Chapter 6- COPD/ASTHMA

Question 1

What’s the aim of asthma management

Answer 1

No daytime symptoms 
No nighttime awakening
No rescue medication 
No asthma attacks 
No limitations on activity 
Normal lung function (FEV1 and/or PEF>80%)
Minimal side effects

Question 2

Should you use a spacer for MDI ?

Answer 2

Yes

Question 3

What does the acronym SIMPLE stand for in asthma management

Answer 3

S=stop smoking 
I= inhaler technique 
M=monitoring (PEF)
P=pharmacotherapy 
L=lifestyle 
E=education

Question 4

What vaccines should you recommend to asthmatics

Answer 4

Pneumococcal vaccination and annual flu vaccination

Question 5

Symptoms of asthma

Answer 5

SoB
Wheeze
Chest tightness
Dry irritating cough

Question 6

Pathology of asthma

Answer 6

Airflow obstruction
Bronchohyperresponsiveness
Inflammation

Question 7

Eosinophils high in asthma?

Answer 7

Yeh

Question 8

What medication is good for airway inflammation

Answer 8

Inhaled corticosteroid

Question 9

What medication is good for smooth muscle dysfunction

Answer 9

long acting beta agonist (formoterol, salmeterol)

Question 10

Smoking history is most like to be asthma or COPD?

Answer 10

COPD

Question 11

The asthma control test refers to the past how many weeks?

Answer 11

4 weeks

Question 12

A score of <20 on the asthma control test indicates what?

Answer 12

Further recommendations regarding management of asthma

Question 13

Life threatening asthma attack has a PEF of what?

Answer 13

<33%

Question 14

Person have an acute severe asthma attack has a PEF of what

Answer 14

33-50%

Question 15

Person Having a moderate asthma attack has a PEF of what?

Answer 15

50-75%

Question 16

What’s target oxygen sats in asthma

Answer 16

94-98%

Question 17

In acute asthma attack due you use driven by oxygen or air?

Answer 17

Oxygen

Question 18

What is bronchiectasis

Answer 18

Abnormal widening of airways, fluid fills gap making prone to infection

Question 19

What is omalizumab

Answer 19

Anti-immunoglobulin E for treating severe persistent allergic asthma in people aged 6 and over

Question 20

Are asthma symptoms often bad at night

Answer 20

Yeh

Question 21

List effects of long term oral corticosteroids

Answer 21

Adrenal suppression 
Glucose intolerance 
Decreased bone mineral density 
Cataracts and glaucoma 
Growth failure

Question 22

How does omalizumab work

Answer 22

Monoclonal antibody that binds to IgE

Question 23

Omalizumab should only be considered for what patients

Answer 23

Patients with convincing IgE mediated asthma

Question 24

Anti-IgE (omalizumab) licensing criteria

Answer 24

Step4/5 asthma 
FEV1<80% 
>2 severe exacerbation
\+ve skin prick test or +ve RAST to common aeroallergen
IgE>50 and <700lu/ml

Question 25

What can the dose of omalizumab be from? What dose it depend on?

Answer 25

75-375mg | Depends on patients body weight and baseline serum IgE concentration

Question 26

Name four drugs that can be used for (steroid sparring effects) in difficult to treat asthma

Answer 26

Cyclosporin MTX Gold Terbutaline

Question 27

T-cell profiling can classify asthma patients into two groups

Answer 27

Th2 high | Th2 low

Question 28

Patients with Th2 high asthma have airway eosinophilia which is promoted by what?

Answer 28

IL-5

Question 29

What is mepolizumab

Answer 29

Monoclonal antibody against IL-5 licensed as add on treatment for use in severe refractory eosinophilic asthma

Question 30

Mepolizumab is approved for patients who have an eosinophil count of at least what?

Answer 30

150 cells per microlitre

Question 31

What is reslizumab

Answer 31

Monoclonal antibody for treating eosinophilic asthma inadequately controlled by ICS

Question 32

How long are immunosuppressants given for initially in difficult to treat asthma

Answer 32

Three month trial

Question 33

Name three cardinal symptoms of COPD

Answer 33

Dyspnea Chronic cough Sputum production

Question 34

List risk factors for COPD

Answer 34

``` Smoking Air pollution Low birth weight Recurrent lung infection Cannabis smoking Low socioeconomic status Alpha-1 antitrypsin deficiency ```

Question 35

Key features of blue bloaters 'chronic bronchitis'

Answer 35

Inflammation change= mucocillary dysfunction | And increase goblet cell secretions (excess mucous)

Question 36

What's the FEV1 values for each of the stages of COPD

Answer 36

``` 1= FEV1 >80% 2= FEV1 50-80% 3= FEV1 30-50% 4= FEV1 <30 or <50+ chronic respiratory failure ```

Question 37

How is staging/assessment of severity in COPD determined?

Answer 37

Severity of symptoms Spirometry Risk of exacerbation

Question 38

List the treatments for COPD

Answer 38

``` Smoking cessation Vaccination Bronchodilators Corticosteroids Pulmonary rehab Oxygen therapy Surgical interventions Carbocysteine ```

Question 39

Less that what value is pO2 life threatening

Answer 39

<8kPa

Question 40

What is magnesium?

Answer 40

Smooth muscle relaxant can be put in saline or glucose

Question 41

What's the oxygen target in COPD

Answer 41

88-92% (don't want too much oxygen as won't get rid of CO2)