Shortness of Breath with Dr. Johns Part II Flashcards
What is dyspnea?
abnormally uncomfortable awareness of breathing
What is on the differential diagnosis for dyspnea on exertion?
CHF angina obstructive lung disease pleural effusion anemia hypohtyroid metabolic acidosis anxiety with hyperventilation
What is COPD’s rank in cause of death in the US?
4th
How is COPD defined?
disease state characterized by airflow limitation that is not fully reversible
progressive and associated with an abnormal inflammatory response of the lungs ot noxious particles or gases
What is chronic bronchitis defined as?
chronic productive cough for three months in two successive years
What is emphysema defined as?
enlargement of airspaces with destruction o bronchiole walls
actually a pathological term
How is asthma defined?
inflammatory disease of airways with significantly REVERSIBLE narrowing
What is the main difference between asthma and COPD?
COPD is permanent and asthma is reversible - but you can have combinations of the two
Who usually gets COPD?
patients who have smoked at least 20 cigarettes per day for 20 or more years
How does COPD usually start symptomatically? When does the dyspnea develop?
chronic cough
dyspea typically doesn’t start until 10-20 years after the cough
What is the main way to establish a diagnosis of COPD?
spirometry
As COPD proresses, what are some symptoms you can expect?
chronic clear sputum production weight loss morning headache hypercapnia with hypoxemia cor pulmonale
IN general, what happens to FEV1 as a person ages normally, ages with asthma and ages with COPD?
FEV1 decreases for all of them, but normal and asthma don’t really differ while people with COPD have a significant decline in FEV1 as they age
What are some physical exam findings you’ll see in COPD?
prolonged expiration hyperinflation - barrel chest hyperresonant percussion depressed diaphragm decreased breath sounds wheezes use of accessory muscles pursed lips cyanosis enlarged liver asterixis
How can you differentiate a pulmonary funtion test abnormality due to asthma from that of COPD?
give a bornchodilator and retest - asthma will improve and COPD won’t
What are some of the findings you would see on CXR for COPD?
hyperlucent lung fields vascular crowding with curvilinear pattern increased anteroposterior diameter flattening of diaphrgm increased retrosternal air space
What happens to FEV1 and FEV/FVC do in COPD?
both go down
What’s the number one thing to do for management of stable COPD?
get them to stop smoking - it can slow the decline in FEV1
What are the two main drugs we use in COPD?
beta-2 agonist bronchodilators (albuterol inhaler prn)
anticholinergic agents (inhaled ipratropium)
What COPD drug is controversial due to high risk of toxicity?
theophylline
When should you use corticosteroids in COPD?
some studies show inhaled corticosteroids may slow the rate of FEV1 decline
consider short term oral use for exacerbations. long term ONLY if all other meds are at maximal therapy
When should you prescribe supplemental oxygen in COPD?
if O2 aturations goes below 88% room air or falls below 85% with exertion
or if cor-pulmonale present
What are the three types of COPD?
asthma, emphysema and chronic bronchitis
What’s been happening to the prevalence of asthma?
increaseing
What’s the classic triad of symptoms in asthma?
persistent wheeze
chronic cough
chronic dyspnea
What will you see on physical exam in asthma?
widespread, high-pitched wheezes
accessory muscle use
pulsus paradoxus (greater than 10 mmHg fall in systolic pressure during inspiration)
What pulmonary function test parameter is used to check an asthmatic’s percent from personal best?
the peak expiratory flow rate
What are the color designations for the peak expiratory flow rates?
red - less than 50% of personal best
yellow - 50-80%
green - over 80%
When you’re doing pulmonary function testing before and after bronchodilators, what is the percent improvement required for it to be considered responsive?
12% or more is considered responsive
What provocative test can we use to establish an asthma diagnosis in someone with symptoms but normal spirometry?
methacholine challenge - it’s a bronchoconstrictor
What are the 4 severity categories of asthma?
mild intermittent
mild persistent
moderate persistent
severe
What is the stepwise approach for manageing asthma in patients aged 12 years or older?
step 1: short acting Beta agonist
step 2: low dose inhaled corticosteroid
stpe 3: low dose inhaled corticosteroid and a long acting beta agonist (or medium dose inhaled corticosteroid alone)
step 4: medium dose and LABA
step 5: high dose ICS and LABA
step 6: high dose ICS, LABA and corticosteroid
Based on the new treatment guidelines, what hsould asthma treatment be based on?
base initially on asthma severity and subsequently on asthma control as assessed serially by validated test
What is the only adjunctive therapy to demonstrate efficancy when added to high-dose inhaled corticosteroids plus long-acting beta agonists in patients with severe persistent allergic asthma?
omalixumab - a monoclonal antibody against immunoglobulin E
What should you test for with severe asthma?
do allergy skin testing
