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Acute Care Seminar 1 > COPD & Asthma > Flashcards

COPD & Asthma Flashcards

1
Q

COPD Definition

A

-Defined by persistent respiratory symptoms due to limitation in the airflow in the airway and/or alveolar abnormalities.
-2 most common types: Chronic Bronchitis and Emphysema

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2
Q

COPD-Spectrum of Disease

A

-Large airway condition: chronic bronchitis, tracheomalacia, asthma, cystic fibrosis, bronchiectasis

-Small airway disease: bronchiolitis, bronchiolectasis

-Distal airspace disease: emphysema

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3
Q

Signs/Symptoms COPD

A

-Dyspnea, cough (chronic) +/- sputum production
-Recurrent respiratory infections
-Signs of malnutrition (BMI<19) or obesity
-Edema or cyanosis in the extremities
-Nasal polyps, cobblestoning in the airway, stridor, dysphonia
-Lung crackles, wheezing, expiratory slowing, decreased breath sounds

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4
Q

Initial COPD workup

A

-PFTs with bronchodilators
-Hyperinflated lungs, diaphragm may appear lower and flat on imaging
-Lung cancer screening
-CBC, BMP, Fasting glucose, NT-ProBNP

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5
Q

Alpha-1Antitrypsin Deficiency

A

-Most common cause of emphysema

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6
Q

Spirometry: FVC

A

-Measures the volume of air that can forcibly be exhaled from the point of maximal inspiration (forced vital capacity, FVC)

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7
Q

Spirometry: FEV1

A

Measures the volume of air exhaled during the first second of FVC (forced expiratory volume in one second, FEV1)

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8
Q

FEV1/FVC Ratio

A

The presence of an FEV1/FVC ratio of < 0.70 postbronchodilator confirms there is airflow limitation

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9
Q

GOLD Stage 1 (mild)

A

-FEV1/FVC <70%
-Can be managed w/ SABA, hospitalization not required

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10
Q

GOLD Stage 2 (moderate)

A

–FEV1/FVC <70%,
-FEV1 <50-70%
-Requires SABA, antibiotics and/or oral corticosteroids, hospitalization likely

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11
Q

GOLD Stage III (severe)

A

-FEV1/FVC <70%
-FEV1 <30-50%
-Evidence of acute respiratory failure

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12
Q

GOLD Stage IV (very severe)

A

-FEV1/FVC <70%
-FEV1 <30% or <insufficiency

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13
Q

Short Acting Beta2-Agonist (SABA) Bronchodilator -Albuterol containing

A

-Rescue Inhaler
-ProAIR
-Proventil
-Ventolin
-Xopenex

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14
Q

Long Acting Beta2-Agonist (LABA) Bronchodilator

A

(offers relief of coughing, wheezing, dyspnea for at least 12 hours)
Servant diskus
Striverdi Respimat

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15
Q

Inhaled Corticosteroids

A

reduce and prevent swelling of airways, does not provide relief for acute symptoms such as coughing, dyspnea, wheezing
-Flovent, Pulmicort
Arnuity Ellipta, Alvesco
Armon Air, Asmanex
QVAR

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16
Q

Muscarinic Antagonists (LAMA)

A

-anticholinergic, relieves cough, sputum production, wheeze, and chest tightness

-Short acting (SAMA)
Atrovent

-Long Acting (LAMA)
Incruse Ellipta
Spiriva
Tudorza

17
Q

COPD Exacerbation

A

-Oxygen: 88-92%
-Blood gas, CBC, BMP, CXR
-Increase bronchodilators for symptomatic relief (DuoNebs)
-Consider oral steriods (typically prednisone 40 mg x 5 days_
-Consider abx (Azithromycin or Doxy x 5 days)
-Provide VTW ppx
-Manage other comorbidities

18
Q

Asthma Definition

A

Respiratory condition in which airways become swollen and narrow. There may also be excess mucus production.

19
Q

Asthma Signs and Symptoms

A

coughing, wheezing, chest tightness, SOB

20
Q

Asthma Diagnostic Tests

A

-Spirometry: >200mL and 12% improvement in FEV1after bronchodilator
-Methacholine challenge if spirometry normal-decrease in FEV1 of 20%
-Exhaled nitric oxide

21
Q

Mild Intermittent Asthma Lung Function

A

-FEV 1 or PEF > OR Equal 80% predicted
-PEF variability <20%

22
Q

Mild Persistent Asthma Lung Function

A

-FEV1 or PEF >80% predicted
-PEF variability 20-30%

23
Q

Moderate Persistent

A

-FEV1 or PEF < or equal to 70% predicted value

24
Q

Severe Persistent

A

-FEV1 or PEF < or equal to 50% predicted

25
Q

Asthma Exacerbation Management

A

-O2 saturations 93-95%
-Frequent dosing of bronchodilator (typically albuterol via nebulizer)
-Systemic steroids (oral or IV) typically prednisone 40-60 mg daily or 32-48 mg of methylprednisone daily. IV is usually reserved for severe exacerbation, can also consider high dose steroids. 5-day course
-Continue home inhaled corticosteroid or combination inhaler

26
Q

Step 1-Intermittent Asthma

A

-PRN SABA

27
Q

Step 2-Persistent Asthma

A

-Daily low dose ICS and PRN SABA or prn concomitant ICS and SABA

28
Q

Step 3-Persistent Asthma

A

-Daily and PRN combination low-dose ICS-formaterol

29
Q

Step 4-Persistent Asthma

A

-Daily and PRN combination medium-dose ICS-formaterol

30
Q

Step 5-Persistent Asthma

A

-Daily medium-high dose ICS-LABA + LAMA and PRN SABA

31
Q

Step 6-Persistent Asthma

A

-Daily high-dose ICS-LABA + oral systemic corticosteroids + PRN SABA

Acute Care Seminar 1 (31 decks)

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