Resp Flashcards
Cut offs for positive, borderline, and negative methacholine challenge test?
Methacholine Challenge – look for drop in FEV1 by 20%
– PC20 <4mg/mL = POSITIVE
– PC20 4-16 = borderline
– PC20 >16 = negative
Cut offs for positive asthma exercise challenge test?
Fall in FEV1 of >10% and >200mL from baseline
Features of severe asthma.
How does this definition vary from uncontrolled asthma?
Asthma requiring treatment with high dose ICS + 2nd controller for previous year, or oral steroids for 50% of the year, to prevent it from becoming uncontrolled, or uncontrolled despite this therapy
Uncontrolled asthma is usually due to noncompliance, poor puffer technique etc.
Work up for severe asthma?
- Total IgE
- Peripheral eosinophil count
- Sputum eosinophils and FeNO where available
Name 3 classes of biologics used to treat severe asthma
- Anti-IgE (Omalizumab) use for + IgE levels.
- IL-5 (mepolizumab, resilzumab, benralizumab)
- IL-4/IL-13 (Dupilumab)
Samter’s triad, what is the best treatment for this special population?
ASA exacerbated respiratory disease
(samter’s triad= asthma, nasal polyps,ASAa/NSAID sensitivity)
Tx: avoid ASA/NSAIDs, can treat like normal but usually good response to LTRA, desensitize to ASA if needed
Features and treatment of EGPA?
Eosinophilic granulomatosis with polyangiitis (EGPA/Churg Strauss)
– Asthma, eosinophilia, granulomatous vasculitis (cardiac, sinusitis, allergic rhinitis, transient pulmonary infiltrates, purpura, neurologic, GI)
–30-60% have positive p-anca
– Tx: prednisone, cyclophosphamide if severe disease
ABPA treatment?
Prednisone +/- itraconazole
Usually high total IgE and Aspergillis specific IgE
How long can symptoms of RADS last?
Reactive airways dysfunction syndrome (RADS)
Classic is chlorine spill
lasts > 3 months, treat like asthma exacerbation
Severity of Airflow Limitation in COPD based on FEV1?
- Mild: FEV1 > 80% predicted
- Moderate: 50% < FEV1 < 80% predicted
- Severe30% < FEV1 < 50% predicted
- Very Severe: FEV1 < 30% predicted
Non-pharm mgmt that improves mortality in COPD
- smoking cessation
- pulmonary rehab
- supplemental oxygen
Parameters to qualify for supplemental O2
severe hypoxemia (PaO2<55 mmHg), (SaO2 <= 88%) or – PaO2 = <60 with: • Cor pulmonale • Pulmonary hypertension • Persistent erythrocytosis
Options for treatment for Dyspnea in end stage COPD
– oral (but not nebulized) opioids (Grade 2C)
– neuromuscular electrical muscle stimulation (Grade 2B)
– chest wall vibration (Grade 2B)
– walking aids (Grade 2B)
– pursed-lip breathing (Gr 2B)
– continuous oxygen therapy for hypoxemic COPD patients reduces mortality, and may reduce dyspnea
Benefits of steroid use in AECOPD Tx?
– Faster recovery time
– Increased FEV1
– Reduce length of stay
Give for 5-7 days, no not exceed 7
Indications for NIV in COPD?
- pH ≤7.35 with pC02 ≥ 45
- severe dyspnea (impending respiratory failure)
- persistent hypoxemia despite supp oxygen
Can also be considered as a long-term treatment strategy in chronic hypercapnia (suggested PCO2≥52) and
history of hospitalization with acute respiratory failure
Interventions that definitely decreased risk of AE in COPD
Grade 1 recommendations:
– Annual flu vaccine
– Pulm Rehab (if RECENT exacerbation <4 weeks ago)
– Education and Case Management
– Inhaled pharmacotherapy [CTS 2017 update]
• LAMA > LABA monotherapy, LAMA/LABA > LABA/ICS (discussed in latest 2019 CTS guideline)
What test would you send to work-up Primary Ciliary Dyskinesia?
nasal nitric oxide
Radiographic features of UIP
- Reticular changes
- Subpleural, basal predominant
- Honeycombing
- Absence of GGO, nodules, cysts, mosiac attenuation
Nephrotic syndrome, exudative or transudative pleural fluid?
Transudative
Hypothyroidism, exudative or transudative pleural fluid?
Transudative
PE, exudative or transudative pleural fluid?
Exudative
Pancreatitis, exudative or transudative pleural fluid?
Exudative
When is drainage of a pleural effusion indicated?
– drainage of frank pus/cloudy
– positive gram stain or culture
– pH <7.2 (if unavailable use glucose <3.4 mmol/L)
– >50% of hemithorax or loculations on imaging
– if no culture then treat for CAP plus anaerobes (empiric add anaerobic!)
• Usually prolonged antibiotic course (often at least 3 weeks, based on clinical and radiographic response)
Size cutoffs for intervention of Pneumothorax?
– Small <2cm with minimal signs and symptoms = monitor
– If >2cm or signs and symptoms = needle aspiration +/- chest tube insertion – Surgery if persistent leak
