Respiratory Treatment Pulmonary Flashcards
Short Acting B2-Agonist Bronchodilators (SABA) Meds
-ProAir HFA (Albuterol sulfate)
-ProAir RespiClick (albuterol sulfate inhalation powder)
-Proventil HFA (albuterol sulfate)
-Ventolin HFA (albuterol sulfate)
-Xopenex HFA (Levalbuterol)
SABA MOA
-Quickly open the airways to stop asthma symptoms. “Rescue” medicines.
-Work within 15-20 minutes and last up to 4-6 hours
-Relax smooth muscle tone and improve airflow
-Stimulate ciliary motion to promote secretion mobilization
Long Acting Beta-2 Agonist Bronchodilators (LABAs) Meds
-Arcapta Neohaler
-Servent Diskus (Salmetrol)
-Striverdi Respimat
-Foradil (Formoterol)
LABA MOA
-Keep airway open for 12 hours
-Use daily
-Also effective in treating exercise induced asthma
Corticosteroids
-Usually used in combo with LABA
-Reduces swelling in airways and lungs
-When FEV1 <60% LABA + Corticosteroid should be used
Anticholinergics MOA
-Block effects of acetylcholine
-Mainstay treatment with COPD
-Effective in controlling difficult asthma symptoms
-Decrease airway secretions and airway smooth muscle tone
Corticosteroid inhalers
-Alvesco HFA (ciclesonide; 80 mcg, 160mcg)
-ArmonAir RespiClick (Fluticasone proponate; 55mpg, 113 mpg, 232 mpg)
-Arnuity, Ellipta (flutcasone furcate inhalation powder; 100mcg, 200 mcg)
-Asmanex HFA (mometasone furcate)
-Asmanex Twishaler (mometason furcate; 110 mcg, 220mcg)
-Flovent, Diskus (flutcasone proponate; 50 mcg, 100 mcg, 250 mcg)
-Flovent HDA (flutcasone proponate; 110 mcg, 220 mcg)
-Plumicort, Flexhaler
Muscarinic Antagonist (Anticholinergic Inhalers WITH COPD)
-Atrovent (ipratropium bromide)
-Spiriva Respimat (tiotropium bromide)
-Aren’t quick-relief medications.
Combo medications (Corticosteroids and LABA)
-Advair Diskus (fluticasone proponate and salmeterol inhalation powder; 100/50, 250/50, 500/50)
-Advair HFA (fluticasone proponate and salmeterol; 45/21, 115/21, 230/21)
-AirDuo RespiClick (Fluticasone propionate and salmeterol; 55/14, 113/14, 232/14 mcg)
-Breo Ellipta (don’t use with asthma; fluticasone/vilanterol; 100/25, 200/25 mcg)
-Dulera
-Symbicort
LAMA (Long acting muscarinic antagonist)
Seebri Neohaler (glycooyrolate)
-Incruse, Ellipta-COPD
-Spiriva (tiotropium bromide)
-Combivent (combo)
LABA + LAMA
-Anoro Ellipta
-Bevespi, Aerosphere
-Stiolto, Respimat
-Utibron, Neohlaer
Trelegy Ellipta
combo of corticosteriod, LABA and LAMA
PDE4 Inhibitors
Used in later stages of COPD
-Increases intracellular cAMP in lung tissue
-Reduces neutrophil and eosinophil counts in lung
-Roflumilast (Daliresp), 500 mcg daily
GOLD 0: At risk
-normal lung function
-cough and sputum production
-remove toxins
GOLD 1: Mild
-FEV1 >80%
-asymptomatic or may have chronic cough and sputum
-SABA
GOLD II: Moderate
-FEV1 50-80%
-Asymptomatic or may have chronic cough and sputum
-Add LABA
GOLD III: Severe
-FEV1 30-50%
-Some symptoms daily
-Add inhaled corticosteroids
GOLD IV: Very severe
-FEV1 <30% or <50% with severe respiratory failure
-multiple symptoms
-long term O2 for severe hypoxia
-consider surgical treatment
COPD Exacerbations
-Systemic corticosteroids and antibiotics
-BiPAP helps decrease CO2 retention and prevent intubation
-Possible mechanical ventilation
-usually caused from bronchial infections
FVC
-Forced vital capacity and forced expiratory flow rates
-FEV1 is forced expiratory volume in one second-considered gold standard by which obstructive airway disease
-Ratio of FEV1/FVC is diagnostic for obstructive disease
-FEV1/FVC <70% of normal is dx of obstructive disorder or obstruction
Measurement of Nitrous oxide
-noninvasive marker of airway inflammation
-reflect lower airway inflammation-hallmark of asthma disease process
-Helps w/ titration of inhaled steriod therapy. Inhaled steroids will quickly reduce nitrous oxide levels
Increased DLCO
-Diffusion capacity of carbon monoxide in the lung
-Increased may indicate asthma, obesity, polycythemia, or cardiac left to right shunting
Decreased DLCO
-Diffusion capacity of carbon monoxide in the lung
-May indicate disorders of pulmonary parenchyma, vascular problems, or decreased in alveolar function (emphysema)
Bronchial Provocation testing (challenge)
-Useful test when spirometry is normal and cough is unexplained
-Involves inhalation of methacholine, histamine, or other chemical stimulants to induce bronchial smooth muscle restriction
-Positive restults for asthma is FEV1 reduced by 20% or more at a dose of 16mg/ml or less
-95% sensitive for dx of asthma; negative results make the dx of asthma unlikely
Spirometry
-with a bronchodilator therapy (eval of bronchospasm)
-determines vital capacity and expiratory flow rates before and after aerosolized bronchodilator therapy
Maximal (inspiratory) respiratory pressures
-helps in dx of neuromuscular causes of respiratory dysfunction
Obstructive ventilatory defects
-Flow rates are reduced
-lung volumes are within normal range or are larger than the normal range due to hyperinflation and air trapping
-Increased reserved volume and TLC
Restrictive Ventilatory Defects
-Flow rates are normal or increased
-Lung volumes are proportionally reduced
Values 60-70% of predicted volume/flow rates
mildly reduced
Values 50-60% of predicted volume/flow rates
moderately reduced
Values lower than 50% pf predicted volumes/flow rates
severely reduced
Values for residual volume and TLC exceed 120% of predicted
air trapping and hyperinflation are present
Expiratory airflow measurements increase by 15% at least over baseline values with bronchodilator
-indicate an obstruction is present
Peak expiratory flowmeter and asthma
-At home use
-Helps determine need for additional medication
-Green zone (no change in therapy): PEFR 80-100% of baseline
-PEFR 50-80% of baseline “Yellow zone” temporary increase in intensity of therapy or additional therapy should be considered
-PEFR <50% of baseline “red zone” urgent/emergency care is advised
Implications in Geriatric Patients
-changes in elastic recoil and musculoskeletal changes of chest wall
