What are prenatal risk factors for asthma?
What are postnatal risk factors for asthma
How is an asthma diagnosis made?
Does normal spirometry rule out asthma?
12% improvement in FEV1 over baseline and a total improvement of at least 200ml
AKA reversibility of airway obstruction
What qualifies as mild asthma?
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
What qualifies as moderate asthma?
SABA use daily with some limitation in daily activities
What qualifies as severe asthma?
SABA use several times per day, extremely limited in daily acitivities
What is the goal of ashtma management?
provide the best QOL through minimizing disease sx and abolishing exacerbations
What are exacerbations caused by?
Best way to treat asthma exacerbations?
Prevention, bronchodilators, glucocorticoids, O2
How to prevent asthma?
avoid tobacco smoke
balanced diet, Vit. D
What is COPD?
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
What are the common causes of COPD?
hx of TB
likely genetic deficiency, esp. A1A deficiency
What are the symptoms of COPD?
What are some comorbidies associated with COPD?
What are the "Pink Puffers"
fewer heart problems/comorbidities
hyperinflation, lower diffusion for CO
worse health status
What are the "Blue Bloaters"
more co-morbidities/heart problems
more chronic bronchitis, less emphysema
more diffusion capacity
higher IL6, CRP
What are the spirometry findings for COPD?
What are the goals of COPD management?
reduce sx, prevent disease progression
Send to pulmonary rehab
consider lung volume reduction surgery and transplantation
What is the mainstay of treatment for COPD?
LAMA+LABA increase lung function 2x (not nec. sx)
In which patients are inhaled corticosteroids used in COPD management?
for those at high risk of exacerbations
improves lung function but increases risk for PNA, thrush, etc.
What is the benefit of using oxygen therapy in patients with COPD?
(Used at least 15hrs if SaO2 is <88%)
what is the initial management of COPD?
Inhaled corticosteroids are indicated for COPD pt's when?
Consider ICS when?
Stop ICS when?
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
What is the mainstay of COPD treatment for acute exacerbations?
consider abx and oxygen if needed
prevent COPD exacerbations how?
flu and pneumococcal vaccine
long acting bronchodilators and ICS