L11 PFTs and Asthma Flashcards
1
Q
FVC
A
forced vital capacity
2
Q
FVC
A
forced vital capacity
3
Q
FEV1
A
forced expiratory capacity in the first second of expiration
4
Q
FEF 25-75%
A
forced expiratory flow 25-75%, the middle half of forced expiration
5
Q
SVC
A
slow vital capacity
6
Q
IC
A
inspiratory capacity
7
Q
ERV
A
expiratory reserve volume
8
Q
TLC
A
total lung capacity
9
Q
VC
A
vital capacity
10
Q
RV
A
residual volume
11
Q
TV
A
tidal volume
12
Q
IRV
A
inspiratory reserve volume
13
Q
FRC
A
functional residual capacity
14
Q
perform spirometry ________ because ______
A
sitting
less likelihood of syncope
15
Q
spirometry is done at least
A
3 times
16
Q
most useful information for obstruction on spirometry
A
FEV1
17
Q
defines severity of obstruction, assists in differentiationg obstructive vs restrictive
A
FEV1/FVC
18
Q
FEV1/FVC ratio indicative of obstructive pattern
A
19
Q
curve quality control involves
A
- volume time curve plateaus
- expiration lasts >6 secs
- Two best efforts within .2 L
- Flow volume loop are free of artifact
20
Q
TV
A
tidal volume
21
Q
diffusion capacity has a false reduction when _______
to compensate ________
A
anemic
adjust for hemoglobin level
22
Q
defines severity of obstruction, assists in differentiationg obstructive vs restrictive
A
FEV1/FVC
23
Q
FEF 25-75%
A
nonspecific for small airway obstruction but may be an early indicator of disease
24
Q
how long after administering 2-4 puffs of bronchodilator do you wait to repeat testing
A
15 minutes
25
how many rounds of bronchodilator testing are done?
3-8 rounds
| possibly repeated during flare
26
bronchodilator may be given by
nebulizer
| inhaler
27
methacholine is given by
nebulizer
28
after givign methacholine, spirometry is conducted at
30 seconds
| 90 seconds
29
a positive methacholine challenge is
FEV1 decreases by 20%
30
problems with methacholine challenges
risky, must be closely monitored
| false positives
31
expiration makes a triangle
normal flow volume loop
32
goes up and then has a weird dip on the way back down
obstructive flow volume loop
33
total lung capacity =
residual volume + vital capacity
34
diffusion capacity measures
ability of lungs to transfer gas and saturate hemoglobin using CO instead of O2
35
after diagnosis, retest FEV1
after 3-6 months of controller treatment
| periodically every 1-2 years
36
asthma
1. Chronic airway inflammations
2. Intermittent and reversible airway obstruction
3. Bronchial hyper-responsiveness
37
obstructive disease inspiration is
normal
38
obstructive disease expiration is
limited
39
lung volumes of obstructive disease
high
40
airway of obstructive disease
narrowed
41
Normal in obstructive disease
VC
42
Increased in obstructive disease
TLC
| RV
43
decreased in obstructive disease
FEV1
| FEV1/FVC
44
lung volume in restrictive disease
reduced
45
Samter's triad
1. sinus disease with nasal polyps
2. ASA sensitivity
3. severe asthma
46
inspiration and expiration in restrictive disease
appear normal but flow and volume are significantly reduced
47
decreased in restrictive disease
TLC
FVC
RV
FEV1
48
normal or increased in restrictive disease
FEV1/FVC
49
normal FEV1 value
rules out obstruction/restriction
50
indicative of obstructive disease
FEV1 < 80% predicted
| TLC increased by 15-20%
51
an alternative to FEV1, as it is more sensitive for detecting early airway obstruction
FEF 25-75%
52
if ratio of FEV1/FVC is .7-lower limit normal
may have mild obstruction
| refer FEV1 and FEF 25-75%
53
asthma symptoms
1. Coughing: nocturnal, seasonal, triggered, longer than 3 weeks
2. Wheezing: inspiratory and expiratroy
Chest pain/pressure, dyspnea, SOB
54
step 4
severe persistant asthma
55
medications which can trigger an asthma attack
beta blockers
aspirin
NSAIDS
56
risk factors for asthma
```
Atopy
ASA/NSAID intolerance
food allergies
GERD
RSV
family history
maternal smoking
