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Exam Prep > Asthma / COPD > Flashcards

Asthma / COPD Flashcards

1
Q

COPD - when to suspect and how to diagnose

A

Consider COPD in patients >35yo if:
1) Sx - SOB, cough +/- sputum
2) current or ex-smoker

Dx via SPIROMETRY; persistent / post-broncodilator FEV1/FVC ratio <0.7
FEV1 %predicted indicates severity

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2
Q

COPD - Sx and spirometry for mild / moderate / severe

A

Mild: FEV1%pred 60-80
- SOB on moderate exertion
- no-minimal impact on ADLs
- cough + sputum

Moderate: FEV1%pred 40-59
- SOB on walking
- impact on ADLs
- recurrent chest infections +/- exacerbations requiring steroids or Abx

Severe: FEV1%pred <40
- SOB on any exertion
- severe impact on ADLs
- increasing frequency and severity of exacerbations

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3
Q

Name 8 broad management areas for COPD

A
  1. pharmacotherapy
  2. pulmonary rehabilitation
  3. COPD action plan
  4. encourage self-management
  5. manage comorbidities
  6. optimise nutrition
  7. smoking cessation
  8. vaccination
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4
Q

Name 4 non-pharmacological management steps for COPD

A
  1. Monitor impact and functional status using COPD assessment test every 2-3 months
  2. Encourage regular physical activity - walking for >150mins / week (>30 mins / day x5 days)
  3. Smoking cessation
  4. Refer for pulmonary rehabilitation
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5
Q

5As for smoking cessation

A
  • Ask and identify smokers at every visit
  • Assess nicotine dependence and motivation to quit
  • Advise about the risks of smoking and benefits of quitting
  • Assist cessation by offering behavioural counselling (inc. Quitline referral) and pharmacotherapy
  • Arrange follow-up within a week of the quit date and one month after
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6
Q

Outline the step-wise pharmacological management of COPD

A
  1. PRN SABA or SAMA
  2. add LAMA or LABA
  3. switch to LAMA + LABA combination
  4. add ICS
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7
Q

Name the drug options for COPD:
- SABA
- SAMA
- LAMA
- LABA
- ICS

A

SABA = short acting beta2-agonist
- salbutamOL or terbutaline

SAMA = short-acting muscarinic antagonists
- ipratropIUM

LAMA = long-acting muscarinic antagonists
- tiotropIUM, glycopyrronIUM, umeclidinIUM or aclidinIUM

LABA = long-acting beta2-agonists
- indacaTEROL, salmeTEROL or formoTEROL

ICS = inhaled corticosteroids
- fluticasONE or budesonIDE

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8
Q

Name at least one brand from each class of COPD inhaler

A

SABA = Ventolin/Asmol (salbutamOL), Bricanyl (terbutaline)
SAMA = Atrovent (ipratropIUM)

LAMA = Spiriva (tiotropIUM), Incruse (umeclidinIUM), Seebri (glycopyrronIUM)

LABA = Onbrez (indacaTEROL)

LABA/LAMA = Spiolto (tiotropIUM/olodaTEROL), Ultibro (indacaTEROL/glycopyrronIUM)

ICS/LABA = Seretide (fluticasONE/salmeTEROL), Symbicort (budesonIDE/formoTEROL), Breo (fluticasONE/vilanTEROL)

ICS/LAMA/LABA = Trelegy (fluticasONE/umeclidinIUM/vilanTEROL), Trimbow (beclometasONE/formoTEROL/glycopyrronIUM)

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9
Q

Outline an approach to COPD action plan for managing exacerbations

A

Treat any increase in baseline Sx early
1. Increase short-acting bronchodilator - eg. 4-8 puffs salbutamol every 3-4 hours
2. If Sx not improved, commence oral prednisolone 30-50mg daily for 5 days
3. If fever or change in colour/volume of sputum, add Abx (amoxicillin 500mg TDS vs. 1g BD or doxycyline 100mg daily) for 5 days

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10
Q

Outline the 4 steps to interpreting spirometry

A
  1. Shape of curve
    - Unable to blow out quickly -> concave curve = obstruction
    - Small volume curve = restrictive
    - Both of above = mixed, eg. CF
  2. FEV1/FVC ratio (>0.7 normal, <0.7 OBSTRUCTION)
  3. FEV1 + FVC (>80%pred normal, FVC <80%pred RESTRICTION)
  4. Change post-bronchodilator (FEV1 >+12% REVERSIBLE airways obstruction)
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11
Q

Asthma Ax - questions on history

A
  • current Sx
  • pattern of symptoms (day/night, seasonal)
  • triggers (exercise, viral infections, ingested substances, allergens)
  • relieving factors (SABA, other meds)
  • impact on work and lifestyle
  • home and work environment
  • smoking history (inc. passive)
  • PHx allergies inc. atopic dermatitis (eczema) or allergic rhinitis (‘hay fever’)
  • FHx asthma and allergies
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12
Q

Asthma - DDx

A

poor cardiopulmonary fitness

resp - bronchiectasis, COPD, hyperventilation, inhaled foreign body, large airway stenosis, pleural effusion, pulmonary fibrosis, rhinitis/rhinosinusitis, upper airway dysfunction

CVD - CCF, pulmonary hypertension

comorbid conditions - obesity, gastro-oesophageal reflux

lung Ca

rare disorders - alpha-1 antitrypsin deficiency

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13
Q

Asthma - when to suspect and how to diagnose

A

2+ of: wheeze, SOB, chest tightness, cough
Sx are recurrent or seasonal, worse at night, associated w common triggers, rapidly relieved by SABA
Esp if PHx atopy, FHx asthma + atopy

Dx via spirometry; expiratory airflow limitation (FEV1/FVC LLN) + reversible (FEV1 ≥+12%)
If high clinical suspicion and normal spirometry, consider treatment trial for Dx

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14
Q

What are the 5 Qs on the asthma score test?

