Asthma And COPD - Dr. Miller

Question 1

Prevalence in the Asthma

Answer 1

Boys childhood (genetics), women adult and puberty (maybe sex hormones)
(Also farther away from equator and rural places have higher rates)

Question 2

Risks of asthma

Answer 2

1. GI microbiome —> pulmonary microbiome
2. Lung function
3. Delayed immune maturation
4. Viral and LRTI

Question 3

Prenatal risks for asthma

Answer 3

Ethnicity, C section, Stress, Low Socioeconomic, tobacco use mother

Question 4

Postnatal risks for asthma

Answer 4

1. Endotoxins and allergens at home (duct mites)
2. Viral and bacterial infection (RSV, adenovirus)
3. Pollution
4. ABs, acetaminophen
5. Obesity

Question 5

Inflammation in asthma consists of what

Answer 5

1. T2 type inflammation (M2 cells)
2. Allergens (dust, fungi, pets, pollen) cause inflammation = Eosinophils
3. Defect in resolution of inflammation

Question 6

Airway remodeling in asthma consists of

Answer 6

1. SM proliferation in airway
2. Mucous cells production increased + more mucous production
3. Thickened subepithelial reticular lamina

Question 7

Asthma SX

Answer 7

1. Exacerbations
2. Worse at night, exercise, viral inf, allergen exposure, weather changes, laugh/crying, stress
3. Chest tightness, SOB
4. Wheezing

Question 8

Asthma DX

Answer 8

SPIROMETRY (does not exclude disease if normal)

1. FEV1 <80%
2. FEV1/FVC <75%
3. obstruction of airway is reversible (12% improvement in FEV1, at least 200mL improvement total)** ——> you know its not COPD

Question 9

Asthma with normal spirometry what do you do

Answer 9

1. Give bronchodilator or corticosteroids and see improvement
2. Give give methocholine or menatol and see hyperrespnsive reaction (you need to be prepared for severe attack)

Question 10

Classifying Asthma (what are the 2 types)

Answer 10

Intermittent and persistent

Question 11

Intermittent asthma is what

Answer 11

1. Sx less then 2d / week
2. Night time awakening < 2d/month
3. Asthma exacerbation needing corticosteroids 0-1/year
4. Normal activity no sx
5. Rescue inhaler < 2days/week

Question 12

Persistent Asthma MILD

Answer 12

1. More then 2d/week sx
2. Minor limitation in normal activity
3. <2/month awake from night
4. 2 or more exacerbation needing tx/ year

Question 13

Persistent Asthma moderate

Answer 13

1. Sx daily
2. 3-4 nights / month awake
3. Daily inhaler need
4. > 2 exacerbation per year

Question 14

Persistent Asthma severe

Answer 14

1. Sx throughout day
2. Several times a week awake night
3. Inhaler multiple times a day
4. Extreme limitation in normal activity
5. More then 2 exacerbation per year

Question 15

Most severe and risky effect of asthma

Answer 15

Exacerbations

Question 16

Intermittent asthma TX

Answer 16

SABA as needed (inhaler), short-acting beta agonist = ALBUTEROL

Question 17

Persistent asthma TX step 2-6

Answer 17

STEP 2 : SABA + LOW ICS (inhaled corticosteroids)
STEP 3 : + LABA (long acting beta agonist) or MEDIUM ICS
STEP 4 : + LABA (long acting beta agonist) and MEDIUM ICS
STEP 5 : + HIGH ICS + LABA + omalizumab
STEP 6 : + HIGH ICS + LABA + corticosteroid

Question 18

SABA more then 2 times a week

Answer 18

Inadequate therapy and need more therapy

Question 19

Asthma TX not responding appropriately causes

Answer 19

1. Correct inhaler use
2. Infections
3. Obesity
4. GERD, exposure to smoke
5. Low VIT D
6. Anxiety Depression, sleep apnea

Question 20

TX exacerbations

Answer 20

1. Bronchodilator
2. Glucocorticoids
3. O2
4. MgSO4 = relax SM
5. Epinephrine
6. Iprotropram

Question 21

Preventing asthma

Answer 21

1. Breastfeeding
2. Avoid tobacco and secondary smoke
3. Prevent obesity
4. Vit D
5. Vaccinations

Question 22

COPD is what

Answer 22

Persistent airflow limitation progressive, and chronic inflammation response
= irreversible airflow limitation (more in men, 3rd leading cause of world death)

