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Flashcards in Lung diseases Deck (74):
1

where does Asthma obstruction occur

bronchi (3-4)

2

where does Asthma obstruction occur

bronchi (3-4)

3

Extrinsic vs Intrinsic asthma

extrinsic is allergic IgE mediated; intrinsic is non-allergic post viral

4

Asthma pathophysiology

inflammation with increased Mast, Th2 and PMns that release histamine, luekotrienes, prostaglandins and cyotkines (IL4, 5, 9, 13) to cause bronchospasm, mucus secretion, structural changes

5

structural changes in asthma

SMC hypertrophy and hyperplasia
mucus hypersecrtion due to submusosal hyperplasia
angiogenesis
epithelial desquamanation

6

Lung volumes in obstructive disease

increase RV and FRC, but decreased IC due to high RV

7

intermittent asthma

less than 2 times per week and asymptomatic in between and less than 2x at night per month

8

mild persistent asthma

more than 2x per week or less than 1 time daily with more than 2x per night monthly

9

moderate persistent asthma

daily symptoms with some recovery, more than once per week at night

10

severe persistent asthma

continual symptoms with frequent night symptoms

11

what is well controlled asthma?

12

not well controlled

>2 days/wk; 1-3 nights/wk; SABA >2 wk; FEV1 60-80% personal best

13

poorly controlled asthma

throughout day symptoms, >4 nights/wk, SABA several times a day,

14

Step ups in Asthma treatment

ICS before LABA, but also use omalizumab for severe and oral CS for very severe

15

LABA vs SABA

SABA: Albuterol is 4-6 hour duration and rapid action
LABA: salmeterol and forometerol is 12 hr sustained duration.
Should not be used along with asthma since they are not antiinflammatory!

16

Systemic Vs. Inhalted Glucocorticosteroids

Systemic: prednisone. Oral that lasts for 36-48 hours - causes growth inhibition!
Inhaled: beclomethasone dipropionate with faster onset and 8 hrs effectivity.

17

Leukotriene Modifiers

Oral D4 antagonists, 5-lipoxygenase inhibitor,
Duration of 12-24 hours and used to block leukotriene path for bronchodilation and anti-inflammatory.
attenuates exercise induced asthma

18

Omalizumab

Immune modulator tx for asthma. Anti-IgE
Used for severe asthma treatment given SC

19

Mepolizumab

immune modulator, anti IL-5

20

Atropine

Anticholinergic used in COPD but not asthma!
Causes bronchodilation via SM reflex and inhibits respiratory secretions by acting on cholinergic receptors.
Ipratrapium - 6 hour anticholinergic
Tiotropium: 12 hours anticholinergic

21

Tiotropium

long term anti-cholinergic used in >12 yo asthma patients

22

Theophylline

oral or IV - no longer used in asthma
Inhibits phosphodiesterase for bronchodilation and some antiinflammatory.
Not used due to narrow therapeutic window, seizures, neurologic damage and DDI

23

Cromolyn and Nedocronil

inhalted to inhibit mast cell release - preventative for exercise induced Asthma and prevents allergen induced asthma.

24

Particles >5 um are deposited

in pharynx and large airways

25

Particles

small airways;

26

Tx of COPD

LABA over SABA

27

Pathogenesis of Chronic Bronchitis

hypertrophy and mucosal gand hyperplasia, increased bronchial wall thickness, squamous metaplasia transition to cause excessive mucus and inflammation.

28

Pathogenesis of Emphysema

loss of alveolar space due to destruction of alveolar septa without fibrosis. Increased compliance, increase protease activity and decrease repair

29

Centriacinar

cigarette smoking related, with central airways more inflated

30

Panacinar

due to alpha-1antitrypsin def over entire respiratory bronchioles and alveoli.

31

DLCO in emphysema vs. Chronic Bronchitis

emphysema has decreased but normal Bronchitis due to aveolar sparing

32

Pink puffer vs Blue Bloater response to hypoxia

Pink: poor - hyperventilation
Blue: can tolerate

33

CO in Pink puffer vs. Blue Bloater

Decreased CO compared to Blue Bloater

34

Blood gas for Pink puffer vs blue bloater

pink: normal blood gas
Blue: low O2 sat

35

Cor Pulmonale Pink puffer vs. blue bloater

more common in blue bloater, can occur with pink puffer but is end stage.

