Obstructive Lung Disease Flashcards
FEV1/FVC ratio of < 70% suggests ____.
obstructive lung diseases such as
-asthma
-bronchiectasis
-COPD
-Cystic fibrosis
-obstruction (tracheal/bronchial)
*FEV1↓↓ & FVC ↓/normal –> ↓ FEV1/FVC (< 70%).
FEV1/FVC ratio of ≥ 70% suggests ____.
Restrictive lung diseases such as
-ILD
-NM diseases
-obesity
-scoliosis
*↓ FEV1 and ↓ FVC in RLD –> normal/ ↑ FEV1/FVC ratio.
Other than asthma, what conditions can cause wheezing in the lungs?
-FB inhalation
-Lt. HF (aka cardiac wheezing)
-COPD/airway obstruction.
True/False? Children with eczema are more likely to develop asthma or allergic rhinitis.
true
List some commonly known asthma triggers.
-allergens
-URI
-cold
-exercise
-drugs (aspirin, beta-blockers, NSAIDs)
-stress (adults & children)
True/False? The hallmark of obstructive lung disease is the narrowing of the airways which leads to difficulty inhaling air.
False;
narrowing or collapse of the airways in OLD causes trapping of the air in airways d/t impaired expiration –> ↑↑ paCO2, & ↓ SpO2.
Asthma usually p/w ___ (? wet, dry) cough plus ___ (list all possible s/s).
dry cough plus
-wheezing (episodic)
-dyspnea
-chest tightness
Symptoms of asthma are usually worse in the ____ (?time).
at night or early morning
The inspiration/expiration ratio is ___ (? increased, decreased) in asthma patients.
decreased (d/t prolonged expiration)
Other than the FEV1/FVC ratio, OLD can be differentiated from RLD on the basis of which spirometric patterns?
FRC:
-high in OLD (d/t air trapping);
-low in RLD (lungs cannot take air in)
TLC:
-high in OLD (d/t air trapping);
-low in RLD (lungs cannot take air in)
True/False? Aspirin can induce an IgE-mediated allergic asthmatic response in asthmatics.
False;
Aspirin mediates a pseudo-allergic response (not IgE-mediated).
Samter triad is marked by ___ and is seen with the use of ____.
characterized by
-asthma
-chronic rhinosinusitis with nasal polyps
-intolerance to aspirin or NSAIDs.
aspirin (or NSAID) exacerbated respiratory disease.
An increase in FEV1 by ___ % and ___ mL with the use of short-acting beta-agonist (SABA) such as albuterol is characteristic of asthma.
Increase in FEV1 by ≥ 12% and > 200 mL with the use of SABA.
When is the methacholine challenge test (bronchial hyperresponsiveness) indicated in the diagnosis of asthma?
useful when PFT is normal in patients with high suspicion of asthma.
A methacholine challenge test is considered +ve with ____ response.
≥ 20% decrease in FEV1 upon exposure to methacholine.
*test is SN but not SP.
ABG in early-stage asthma exacerbation reveals ____ findings.
hyperventilation –> ↓ PaCO2, ↑ pH (Resp. alkalosis)
____ ABG findings indicate progress/worsening of exacerbated asthmatic state to severe late stage with impending respiratory failure presenting with characteristic respiratory acidosis (↑ ↑ PaCO2, ↓ pH).
normalizing pH and normalizing PaCO2
[from the early stage resp. alkalosis (early hyperventilation response)].
What are the CXR findings in Asthma?
initially normal –> hyperinflation –> flattening of the diaphragm in late/severe disease.
The flow-volume loop shifts to the ___ in obstructive lung disease (OLD).
left (see attached image) indicating an increase in RV and TLC in OLD.
The flow-volume loop shifts to the ___ in restrictive lung disease (RLD).
right shift (see attached image) indicating a decrease in all volumes (RV, TLC, FRC) in RLD.
An example of a short-acting beta-agonist (SABA) is __.
Albuterol
*SABAs are used for prn use in asthmatics.
An example of a long-acting beta-agonist (LABA) is __.
Salmeterol
LABAs are used for ___ therapy in asthmatics.
maintenance therapy
Maintenance and reliever therapy with both short-acting and long-acting in asthmatics include agents such as ___ (list all).
Formoterol + ICS (inhalation corticosteroid)
Name a short-acting muscarinic antagonist (SAMA) and a long-acting muscarinic antagonist (LAMA) used in t/t of asthma.
SAMA: Ipratropium
LAMA: Tiotropium
Theophylline is a __ class of drug, and acts by ____.
methylxanthine class;
inhibits PDE-> ↓ cAMP -> bronchodilate
Theophylline has limited use in t/t of asthma because of ____.
-narrow TI –> high toxicity risk
-cardiotoxicity, neurotoxicity.
___ prevents the release of vasoactive mediators from mast cells, thus mostly used as a prophylactic agent in t/t of asthma (exercise-induced).
cromolyn
____ blocks the conversion of arachidonic acid to leukotrienes by inhibiting the 5-LOX pathway.
Zileuton.
Monetlukast and Zafirlukast prevent/treat bronchoconstriction by ____ (? MOA).
by blocking leukotriene receptors.
List the monoclonal Abs against IgE, IL-4, IL-4R, IL-5, IL-5R.
Anti-IgE: Omalizumab
Anti-IL4/IL-4R: Dupilumab
(↓ release of inflammatory cytokines, chemokines, and IgE).
anti-IL5: Mepolizumab, Reslizumab (↓↓↓ Eo chemo-attraction).
Anti-IL5R: Benralizumab (↓↓↓ Eo differentiation and maturation)
When must a physician consider intubation in m/m of severe asthma?
in severe cases with any of the below:
-cyanosis, v. poor resp. effort, AMS
-PaCO2 > 50 mmHg,
-PaO2 < 50 mmHg.
____ can be used as empiric antibiotics in t/t of acute exacerbations in pts. with bronchiectasis.
Respiratory fluoroquinolones
-levofloxacin,
-moxifloxacin
ABPA in pts. with bronchiectasis can be t/t with ____ (list all).
systemic glucocorticoids + Voriconazole/ Itraconazole.
