Pulmonary Disorders

Question 1

Is a cough with asthma usually productive?

Answer 1

No, it is usually productive with COPD

Question 2

What measure in lung function differentiates COPD from asthma?

Answer 2

COPD has persistent airflow limitations that is not reversible (post-brochiodilator FEV1/FVC <0.7)

Question 3

Define FEV1, what is normal?

Answer 3

Maximum volume of air exhaled forcefully in the first second of maximum expulsion
Normal is >/=80%

Question 4

Define FVC
What is normal?

Answer 4

Maximum volume of air that can be exhaled after full inspiration
Normal is empty 80% of air in <6 secs

Question 5

Define FEV1/FVC
What is normal?

Answer 5

Percentage of lung capacity able to be expelled in one second
Normal usually 75-80%

Question 6

What is the cutoff from moderate persistent to severe persistent asthma in FEV1/FVC and FEV1 (percent of normal)

Answer 6

<75%, <60%

Question 7

What is step 1 of treatment of asthma?

Answer 7

Low-dose ICS+formeterol PRN when >12 yo

Question 8

What is step 2 of treatment of asthma?

Answer 8

Low-dose ICS daily or low dose ICS + formeterol PRN

Question 9

What is step 3 of treatment of asthma?

Answer 9

Low dose ICS +LABA

Question 10

What is step 4 of treatment of asthma?

Answer 10

Medium dose ICS+LABA

Question 11

What is step 5 of treatment of asthma?

Answer 11

High-dose ICS+LABA and add-on tiotropium or omalizumab or IL-5 antagonist if eosinophilic asthma

Question 12

What are the names of common ICS?

Answer 12

-Key suffix -sone
Beclomethasone
Ciclesonide
Flunisolide
Fluticasone
Mometasone

Question 13

What are the names of common SAMAs?

Answer 13

Ipratropium (Atrovent)

Question 14

What are some common names of LAMAs?

Answer 14

-Aclidinium bromide
-Glycopyrrolate
-Revefenacin
-Tiotropium
-Umeclidinium

Question 15

What are some common names of SABAs?

Answer 15

Albuterol
Levalbuterol

Question 16

What are some names of common LABAs?

Answer 16

Arformoterol
Formeterol
Indaceterol
Olodaterol
Salmeterol

Question 17

What are the three LTMs on the market?

Answer 17

Montelukast
Zafirlukast
Zileuton

Question 18

What IgE-binding inhibitor is used in asthma

Answer 18

Omalizumab

Question 19

What IL-4 antagonist is used in asthma? When is it indicated

Answer 19

Dupilumab, as an add-on in those with eosinophilic asthma or if OCS-dependent

Question 20

What IL-5s antagonists are used in asthma? When are they indicated?

Answer 20

Mepolizumab
Reslizumab
Benralizumab
-Eosinophilic phenotype asthma (>150-400 /mm3 if PT is not taking daily systemic steroids)

Question 21

Patient has a FEV1 82% and wakes up 3 times a night a diagnosis of asthma what NAEPP classification of asthma is she?

Answer 21

Mild persistent

Question 22

What medication class is best recommended?

Answer 22

ICS/formeterol PRN

Question 23

If a patients mild persistent asthma is not well controlled with ICS/formeterol what should be added to therapy?

Answer 23

Montelukast (LTM)

Question 24

If an 8-yo is experiencing 1-2 daytime asthma symptoms weekly and waking twice weekly coughing what should be added to Albuterol PRN?

Answer 24

Fluticasone low-dose twice daily

Question 25

How are LABAs indicated to be used per the FDA safety announcement?

Answer 25

Use of LABAs in asthma without ICS is contraindicated because of increased risk of severe worsening of asthma symptoms that can lead to hospitalization and death -Always try to step down from LABAs as asthma symptoms are controlled

Question 26

When are personal best peak expiratory flow rates used? (PEFR)

Answer 26

To assess asthma exacerbations and use an asthma exacerbations action plan

Question 27

What PEFR indicates seeking medical attention immediately?

Answer 27

PEFR 50%

Question 28

How should mild to moderate asthma exacerbation be treated?

Answer 28

-O2 to reach 93-98% -Inhaled SABA every 20 mins for up to 4 hours then every 1-4 hours -OCS if no response immediately or if PT recently took an OCS