obesity
```
57
pulmonary function tests in intermittent asthma
Normal pulmonary function tests between exacerbations, no limits on activities
58
associated signs of asthma
```
rhinitis
sinusitis
conjunctivitis
URI
atopic dermatitis
```
59
chest of an asthmatic
increased AP diameter
60
samter's triad aka
ASA triad
61
moderate persistent asthma symptoms/SABA use
daily
| some activity limitations
62
atopic triad
1. Atopic dermatitis
2. Allergic rhinitis
3. Asthma
63
atopic march
atopic dermatitis → food allergy → allergic rhinitis → asthma
64
moderate persistant asthma FEV1/FVC
reduced by 5%
65
severe persistent asthma symptoms/SABA use
daily, throughout the day
| extremely limited physical activity
66
severe persistent asthma nighttime awakenings
0-4: more than once a week
| 5+: nightly
67
FEV1/FVC in asthma
normal or decreased relative to predicted values
68
reversibility with bronchodilaotr in young kids
>8% in young children
69
step 1
intermittent asthma
70
step 2
mild persistant asthma
71
step 3
moderate persistant asthma
72
step 4
severe persistant asthma
73
intermittent asthma nighttime awakenings
0-4: none
| 5+: less than two nights/month
74
intermittent asthma symptoms/SABA use
less than 2 days/week
75
cromolyn
mast cell stabilizer
76
Symptoms/SABA use in mild persistent asthma
more than 2 days/week
77
mild persistent asthma pulmonary function tests
Normal pulmonary function tests with minor limitation in activity
78
step 5 treatment
High dose ICS + LABA (or LTRA in ages 0-11)
79
step 6 treatment
High dose ICS + LABA (or LTRA in ages 0-11) + oral steroids
80
moderate persistent asthma FEV1
*********
60-80%
*********
81
if positive for any condition of rule of 2
asthma is not under control
82
severe persistent asthma symptoms/SABA use
daily, throughout the day
83
well controlled asthma symptoms/SABA
less than 2x/week
84
severe persistent asthma FEV1
<60%
85
severe persistent asthma FEV1/FVC
reduced by more than 5%
86
montelukast
leukotriene receptor antagonist
| used ages 0-4
87
in chilren older than 12, use _________ to assess control instead of ____________
3 validated questionnaires
| FEV1/FVC
88
benralizumab
monoclonal anti-IL5 receptor a antibodies
89
not well controlled asthma nighttime awakenings
0-4: >1x/month
5-11: >2x/month
12+: 1-3x/week
90
used in all stages of asthma PRN
SABA
91
step 1 treatment
SABA prn
92
step 2 treatment
Low dose ICS daily
-or-
LTRA or cromolyn
93
step 3 treatment
Medium dose ICS
Or
Low dose ICS + LABA (or LTRA)
94
Rule of 2:
1. symptoms more than 2x a week
2. awaken with asthma more than 2x a month
3. refil rescue inhaler more than 2x a year
4. peak flow meter measure less than 20% from baseline
95
how often to follow up asthma
initially: every 1-3 months
| then every 3-12 months depending on severity
96
yellow PFER should
use SABA and increase meds
97
well controlled asthma FEV1
>80%
98
well controlled asthma FEV1/FVC
>.8 for ages 5-11
99
not well controlled asthma symtoms/SABAA
>2 days/week
100
not well controlled asthma FEV1
60-80%
101
not well controlled asthma FEV1/FVC
75-80%
102
very poory controlled asthma symptoms/SABA
daily
103
very poory controlled asthma FEV1
<60%
104
very poory controlled asthma FEV1/FVC
<75%
105
signs of severe obstruction
```
tachypnea
tachycardia
tripod positioning
accessory muscle use
pulsus paradoxus
```
106
useful handheld on the go measurement of asthma control
peak flow expiratory rate (PFER)
107
green: good control PFER
>80%
108
yellow: caution PFER
50-80%
109
red: medical alert PFER
<50%
| GO TO ED
110
when to use a CXR for asthma
| may show
ruling out infection or obstruction
| hyperinflation
111
treatment for asthma exacerbation
1. O2
2. SABA (albuterol/xopenex) +/- ipratropium bromide
3. Systemic corticosteroids: prednisolone 1mg/kg/day
+/- abx, respiratory monitoring, CPAP, BiPAP, intubation
112
xopenex
saba
