Asthma and COPD Flashcards

1
Q

What are prenatal risk factors for asthma?

A

ethnicity

low SES

stress

C-section

maternal smoking

prematurity

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2
Q

What are postnatal risk factors for asthma

A

allergens

viral/bacterial infections

pollution

abx use

tylenol use

obesity

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3
Q

How is an asthma diagnosis made?

Does normal spirometry rule out asthma?

A

12% improvement in FEV1 over baseline and a total improvement of at least 200ml

AKA reversibility of airway obstruction

No

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4
Q

What qualifies as mild asthma?

A

symptoms >2 days/week but not daily

night time wakenings 1-2xmonth to 3-4xmonth

exacerbations requiring corticosteroids >2 in 6 months or wheezing >4x per year lasting >1 day and risk factors for persistent asthma

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5
Q

What qualifies as moderate asthma?

A

SABA use daily with some limitation in daily activities

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6
Q

What qualifies as severe asthma?

A

SABA use several times per day, extremely limited in daily acitivities

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7
Q

What is the goal of ashtma management?

A

provide the best QOL through minimizing disease sx and abolishing exacerbations

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8
Q

What are exacerbations caused by?

Best way to treat asthma exacerbations?

A

infections, allergens

Prevention, bronchodilators, glucocorticoids, O2

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9
Q

How to prevent asthma?

A

breastfeeding

avoid tobacco smoke

target obestiy

balanced diet, Vit. D

allergy avoidance?

Gut microbiome?

vaccinations

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10
Q

What is COPD?

A

persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles and gases

It is largely irreversible

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11
Q

What are the common causes of COPD?

A

smoking

hx of TB

pollution?

likely genetic deficiency, esp. A1A deficiency

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12
Q

What are the symptoms of COPD?

A

dyspnea

sputum

cough

wheezing

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13
Q

What are some comorbidies associated with COPD?

A

CAD

arrhythmias

HTN

HF

Lung Ca

depression/anxiety

metabolic syndrome

osteoporosis

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14
Q

What are the “Pink Puffers”

A

more emphysema

lower BMI

fewer heart problems/comorbidities

hyperinflation, lower diffusion for CO

more dyspnea

worse health status

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15
Q

What are the “Blue Bloaters”

A

higher BMI

more co-morbidities/heart problems

OSA-COPD overlap

less hyperinflation

more chronic bronchitis, less emphysema

more diffusion capacity

higher IL6, CRP

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16
Q

What are the spirometry findings for COPD?

A

FEV1/FVC <.70

Low FEV1

<12% reversibility

17
Q

What are the goals of COPD management?

A

reduce sx, prevent disease progression

Send to pulmonary rehab

consider lung volume reduction surgery and transplantation

18
Q

What is the mainstay of treatment for COPD?

A

bronchodilators

LAMA+LABA increase lung function 2x (not nec. sx)

19
Q

In which patients are inhaled corticosteroids used in COPD management?

A

for those at high risk of exacerbations

improves lung function but increases risk for PNA, thrush, etc.

20
Q

What is the benefit of using oxygen therapy in patients with COPD?

A

REDUCES MORTALITY

(Used at least 15hrs if SaO2 is <88%)

21
Q

what is the initial management of COPD?

A

smoking cessation

vaccination

encourage xercise

patient education

manage co-morbidities

22
Q

Inhaled corticosteroids are indicated for COPD pt’s when?

Consider ICS when?

Stop ICS when?

A

history of exerbation requiring hospital stay, >2 exerbations per year, blood eosinophils >300, hx of asthma

1 exacerbation per year, eosinophils 100-300

repeated PNA, eosinophils <100, mycobacterial infection

23
Q

What is the mainstay of COPD treatment for acute exacerbations?

A

Oral corticosteroids

consider abx and oxygen if needed

24
Q

prevent COPD exacerbations how?

A

flu and pneumococcal vaccine

long acting bronchodilators and ICS

consider mucolytics