36

Gold rating of COPD

Mild Ratio is 80
Mod ratio is 70 with FEV

37

Tx of COPD

smoking cessation, increase physical activity, overall health preseveration.
GOLd 1-2 that are low risk with low-mod symptoms have SAMB/SABA PRN or LAMA/LABA
Gold 3-4 with high risk and low-high symptoms: ICS with LABA

38

Bronchiectasis:

abnormal dilation of proximal bronchi due to muscular and elsatic components to decrease mucociliary clearance and increase colonization and infection.
Due to frequent bacterial infection in recurrent Px, CF,
Cuases foul smelling sputum, wheeze, hemoptysis, airflow limitation.
Airways are dialted but collapsed.
tx: airway clearance, Antibiotic

39

Extrinsic vs Intrinsic asthma

extrinsic is allergic IgE mediated; intrinsic is non-allergic post viral

40

Asthma pathophysiology

inflammation with increased Mast, Th2 and PMns that release histamine, luekotrienes, prostaglandins and cyotkines (IL4, 5, 9, 13) to cause bronchospasm, mucus secretion, structural changes

41

structural changes in asthma

SMC hypertrophy and hyperplasia
mucus hypersecrtion due to submusosal hyperplasia
angiogenesis
epithelial desquamanation

42

Lung volumes in obstructive disease

increase RV and FRC, but decreased IC due to high RV

43

intermittent asthma

less than 2 times per week and asymptomatic in between and less than 2x at night per month

44

mild persistent asthma

more than 2x per week or less than 1 time daily with more than 2x per night monthly

45

moderate persistent asthma

daily symptoms with some recovery, more than once per week at night

46

severe persistent asthma

continual symptoms with frequent night symptoms

47

what is well controlled asthma?

Given

48

not well controlled

>2 days/wk; 1-3 nights/wk; SABA >2 wk; FEV1 60-80% personal best

49

poorly controlled asthma

throughout day symptoms, >4 nights/wk, SABA several times a day,

50

Step ups in Asthma treatment

ICS before LABA, but also use omalizumab for severe and oral CS for very severe

51

LABA vs SABA

SABA: Albuterol is 4-6 hour duration and rapid action
LABA: salmeterol and forometerol is 12 hr sustained duration.
Should not be used along with asthma since they are not antiinflammatory!

52

Systemic Vs. Inhalted Glucocorticosteroids

Systemic: prednisone. Oral that lasts for 36-48 hours - causes growth inhibition!
Inhaled: beclomethasone dipropionate with faster onset and 8 hrs effectivity.

53

Leukotriene Modifiers

Oral D4 antagonists, 5-lipoxygenase inhibitor,
Duration of 12-24 hours and used to block leukotriene path for bronchodilation and anti-inflammatory.
attenuates exercise induced asthma

54

Omalizumab

Immune modulator tx for asthma. Anti-IgE
Used for severe asthma treatment given SC

55

Mepolizumab

immune modulator, anti IL-5

56

Atropine

Anticholinergic used in COPD but not asthma!
Causes bronchodilation via SM reflex and inhibits respiratory secretions by acting on cholinergic receptors.
Ipratrapium - 6 hour anticholinergic
Tiotropium: 12 hours anticholinergic

57

Tiotropium

long term anti-cholinergic used in >12 yo asthma patients

58

Theophylline

oral or IV - no longer used in asthma
Inhibits phosphodiesterase for bronchodilation and some antiinflammatory.
Not used due to narrow therapeutic window, seizures, neurologic damage and DDI

59

Cromolyn and Nedocronil

inhalted to inhibit mast cell release - preventative for exercise induced Asthma and prevents allergen induced asthma.

60

Particles >5 um are deposited

in pharynx and large airways

61

Particles

small airways;

62

Tx of COPD

LABA over SABA

63

Pathogenesis of Chronic Bronchitis

hypertrophy and mucosal gand hyperplasia, increased bronchial wall thickness, squamous metaplasia transition to cause excessive mucus and inflammation.

64

Pathogenesis of Emphysema

loss of alveolar space due to destruction of alveolar septa without fibrosis. Increased compliance, increase protease activity and decrease repair

65

Centriacinar

cigarette smoking related, with central airways more inflated

66

Panacinar

due to alpha-1antitrypsin def over entire respiratory bronchioles and alveoli.

67

DLCO in emphysema vs. Chronic Bronchitis

emphysema has decreased but normal Bronchitis due to aveolar sparing

68

Pink puffer vs Blue Bloater response to hypoxia

Pink: poor - hyperventilation
Blue: can tolerate

69

CO in Pink puffer vs. Blue Bloater

Decreased CO compared to Blue Bloater

70

Blood gas for Pink puffer vs blue bloater

pink: normal blood gas
Blue: low O2 sat

71

Cor Pulmonale Pink puffer vs. blue bloater

more common in blue bloater, can occur with pink puffer but is end stage.

72

Gold rating of COPD

Mild Ratio is 80
Mod ratio is 70 with FEV

73

Tx of COPD

smoking cessation, increase physical activity, overall health preseveration.
GOLd 1-2 that are low risk with low-mod symptoms have SAMB/SABA PRN or LAMA/LABA
Gold 3-4 with high risk and low-high symptoms: ICS with LABA

74

Bronchiectasis:

abnormal dilation of proximal bronchi due to muscular and elsatic components to decrease mucociliary clearance and increase colonization and infection.
Due to frequent bacterial infection in recurrent Px, CF,
Cuases foul smelling sputum, wheeze, hemoptysis, airflow limitation.
Airways are dialted but collapsed.
tx: airway clearance, Antibiotic