Pulm - Airway Disease Flashcards
Strong risk factors for development of asthma?
which affects 8% of US population
- personal or family hx of atopy
- maternal smoking qhile pregnant
- environmental exposure of tobacco smoke in childhood
first step in eval of asthma is what?
spirometry should show:
- reduced FEV1/FVC
- reversibility, 12+% improvement with bronchodilator
Describe aspirin-sensitive asthma and how to manage it?
severe persistent asthma, aspirin sensitivity, and hyperplastic eosinophilic sinusitis with nasal polyposis
Tx is to avoid ASA - if patients require aspirin then an aspirin desensitization procedure can be used.
What is allergic bronhcopulmonary aspergillosis?
How to diagnose?
Chronic hypersensitivty reaction that occurs in response to lower lobes colonization with aspergillosus. Inflammatoion causes impaired mucociliary clearance and expectoration of mucus plugs, destruction of pulmonary parenchyma, difficult to control asthma, and weight loss.
Diagnosed clinically and labs:
positive skin testing for aspergillus, high IgE titers of aspergillus, peripheral eosinophilia
imaging: proximal bronchiectasis, pleural thickening, transient infiltrates/atelectasis.
Treatment for allergic bronchopulmonary aspergillosis?
systemic glucocorticoids
fluconazole can be helpful
Anti-IgE tx like Omalizumab can be used in some patients
How might you differentiate allergic bronchopulmonary aspergillosis from Eosinophilic granulomatosis with polyangiitis?
Both have asthma syndrome with peripheral eosinophilias, BUT eosinophilic granulomatosis w/ polyaniitis typically has additional features like purpura on the hands and sensory or motor neuropathy
18yo patient complaints of throat and mid-chest tightness for the last 6 months during basketball practice and games. Hx of moderate perssitent asthma which has been realtively well controlled. He takes an as needed inhlaer with his symptoms, but his symptoms don’t respond much. On ENT evaluation it is noted that vocal cords adduct during inspiration. Diagnosis?
Vocal cord dysfunction
or paradoxical vocal cord motion
Threshold for intermittent rather than persistent asthma?
<2 days per week of sx <2x/month of nighttime awakening <2 days per week of SABA use for sx No interference of disease with normal life Normal FEV1 between exacerbations (>80%)
Difference between mild persistent and moderate persistent asthma?
mild:
- sx over 2 days per week, but not daily
- nighttime awakenings 3-4x per month
- SABA use multiple times per week, but not daily
- minor limitations in normal activities
- FEV1 >80% predicted, FEV1/FVC normal
moderate: over threshold into medium, but not severe sx and impairment
For what condition is Omaizumab indicated?
Moderate to severe persistent asthma with the following characteristics: (1) symptoms inadequately controlled with inhaled glucocorticoids, (2) evidence of allergies to perennial aeroallergens, and (3) serum IgE levels between 30 and 700 U/mL (30-700 kU/L) (normal range, 0-90 U/mL [0-90 kU/L]). Although it is very expensive, omalizumab has been shown to reduce emergency department visits and appears to be cost effective in appropriately selected patients; it is not indicated for use in patients other than those meeting these treatment parameters.
When a long-acting medicine is initiated in asthma, what’s the first one that is added?
Inhaled glucocorticoid (mainstay of asthma treatment, improves and controls symptoms, reduces exacerbations, and improves lung function)
Indications for lung tx in COPD?
In patients with advanced COPD, criteria for referral for lung transplantation include
-a history of exacerbations associated with acute hypercapnia; pulmonary hypertension, cor pulmonale, or both despite oxygen therapy;
or
-FEV1 less than 20% of predicted with DLCO less than 20% of predicted or homogeneous distribution of emphysema.
