Shortness of Breath with Dr. Johns Part II

Question 1

What is dyspnea?

Answer 1

abnormally uncomfortable awareness of breathing

Question 2

What is on the differential diagnosis for dyspnea on exertion?

Answer 2

CHF
angina
obstructive lung disease
pleural effusion
anemia
hypohtyroid
metabolic acidosis
anxiety with hyperventilation

Question 3

What is COPD’s rank in cause of death in the US?

Answer 3

4th

Question 4

How is COPD defined?

Answer 4

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

Question 5

What is chronic bronchitis defined as?

Answer 5

chronic productive cough for three months in two successive years

Question 6

What is emphysema defined as?

Answer 6

enlargement of airspaces with destruction o bronchiole walls

actually a pathological term

Question 7

How is asthma defined?

Answer 7

inflammatory disease of airways with significantly REVERSIBLE narrowing

Question 8

What is the main difference between asthma and COPD?

Answer 8

COPD is permanent and asthma is reversible - but you can have combinations of the two

Question 9

Who usually gets COPD?

Answer 9

patients who have smoked at least 20 cigarettes per day for 20 or more years

Question 10

How does COPD usually start symptomatically? When does the dyspnea develop?

Answer 10

chronic cough

dyspea typically doesn’t start until 10-20 years after the cough

Question 11

What is the main way to establish a diagnosis of COPD?

Answer 11

spirometry

Question 12

As COPD proresses, what are some symptoms you can expect?

Answer 12

chronic clear sputum production
weight loss
morning headache
hypercapnia with hypoxemia
cor pulmonale

Question 13

IN general, what happens to FEV1 as a person ages normally, ages with asthma and ages with COPD?

Answer 13

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

Question 14

What are some physical exam findings you’ll see in COPD?

Answer 14

prolonged expiration
hyperinflation - barrel chest
hyperresonant percussion
depressed diaphragm
decreased breath sounds
wheezes
use of accessory muscles
pursed lips
cyanosis
enlarged liver
asterixis

Question 15

How can you differentiate a pulmonary funtion test abnormality due to asthma from that of COPD?

Answer 15

give a bornchodilator and retest - asthma will improve and COPD won’t

Question 16

What are some of the findings you would see on CXR for COPD?

Answer 16

hyperlucent lung fields
vascular crowding with curvilinear pattern
increased anteroposterior diameter
flattening of diaphrgm
increased retrosternal air space

Question 17

What happens to FEV1 and FEV/FVC do in COPD?

Answer 17

both go down

Question 18

What’s the number one thing to do for management of stable COPD?

Answer 18

get them to stop smoking - it can slow the decline in FEV1

Question 19

What are the two main drugs we use in COPD?

Answer 19

beta-2 agonist bronchodilators (albuterol inhaler prn)

anticholinergic agents (inhaled ipratropium)

Question 20

What COPD drug is controversial due to high risk of toxicity?

Answer 20

theophylline

Question 21

When should you use corticosteroids in COPD?

Answer 21

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

Question 22

When should you prescribe supplemental oxygen in COPD?

Answer 22

if O2 aturations goes below 88% room air or falls below 85% with exertion

or if cor-pulmonale present

Question 23

What are the three types of COPD?

Answer 23

asthma, emphysema and chronic bronchitis

Question 24

What’s been happening to the prevalence of asthma?

Answer 24

increaseing

Question 25

What’s the classic triad of symptoms in asthma?

Answer 25

persistent wheeze
chronic cough
chronic dyspnea

Question 26

What will you see on physical exam in asthma?

Answer 26

widespread, high-pitched wheezes

accessory muscle use

pulsus paradoxus (greater than 10 mmHg fall in systolic pressure during inspiration)

Question 27

What pulmonary function test parameter is used to check an asthmatic’s percent from personal best?

Answer 27

the peak expiratory flow rate

Question 28

What are the color designations for the peak expiratory flow rates?

Answer 28

red - less than 50% of personal best
yellow - 50-80%
green - over 80%

Question 29

When you’re doing pulmonary function testing before and after bronchodilators, what is the percent improvement required for it to be considered responsive?

Answer 29

12% or more is considered responsive

Question 30

What provocative test can we use to establish an asthma diagnosis in someone with symptoms but normal spirometry?

Answer 30

methacholine challenge - it’s a bronchoconstrictor

Question 31

What are the 4 severity categories of asthma?

Answer 31

mild intermittent
mild persistent
moderate persistent
severe

Question 32

What is the stepwise approach for manageing asthma in patients aged 12 years or older?

Answer 32

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

Question 33

Based on the new treatment guidelines, what hsould asthma treatment be based on?

Answer 33

base initially on asthma severity and subsequently on asthma control as assessed serially by validated test

Question 34

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?

Answer 34

omalixumab - a monoclonal antibody against immunoglobulin E

Question 35

What should you test for with severe asthma?

Answer 35

do allergy skin testing