEV1 (age over 12 y/o)

A

Intermittent: >80%
Mild Persistent: >80%
Moderate Persistent: : >60-<60%

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10
Q

Classification of Asthma Severity by Exacerbations requiring oral steroids (age over 12 y/o)

A

Intermittent: 0-1 /year
Mild Persistent: > or = 2 /year
Moderate Persistent: > or = 2 /year
Severe Persistant: > or = 2 /year

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11
Q

Recommended Steps for Treatment Initiation based on Asthma Severity

A

Intermittent: Step 1
Mild Persistent: Step 2
Moderate Persistent & Severe Persistant: Step 3 and consider short course of oral steroids.

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12
Q

FEV1

A

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

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13
Q

FVC

A

The maximum volume of air that can be exhaled after full inspiration. normal lungs can empty 80% of air in < 6 seconds.

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14
Q

FEV1/FVC Ratio

A

Differentiates between obstructive and restrictive disease.
Decreased in obstructive disease (asthma/COPD)
Normal/high in restrictive disease (ex. pulmonary fibrosis)

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15
Q

Assessing Asthma Control in Adults >12 y/o based on SX

A

Well Controlled:< or = to 2 days/week
Not Well Controlled: >2 days/week
Very Poorly Controlled: Throughout the day

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16
Q

Assessing Asthma Control in Adults >12 y/o based on Nighttime Awakenings

A

Well Controlled: < or = 2 times/month
Not Well Controlled: 1-3 times/week
Very Poorly Controlled: > or = to 4 times/week

17
Q

Assessing Asthma Control in Adults >12 y/o based on Interference with Normal Activities

A

Well Controlled: None
Not Well Controlled: Some limitation
Very Poorly Controlled: Extremely Limited

18
Q

Assessing Asthma Control in Adults >12 y/o based on Short-acting B2 agonist use for Sx control

A

Well Controlled:< or = to 2 days/week
Not Well Controlled: >2 days/week
Very Poorly Controlled: Several times/day

19
Q

Assessing Asthma Control in Adults >12 y/o based on FEV1 or peak flow

A

Well Controlled: 80% of predicted/personal best
Not Well Controlled: 60-80% of predicted
Very Poorly Controlled: <60% of predicted

20
Q

Assessing Asthma Control in Adults >12 y/o based on ACT

A

Well Controlled: > or = to 20
Not Well Controlled: 16-19
Very Poorly Controlled: < or = to 15

21
Q

Assessing Asthma Control in Adults >12 y/o based on Exacerbations requiring oral steroids

A

Well Controlled: 0 or 1 per year
Not Well Controlled: > or = to 2 per year
Very Poorly Controlled: > or = to 2 per year

22
Q

Recommended Action for treatment based on Asthma Assessment

A

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.

23
Q

Treatment Guideline Steps (age >12 y/o)

A

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

24
Q

Inhaled Corticosteriod Daily Dosing in Adults-Budesonide

A

Low: 180-600 mcg/day
Med: 600-1200 mcg/day
HIgh: >1200 mcg/day

25
Q

Inhaled Corticosteriod Daily Dosing in Adults-Fluticasone

A

Low: 88-264 mcg/day
Med: 264-440 mcg/day
HIgh: >440 mcg/day

26
Q

Inhaled Corticosteriod Daily Dosing in Adults-Beclomethasone

A

Low: 80-240 mcg/day
Med: >240-480 mcg/day
HIgh: >480 mcg/day

27
Q

Inhaled Corticosteriod Daily Dosing in Adults-Mometasone

A

Low: 200 mcg/day
Med: 400 mcg/day
HIgh: >400 mcg/day

28
Q

Inhaled Corticosteriod Daily Dosing in Adults-Ciclesonide

A

Low: 160 mcg/day
Med: 320 mcg/day
HIgh: 640 mcg/day

29
Q

Inhaled Corticosteriod Daily Dosing in Children-Budesonide Suspension for nebulization

A

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

30
Q

COPD Definition

A

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%

31
Q

Gold Guidelines Assessment of COPD Severity (A-D)

A

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

32
Q

Pharmacotherapy for COPD based on Staging

A

A: SA ANC PRN or SABA PRN
B: LA ANC or LABA
C & D: ICS + LABA or LA ANC

ANC= Anticholinergic

33
Q

When do you use antibiotics in COPD Exacerbation?

A
  1. Should be given if all three cardinal Sx of COPD are present (dyspnea, increased sputum volume, increased sputum purulence)
  2. If 2 of 3 cardinal sx are present and if increased purulence is one of the symptoms
  3. If patients require mechanical ventilation

Treatment duration is generally 5-10 days

34
Q

Duration of therapy for Nicotine Patch (Including Step-downs)

A

21 mg/24 hours X 4 weeks
14 mg/24 hours X 2 weeks
7 mg/24 hours X 2 weeks

35
Q

Nicotine Gum Dose

A

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.

36
Q

True or False…Single therapy is favored over combination therapy in Smoking Cessation

A

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.

BCACP Flash Cards (9 decks)

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