Pulm/crit care key points

Question 1

What FEV1/FVC ratio is c/w airflow obstruction?

Answer 1

Less than 70%

Question 2

What test is helpful in patients w/ dyspnea or cough of uncertain cause when spirometry results are normal?

Answer 2

Bronchial challenge testing w/ a controlled stimulus

Question 3

Describe fiberoptic bronchoscopy

Answer 3

Encoscopic technique that allows visualization of tracheobronchial lumen and sampling of suspected areas of disease, including endobronchial mucosa, lung parenchyma, and accessible lymph nodes.

Question 4

Describe fiberoptic bronchoscopy

Answer 4

Encoscopic technique that allows visualization of tracheobronchial lumen and sampling of suspected areas of disease, including endobronchial mucosa, lung parenchyma, and accessible lymph nodes.

Question 5

What test is helpful in patients w/ dyspnea or cough of uncertain cause when spirometry results are normal?

Answer 5

Bronchial challenge testing w/ a controlled stimulus

Question 6

Classic presentation of asthma is episodes of what 4 symptoms?

Answer 6

SOB
Chest tightness
Cough
Wheezing

Question 7

Describe fiberoptic bronchoscopy

Answer 7

Encoscopic technique that allows visualization of tracheobronchial lumen and sampling of suspected areas of disease, including endobronchial mucosa, lung parenchyma, and accessible lymph nodes.

Question 8

2 major things you’re looking for when assessing potential asthma with spirometry?

Answer 8

Obstruction (reduced FEV1/FVC ratio)

Reversibility (12% or more improvement in FEV1 s/p bronchodilator)

Question 9

Name 3 major exposures that can predispose to asthma

Answer 9

Indoor environmental allergens
Environmental tobacco smoke
Viruses

Question 10

Classic presentation of asthma is episodes of what 4 symptoms?

Answer 10

SOB
Chest tightness
Cough
Wheezing

Question 11

First step in eval of suspected asthma?

Answer 11

Spirometry

Question 12

Name 3 major groups of occupations that are at risk for occupational asthma

Answer 12

Farmers
Factory workers
Hair dressers

Question 13

Management of exercise-induced bronchospasm that only occurs a few times a week?

Answer 13

Inhaled SABA 5-20 min before exercise

Question 14

When giving a patient w/ exercise-induced bronchospasm a SABA before exercise, how long should they expect it to be protective?

Answer 14

2-4 hours

Question 15

What percent of workers exposed to known sensitizing agents have asthma?

Answer 15

10%

Question 16

Name 2 main SABA inhalers

Answer 16

Albuterol, salbutamol

Question 17

3 major features characterizing vocal cord dysfunction

Answer 17

Mid-chest tightness w/ exposure to triggers
Difficulty breathing in
Partial response to asthma medications

Question 18

What is vocal cord dysfunction commonly mis-diagnosed as?

Answer 18

Severe asthma

Question 19

Omalizumab reduces ED visits and is cost-effective in patients with what 3 characteristics?

Answer 19

Sx inadequately controlled with inhaled steroids
Allergies to perennial aeroallergens
Serum IgE levels btwn 30-700 U/mL

Question 20

Name 2 main SABA inhalers

Answer 20

Albuterol, salbutamol

Question 21

What procedure is FDA approved for asthma not controlled with optimization of medications?

Answer 21

Bronchial thermoplasty

Question 22

When is the appropriate time to add LABA inhalers into asthma therapy?

Answer 22

When inhaled steroids alone don’t achieve control

Question 23

Omalizumab reduces ED visits and is cost-effective in patients with what 3 characteristics?

Answer 23

Sx inadequately controlled with inhaled steroids
Allergies to perennial aeroallergens
Serum IgE levels btwn 30-700 U/mL

Question 24

Name 3 non-pharm management tips for asthma

Answer 24

Avoidance of triggers w/ allergen management
Reduced exposure to environmental tobacco smoke
Healthy diet and exercise program

Question 25

What procedure is FDA approved for asthma not controlled with optimization of medications?

Answer 25

Bronchial thermoplasty

Question 26

4 groups of patients considered to have severe refractory asthma?

Answer 26

Multiple exacerbations per year
Need for high-dose inhaled or PO steroids
Inability to step down therapy w/o compromising asthma control
Hx of multiple hospitalizations or intubations

Question 27

Safety of inhaled steroids for asthma during pregnancy?

Answer 27

Safe- abundant long-term safety evidence for budesonide

Question 28

Single most clinically efficacious and cost-effective way to prevent COPD, slow progression of established disease, and improve survival?

Answer 28

Smoking cessation (duh)

Question 29

What are the recommendations on screening for COPD in ASx patients?

Answer 29

Don’t do it (at least no spirometry)

Question 30

What’s the major difference seen on spirometry in COPD vs asthma?

Answer 30

COPD will have post-bronchodilator fixed FEV1/FVC ratio of less than 70%, while asthma shows reversible obstruction. Note: this finding is diagnostic of COPD in the correct clinical setting.

Question 31

Name 3 general components of monitoring COPD patients

Answer 31

Ongoing review of Sx
Evaluation for Cpx of COPD
Assessment of freq and severity of exacerbations

Question 32

What should you check in suboptimally controlled COPD patients before changing meds?

Answer 32

Inhaler technique

Question 33

What group of meds in mainstay of therapy in COPD?

Answer 33

Bronchodilators

Question 34

All COPD patients with long-acting bronchodilators should also have what other med?

Answer 34

A short-acting bronchodilator for rescue use

Question 35

How do long-acting bronchodilators affect course of COPD (4)?

Answer 35

1. Improve FEV1
2. Improve health status
3. Significantly reduce frequency of exacerbations
4. NO change in mortality

Question 36

Would you ever use inhaled steroids as primary therapy or monotherapy in COPD?

Answer 36

Nope

Question 37

When is it appropriate to use Abx in COPD?

Answer 37

Infectious exacerbations

Question 38

What is roflumilast, and when should you use it in COPD?

Answer 38

Oral selective PDE-4 inhibitor. Use only as add-on therapy in severe COPD a/w chronic bronchitis and a history of recurrent exacerbations. Not shown to be effective in any other groups of COPD pts.

Question 39

Which groups of COPD patients benefit from exercise maintenance?

Answer 39

All of them

Question 40

While all groups of COPD patients could potentially benefit from pulmonary rehab, which 2 major groups is it specifically recommended for?

Answer 40

1. All symptomatic patients with FEV1 less than 50% expected.
2. COPD patients hospitalized 2/2 acute exacerbation.