Treatment of Obstructive Lung Disease

Question 1

Well-controlled asthma presents with the following criteria:

Answer 1

• Symptoms no more than twice per week
• Night symptoms no more than twice per month
• Rescue inhaler used less than twice weekly (except prior to exercise)
• Peak flow near normal
• Oral steroid no more than once per year
• Urgent care no more than once per year

Question 2

The first step of asthma treatment is __________.

Answer 2

short-acting ß-agonist as needed

Question 3

Omalizumab inhibits ___________.

Answer 3

IgE binding to the high-affinity IgE receptors on mast cells

Question 4

Mepolizumab is ___________.

Answer 4

an inhibitor of IL-5, the cytokine responsible for eosinophil growth and differentiation

Question 5

Allergic immunotherapy has been shown to be effective for _________ than asthma.

Answer 5

allergic rhinitis and conjunctivitis

Question 6

Systemic glucocorticoids are used only for __________.

Answer 6

management of severe asthma and asthma exacerbations

Question 7

ß-agonists stimulate ________ in the lungs that leads to ________.

Answer 7

ß2 adrenergic receptors; bronchodilation and decreased mucus secretion

Question 8

How do anticholinergic agents (like tiotropium) work?

Answer 8

They inhibit the parasympathetic input of acetylcholine, which would stimulate bronchoconstriction and mucus secretion.

Question 9

Glucocorticoids inhibit the phospholipase that produces arachidonic acid. What are two beneficial corollaries of this?

Answer 9

It decreases inflammation and induces vasoconstriction (an effect that reduces pulmonary edema).

Question 10

Leukotriene inhibitors (like montelukast) ___________.

Answer 10

induce bronchodilation and inhibit inflammation

Question 11

Cromolyn/nedocromil are ___________.

Answer 11

inhaled mast-cell mediator inhibitors

Question 12

Theophylline is a __________ inhibitor.

Answer 12

phosphodiesterase inhibitor

Question 13

The desirable range for inhaled medications is __________.

Answer 13

1 - 5 microns

Question 14

Asthma symptoms are typically worse at __________.

Answer 14

night and in the early mornings

Question 15

All those with COPD have FEV/FVC

Answer 15

• Mild: >80%
• Moderate: 50% - 80%
• Severe: 30% - 50%
• Very severe:

Question 16

The best treatment for COPD is ________.

Answer 16

smoking cessation

Question 17

Secondary therapeutic options (i.e., after smoking cessation) for those with COPD include ___________.

Answer 17

physical activity and pulmonary rehab

Question 18

What is step 2 of asthma management?

Answer 18

SABA as needed and low-dose ICS

Question 19

What is step 3 of asthma management?

Answer 19

SABA as needed and either (1) low-dose ICS and LABA or (2) medium-dose ICS

Question 20

What is step 4 of asthma management?

Answer 20

SABA, medium-dose ICS, and LABA

Question 21

What is step 5 of asthma management?

Answer 21

SABA, high-dose ICS, and LABA

Question 22

What is step 6 of asthma management?

Answer 22

SABA, high-dose ICS, LABA, and oral corticosteroid

Question 23

Which asthma medication has a black-box warning for increased risk of asthma-related deaths?

Answer 23

LABAs

Question 24

LABAs do not reduce __________.

Answer 24

inflammation

Question 25

Anticholinergics are preferred in those with _________.

Answer 25

COPD

Question 26

Children given greater than 400 micrograms of fluticasone per day have been shown to _________.

Answer 26

have growth impairment

Question 27

The dose of ICS should be __________ every three months.

Answer 27

reduced to the minimum needed for control

Question 28

All COPD patients are given ___________; only those in the most severe category (D) are given __________.

Answer 28

LAMAs and/or LABAs; ICS

Question 29

Ipratropium is an ____________.

Answer 29

anticholinergic agent