General Flashcards
What FEV1/FVC ratio is considered to be obstructive?
What are the differentials?
How would you differentiate?
70%
COPD or asthma - based on hx, asthma will be episodic and have triggers - it is reversible.
COPD is not reversible. This can be tested by exercise spirometry, but history should tell you.
Once asthma has been diagnosed by FEV1/FVC, how can the severity and responsiveness of it be measured?
FEV1 reduction below normal.
treatment with bronchodilators folowed by remeasuring FEV1 will show how responsive the asthma is.
30yo gives a 2 yr hx of SOB. BMI is 30, leads sedentary lifestyle. Smokes 20 a day. CRP normal, CXR normal. What further test would be most appropriate to give diagnosis?
Spirometry
Specifically FEV1/FVC to look for airway obstruction.
Also FVC of predicted value can be used
What tests can be done to help diagnose asthma?
(if an intermediate probability has been determined)
- Spirometry
- PEFR
- FeNO
- challenge tests
- Blood eosinophils
- IgE skin prick test (for atopy)
Hx gives a high probability of diagnosis of asthma.
Next step?
Initiate treatment and assess response.
Usually low dose ICS.
If there is a good response - it is asthma, if not - more tests are needed (intermediate probability of asthma)
56yo male with slow onset SOBOE, wheeze, worse at night. Hx of working at a logging plant. Diagnose with high probability of asthma and start on ICS. Next appropriate step?
Referral.
All occupational asthmas should be referred.
Occupations include:
Spray painting
varnishing
soldering
wood dust
bleaches
metals
animals
antibiotics
What is the baseline treatment for every confirmed diagnosis of asthma?
Low dose ICS preventer
SABA
16yo with asthma treated with low dose ICS is getting SOB with a wheeze, requiring him to take his SABA when playing football 5 times a week. What is the most appropriate next step?
Addition of a LABA to the ICS inhaler.
Use of SABA >3 times a week is an indication that asthma is not well controlled and an additional treatment needs to be considered.
14yo with asthma on low dose ICS was using his SABA 12 times a week in the school playground. LABA was added, but he is still having to use SABA just as regularly.
Next appropriate step?
Stop LABA - it is innefective.
Attempt better control by increasing dose of ICS.
14yo with asthma on low dose ICS was using his SABA 12 times a week in the school playground. LABA was added, but he is still having to use SABA 6 times a week.
Next appropriate step?
LABA is effective, but not good enough.
Continue LABA
Increase dose of ICS to medium.
26yo with asthma is on medium dose ICS and LABA, has 5 acute episodes of asthma a week when he commutes to work. These are controlled well by his SABA.
Additional appropriate therapy?
Addition of another drug, either:
- LAMA
- LTRA
- Xanthine (theophyline)
30yo with asthma on low dose ICS has to use their SABA 12 times a week due to acute episodes. GP prescribes LABA in addition. pt still has to use SABA 9 times a week. ICS dose raised to medium, but pt still has to use SABA 6 times a week.
Next appropriate step?
Additional therapy of either:
- LAMA
- LTRA
- Xanthine (theophyline)
32yo asthmatic on medium dose ICS with LABA and LAMA. Has to use SABA 8 times a week when at work.
What treatment options are available?
ICS dose to high
addition of another therapy:
Xanthine
LTRA.
40yo with asthma which is usually well controlled with medium dose ICS, LABA, and theophyline presents to A&E with moderate acute epidose due to accidental exposure to cats. PEF is 70% predicted. You give oxygen, nebulised salbutamol and ipratropium, hydrocortisone and theophylline.
PEF increases but the pt deteriorates and begins vomiting.
What is most likely to be causing the vomiting?
Theophylline
Has a very small theraputic window. Pt is already on theophylline and it is inferred that she is compliant. You add more theophylline and cause a toxic level.
STOP THEOPHYLLINE!
65yo asthmatic experienceing arrhythmias and tachycardia.
What should you check for?
Beta blockers - contraindicated with Beta agonists!
Beta agonists alone in HF/nypertensive pts can cause problems.