A

In the last 4 weeks …
1. Impact on ADLs
2. Frequency of SOB
3. Frequency of night/morning Sx
4. Frequency of reliever use
5. Subjective rating of asthma control

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15
Q

What aspects are needed for GOOD asthma control?

A
  1. Daytime Sx 2 or fewer days per week
  2. SABA use 2 or fewer days per week
  3. No limitation of activities
  4. No Sx at night or on waking

Partial control if 1-2 and Poor control if 3+ not met

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16
Q

Outline the step-wise pharmacological management of asthma

A
  1. SABA PRN
  2. low dose ICS + SABA PRN; or low dose budesonIDE-formoTEROL PRN
  3. low dose ICS-LABA + SABA PRN; or low dose ICS-formoTEROL preventer + reliever
  4. medium-high dose ICS-LABA + SABA PRN; or ICS-formoTEROL medium dose preventer + low dose reliever; consider LAMA
  5. Refer specialist
17
Q

Name at least one brand of inhaler from each level of asthma treatment - level 1

For which pts can level 1 treatment be used?

A

SABA PRN
- Asmol/Ventolin (salbutamOL)
- Bricanyl (terbutaline)

18
Q

Name at least one brand of inhaler from each level of asthma treatment - level 2

A

low dose ICS + SABA PRN
- Pulmicort (budesonIDE 200-400mcg)
- Flixotide (fluticasONE 100-200mcg)

or

budesonIDE-formoTEROL PRN
- Symbicort turbuhaler (200/6 DPI) or rapihaler (100/3 MDI)

19
Q

Name at least one brand of inhaler from each level of asthma treatment - level 3

A

low dose ICS-formoTEROL preventer + reliever
- Symbicort (budesonIDE-formoTEROL), ICS dose <200mcg preventer <400mcg daily
- Fostair (beclametasONE-formoTEROL), ICS dose <100mcg preventer <200mcg daily)

or

low dose ICS-LABA + SABA PRN
- Seretide (fluticasONE-salmeTEROL), ICS dose <200mcg
+ above

20
Q

Name at least one brand of inhaler from each level of asthma treatment - level 4

A

ICS-formoTEROL medium dose preventer + low dose reliever
- Symbicort (budesonIDE-formoTEROL), medium dose 250-400mcg, low dose 100-200mcg
- Fostair (beclametasONE-formoTEROL)

or

medium-high dose ICS-LABA + SABA PRN
- Breo (fluticasONE-vilanTEROL), ICS dose 100-200mcg
- Seretide (flutcasONE-salmeTEROL), ICS dose 250+mcg
+ above

21
Q

When should LAMA’s be considered in asthma?

A

At level 4 of asthma treatment
Ie. Sx on most days, frequent waking, poor baseline lung function
Eg. Spiriva (tiotropIUM) 2.5mcg (PBS restricted)

22
Q

Outline the general approach to an Asthma Action Plan

A
  1. Use 1-2 puffs of reliever if asthma Sx
  2. Increase steroid dose:
    - start ICS preventer and continue for >2-4/52
    - increase ICS-only preventer dose x4 for 7-14d
    - increase ICS-LABA dose for 7-14d
  3. Oral pred 37.5-50mg daily for 5-10d
23
Q

Outline the approach to reviewing asthma treatment

A

Step down if good asthma control for 2-3 months -> reduce ICS dose by 25-50%

Before stepping up treatment, review adherence, exposure to triggers and inhaler technique

24
Q

When is asthma vs COPD more likely
- age of onset
- pattern of Sx
- lung function
- history
- long-term disease trajectory
- chest XR

A

Age of onset
- asthma if <20yo, COPD if >40yo

Pattern of Sx
- asthma if variable, COPD if persistent

Lung function
- asthma if variable / reversible, COPD if persistent

History
- asthma if PHx asthma, COPD if PHx COPD/chronic bronchitis/emphysema
- asthma if FHx asthma/allergies
- COPD if smoke exposure

Long-term disease trajectory
- asthma if seasonal or yearly
- COPD if progressive over years
- asthma if response to treatment lasts weeks, COPD if response to treatment is limited/short term

Chest XR
- asthma if normal, COPD if hyperinflation

25
Q

Paeds Asthma Dx
- <12m
- 1-5yo
- >6yo

A

<12m - wheeze most commonly due to acute viral bronchiolitis and/or small/floppy airways

1-5yo = preschool wheeze - treatment trial -> ‘provisional’ Dx if responsive

> 6yo - spirometry vs treatment trial

26
Q

Paeds Asthma Mx
- <12m
- 1-5yo
- >6yo

A

<12m - asthma unlikely, specialist input prior to commencing SABA or steroid

1-5yo - SABA PRN if Sx responsive + preventer if Sx in between URTIs

> 6yo - SABA PRN + regular preventer if frequent intermittent or persistent Sx, or severe flare-ups

27
Q

Paeds Asthma preventer options + step-wise Mx

A

low dose ICS (preferred if atopy)
- Flixotide junior (fluticasONE 50-100mcg, max 200mcg)
or
montelukast (note risk of behavioural/neuropsychiatric AEs)

Step up:
1. high dose ICS (Flixotide max 500mcg) vs. combo low dose ICS + montelukast
2. If >6yo, low dose ICS-LABA combination

27
Q

Inhaled corticosteroid dose categories for:
Budesonide

Fluticasone furoate

A

Budesonide:
- Low 200-400
- Medium 500-800
- High >800

Fluticasone furoate:
- Low 50
- Medium 100
- High 200

Exam Prep (28 decks)

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