what are clues of asthma?
night time symptoms
what are common clear triggers for asthma?
dust, fumes, perfumes, cold air, cockroach, exercise
what is the DDx of night time cough?
what does aspirin rarely cause?
at what age are most ppl diagnosed with asthma?
age of 7 (75% of the time)
what is methacholine challenge testing?
produces asthma attacks which rules out asthma
what can cause tracheal stenosis?
prolonged mechanical ventilation
when are we operating under negative pressure?
when are we operating under positive pressure?
in variable intrathoracic obstruction, when is the greatest deficit?
obstruction below the thoracic inlet
in variable extrathoracic obstruction, when is the greatest deficit?
obstruction above the thoracic inlet
what is the MCC of wheezing?
allergic rhinitis with post nasal drip
what is another common cause of wheezing?
what will you typically hear with ILD/pulmonary fibrosis?
fine crackles on inspiration
young hystrionic female who wheezes has what?
vocal cord dysfunction syndrome
what is a positive bronchodilator response?
12% or greater
increase of at least 200cc in FVC or FEV1
when would you use a peak expiratory flow monitor?
occupational asthma (look for difference b/w work and home) scary asthma (don't have dyspnea so they can't tell when they are in trouble)-monitoring at home
what does exhaled nitric oxide tell you?
NO is a by product of an asthma related reaction and increased amounts indicates asthma
what labs do you order for asthma pts?
IgE, allergy testing (RAST panel), CBC (eosinophils)
what might you see on CXR with asthma pt?
-used to exclude another problem
how would atelectasis appear on CXR?
what defines severe respiratory failure?
High respiratory rate combined with acidosis and normal pCO2
why are paralytics helpful?
ventilator can take complete control and less energy is going to the diaphragm to try to breathe
what can steroids plus paralytics cause?
critical illness polyneuropathy and myopathy
what is involved in vent management?
anything to prolong the expiratory time to decrease autopeep and subsequent barotrauma and improve hemodynamics
what is autoPEEP?
baseline volume of air needed to be maintained in order to allow continuous airway access
what is the underlying component of all COPD theray?
bronchodilate to allow air to get out of the lungs
what is the role of heliox?
prevents air turbulence in the vented pt
what is the role of nebulized heparin?
what is the overall approach to asthma txment?
monitor lung function serially
what are the goals of asthma therapy?
- symptom free
2. use SABA < 2x per month
what is a common asthma trigger?
who should avoid non selective beta blockers?
what do sulfites do?
can be an asthma trigger
what is the step up/step down approach?
step up to get control
then once controlled, step down to get minimal amount of drug necessary to control sxs
what is the txment approach for mild persistent asthma?
low dose ICS (1st choice) OR leukotriene antagonist or theophylline
what is the txment approach for moderate persistent asthma?
low dose ICS/LABA (shown to do better) or medium dose ICS
what is the main pathophysiology of asthma?
small airways and inflammation
who has an increased risk of pneumonia?
ICS use in COPD pts
-not first line therapy for COPD pts b/c of this
what is the txment approach for severe persistent asthma?
high dose ICS/LABA, IgE to see if may benefit from omalizumab (xolair) infusions, daily or qod oral steroids, leukotriene antagonist
what are -MAB drugs?
mono clonal antibodies
what are less studied, but useful drugs for severe asthma?
methotrexate, cyclosporine, new meds against IL-5
when do you need to get a contrast CT/
only when you want to visual mediastinum
what is ABPA?
allergic bronchopulmonary aspergillosis
how do you treat ABPA?
high dose steroids with long taper and anti-fungal (itraconazole 1st choice)
what do p and c-ANCA characterize?
small vessel vasculitis
what is Churg-Strauss dz?
can occur in steroid dependent asthmatic
can occur when leukotriene antagonist as added to regimen
how will atelectasis look on xray?
wedge toward anterior
cardiac asthma you should think
what are classic findings of mitral stenosis
straight left heart border
large left atrium