Week 12 Chronic Resp.

Question 1

Examples of some chronic respiratory diseases…

Answer 1

1) Asthma
2) COPD (chronic bronchitis and emphysema)

Question 2

What is asthma?

Answer 2

A chronic inflammatory obstructive disease

Question 3

The cause of asthma

Answer 3

is unknown (may b related to allergens/ environmental factors, URIs, or physiologic factors such as stress)

Question 4

Asthma causes

Answer 4

Smooth muscle contraction and excessive mucus production
V/Q abnormalities Hyper-inflammation of the lungs with increase in lung volume Air wall remodeling

Question 5

Asthma Symptoms

Answer 5

Shortness of breath
Wheezing
Cough
Chest tightness

Question 6

When do the symptoms of asthma commonly occur?

Answer 6

In evening and early morning, may cause nocturnal arousal

Question 7

What triggers asthma?

Answer 7

Allergen exposure (Dust, Drugs, Pets)
Respiratory infections
Strong expression of emotion
Vigorous exercise
Cold air
Air pollution Cigarette smoke

Question 8

Allergic Asthma

Answer 8

Underlying allergic disease
Usual childhood onset
H/o atopic dermatitis (eczema)
Elevated IgE
Eosinophilia
Skin testing positive
Triggers

Question 9

Non Allergic Asthma

Answer 9

Onset after age 30
Negative skin testing
Eosinophilia
Chronic sinusitis, nasal polyps, sensitivity to NSAIDs, ASA, exercise, chemical triggers, GERD, URIs

Question 10

What are some findings with asthma?

Answer 10

CxR may be normal or hyper-lucent
Thick tenacious secretions
Wheezing
Prolonged expiration
Dyspnea
Increase in airway resistance

Question 11

How is asthma diagnosed?

Answer 11

Thorough History Clinical exam
PFTs
Spirometry (Gold standard)
Decreased FEV1 (airflow obstruction)

Question 12

Asthma goals for therapy

Answer 12

Control of chronic and nocturnal sxs
Maintain normal activity levels including exercise
Prevent acute episodes
Minimize hospitalizations
Near normal/ normal pulmonary function
Avoid medication side effects

Question 13

Long term control medications for Asthma

Answer 13

Corticosteroids
Long acting beta agonists (LABAs) Inhaled corticosteroids (ICS) +LABA Leukotriene modifiers

Question 14

Quick relief medications for Asthma

Answer 14

Short acting inhaled beta agonists Anticholinergics Systemic corticosteroids

Question 15

What is Albuterol?

Answer 15

Short acting Beta 2 Agonist

Question 16

How does Albuterol act?

Answer 16

It acts on the smooth muscle of the bronchial tree reducing airway resistance

Question 17

Albuterol routes

Answer 17

Inhaled

Nebulized

Question 18

1) Albuterol Onset
2) Albuterol Duration

Answer 18

1) 5-15 min
2) 2-6 hours

Question 19

Albuterol Drug Interactions

Answer 19

Digoxin (PO increases whereas albuterol decreases potassium) MAOIs — potentiates albuterol Beta blockers — bronco spasm, inhibition of therapeutic effects Thyroid hormones — potentiates cardiac effects of both drugs

Question 20

LABAs are used for

Answer 20

(Salmeterol –Serevent & Fomoterol – Foradil) short term for bronchodilation or in combination with Inhaled Corticosteroids (ICS)

Question 21

What is the black box warning for LABAs?

Answer 21

NEVER to use singly in patients with asthma and children under 4 (increases the death and intubation by 2 folds)

Question 22

LABA route

Answer 22

Inhaled as a powder

Question 23

1) Anticholinergics use in respiratory comfort for ____

2) What are they primarily used for respiratory wise?

Answer 23

1) Reducing mucus production

2) Primarily used in ppl with COPD

Question 24

Anticholinergics are contraindicated for ____

Answer 24

Ppl with peanut and soybean allergy