Question 23

Genetics playing in COPD

Answer 23

A1-antitrypsin deficiency = 1% of COPD (only one we know right now)

Question 24

What happens in COPD

Answer 24

1. Obstructive bronchitis (inflammation, bacteria colonization)
2. Emphysema (elastic walls destroyed)
3. Hypersecretion of mucous
   = lung is like a paper lunch bag

Question 25

COPD FEV

Answer 25

Acceleration in decline of FEV1

Question 26

COPD SX

Answer 26

1. Dyspnea, SOB (progressively worsening, worse with exercise) 2. Sputum and purulence chronic 3. Cough (unproductive) 4. Wheezing 5. Tiggers in Day by day variation

Question 27

COPD TX

Answer 27

1. ABs 2. Steroids = lower inflammation 3. Bronchodilators 4. Pulmonary rehabilitation = increase pulmonary function

Question 28

Pink puffers

Answer 28

COPD more like emphysema 1. Expanded lung, low BMI 2. Fewer cardiac + comorbidities probs 3. Hyperinflation 4. Low CO capacity 5. More SOB + lower exercise tolerance 6. Worse health

Question 29

Blue Bloaters

Answer 29

``` COPD less emphysema 1. High BMI 2. More comorbidities 3. Cardiac probs 4. Chronic bronchitis 5. High IL6 and CRP 6 more exacerbations + sleep apnea ```

Question 30

How to DX COPD

Answer 30

SPIROMETRY : 1. FEV1/FEV < 0.7 2. FEV1 LOW (classified by GOLD) 3. <12% reversibility

Question 31

GOLD classification

Answer 31

Classify COPD 1-4 (4 being worse FEV1 <30%)

Question 32

GOLD 1

Answer 32

FEV 1 > 80% + FEV1/FVC < 0.7

Question 33

GOLD 2-4

Answer 33

FEV1 = <80% + FEV1/FCV = <0.7

Question 34

No pharmacology TX COPD

Answer 34

- pulmonary rehab : exercise, breathlessness, mental and physical health - lung volume reduction surgery + transplant :

Question 35

TX COPD pharm

Answer 35

1. LABA and LAMA improve sx and lung function (if both are given lung function 2x improvement only sx don’t improve x2)**** 2. Inhaled corticosteroids (ICS not always helpful) ——> exacerbation risk pts 3. Oxygen (15hours per day) = reduced mortality ****

Question 36

Group A - D COPD

Answer 36

GROUP A : bronchodilator GROUP B : LAMA or LABA (no hospitalization) GROUP C : LAMA ( more then 2 exacerbations hospitalized pts) GROUP D : LAMA or LAMA + LABA or ICS + LABA

Question 37

Acute exacerbation TX in COPD

Answer 37

1. Oral corticosteroids ** | 2. ABs + O2

Question 38

Some things that can improve COPD SX

Answer 38

1. Opiates = air hunger improvement 2. Fans and O2 blowing 3. Nutrition supplements 4. Pulmonary rehabilitation

Question 39

When to use ICS in COPD

Answer 39

****frequent exacerbations + reactive airway component (Eosinophils >300 cells)

Question 40

When to definitely not use ICS in COPD

Answer 40

1. Repeated pneumonia 2. E < 100 cells 3. Mycobacterium infection history

Question 41

Normal FEV1/FVC

Answer 41

Above 0.70

Question 42

Asthma with bronchodilator should do what

Answer 42

Increase FEV1 more then 200ml + increase FEV1/FVC

Question 43

Long-acting B- Agonist should always be used with

Answer 43

ICS

Question 44

When do you not do spirometry

Answer 44

Unstable acute patients

Question 45

GOLD 2 and GOLD 3

Answer 45

GOLD 2 : 50%-80% FEV1 predicted | GOLD 3 : 30% - 50% FEV1 predicted

Question 46

Acute COPD TX | Managements COPD TX

Answer 46

1. Oral Corticosteroids + O2 + bronchodilator + ABS (if sx of consolidation or type of inflammation/infection shown) 2. LABA OR LAMA OR SABA + ICS (frequent exhasterbaitons only or hospitalizations)