Asthma and COPD

Question 1

what gender is more at risk for asthma?

Answer 1

childhood: boys; women when in puberty or young adulthood

Question 2

what are the prenatal risk factors for asthma?

Answer 2

ethnicity, low SES, stress, c-section, maternal tobaccos smoking

Question 3

what is the largest epidemiological risk factor for asthma?

Answer 3

prematurity

Question 4

what are the postnatal risk factors for developing asthma?

Answer 4

levels of endotoxins and allergens within the home, viral and bacterial infection (especially RSV and adenovirus), air pollution, antibiotic use, acetaminophen exposure, obesity

Question 5

what is the pathophysiology of asthma: airway inflammation?

Answer 5

T2-type inflammation, sensitized by allergens, accompanying inflammatory infiltrate= eosinophils, defective resolution of process

Question 6

what is the pathophysiology of asthma: airway remodeling?

Answer 6

increased airway smooth muscle, thickened subepithelial reticular lamina, increased mucous cells in new areas, increased mucous production

Question 7

how do you diagnose asthma?

Answer 7

appropriate clinical symptoms+ reversible airflow limitation and/or airway hyper-responsiveness

Question 8

what would spirometry show in in a symptomatic asthmatic patient?

Answer 8

a predicted FEV1 of less than 80%; age adjusted FEV1/FVC of less than 75%; reversibility of airway obstruction: 12% improvement in FEV1 over baseline + total improvement of at least 200 ml; but normal spirometry does not exclude this disease

Question 9

there are two main types of asthma, what are they?

Answer 9

intermittent asthma and persistent asthma

Question 10

how is intermittent asthma defined?

Answer 10

symptoms fewer than 2 days a week, nighttime awakenings less than 2 times a month, going to need their rescue inhaler less than 2 times a week

Question 11

how do you treat intermittent asthma?

Answer 11

SABA only

Question 12

how is mild persistent asthma defined?

Answer 12

symptoms more than 2 days a week, but not daily, nighttime awakenings 3-4x/month, SABA use more than 2 times a week but not daily

Question 13

how do you treat mild persistent asthma?

Answer 13

they need an ICS

Question 14

how is moderate persistent asthma defined?

Answer 14

symptoms daily, nighttime awakenings more than one time a week, but not daily, SABA use daily

Question 15

how do you treat moderate persistent asthma?

Answer 15

add a LABA

Question 16

how is severe persistent asthma defined?

Answer 16

symptoms present throughout the day, daily nighttime awakenings, SABA use several times per day

Question 17

what occurs at an initial visit for asthma?

Answer 17

diagnose the asthma, assess asthma severity, initiate medication and demonstrate use, develop written asthma action plan, schedule follow up appointment

Question 18

what is the major goal of the treatment and management of asthma?

Answer 18

provide the best quality of life through minimizing disease symptoms and abolishing disease exacerbations

Question 19

how do you treat intermittent asthma?

Answer 19

SABA as needed

Question 20

step 2 of asthma plan?

Answer 20

low dose ICS

Question 21

step 3 of asthma plan?

Answer 21

low dose ICS + laba OR medium dose ICS

Question 22

step 4 of asthma treatment plan

Answer 22

medium dose ICS + LABA

Question 23

step 5 of asthma treatment plan

Answer 23

high dose ICS+ LABA AND consider omalizumab

Question 24

step 6 of asthma treatment

Answer 24

high dose ICS + LABA + oral corticosteroid

Question 25

what is important to remember about the treatment of persistent asthma?

Answer 25

need to have an ICS and if they are at a moderate or severe persistent stage or classification then you will likely add a LABA while considering increasing the intensity of their ICS

Question 26

how should SABAs be prescribed?

Answer 26

the intensity of treatment depends on severity of symptoms; up to 3 treatments every 20 minutes as needed

Question 27

what is generally a sign of inadequate control of asthma?

Answer 27

use of saba more than 2 days per week for symptom relief

Question 28

what are some of the complications associated with asthma?

Answer 28

poor QOL, PNA, pneumothorax, resp failure, COPD

Question 29

what is one of the best studied asthma prevention measures?

Answer 29

breastfeeding

Question 30

what is the strongest association with mortality from COPD?

Answer 30

poverty

Question 31

what are the risk factors for COPD?

Answer 31

smoking, history of tuberculosis

Question 32

what are the three main pathological features of COPD?

Answer 32

obstructive bronchiolitis, emphysema, and mucus hypersecretion

Question 33

what are acute exacerbations of COPD?

Answer 33

episodes of symptom worsening that are usually associated with increased airway inflammation and systemic inflammatory effects

Question 34

what are the symptoms of an acute exacerbation of COPD?

Answer 34

increased dyspnea, increased sputum purulence, increased cough, increased wheezing, and beyond normal day-to-day variation

Question 35

what does spirometry show in a patient with COPD?

Answer 35

FEV1/FVC is going to be less than .7; low FEV1; less than 12% reversibility

Question 36

what is the gold 1 classification of copd?

Answer 36

mild: FEV1 will be greater than 80% of the predicted value

Question 37

what is the gold 2 classification of COPD?

Answer 37

moderate: 50% < FEV1< 80% predicted

Question 38

what is the gold 3 classification of COPD?

Answer 38

severe: 30% < FEV1< 50% predicted

Question 39

what is the gold 4 classification of COPD?

Answer 39

very severe: FEV1 < 30% predicted

Question 40

what are the goals of COPD treatment and management?

Answer 40

to reduce symptoms and to reduce risk

Question 41

how do you pharmacologically treat COPD?

Answer 41

bronchodilators are the mainstay: prefer long-acting meds: LABA=LAMA in effectiveness LABA+ LAMA= 2x the lung function but not 2x symptom improvement

Question 42

when do you use inhaled corticosteroids in COPD patients?

Answer 42

for those at risk of exacerbations

Question 43

what are the risks of using ICS in COPD patients?

Answer 43

increases risk of PNA, oral thrush, hoarse voice, maybe osteoporosis

Question 44

how does oxygen affect copd?

Answer 44

oxygen for at least 15 hours per day if SaO2 is <88% REDUCES MORTALITY

Question 45

when should you be against the use of ICS?

Answer 45

repeated PNA events, blood eosinophils less than 100, and history of mycobacterial infection

Question 46

what is the mainstay for treatment of acute exacerbations of COPD?

Answer 46

oral corticosteroids