Pulmonology

Question 1

If FEV1 improves by more than ____ % after administration of a beta-agonist it is considered diagnostic of Asthma.

Answer 1

12%

Question 2

Cough in Asthma is generally Productive or non-productive? Is it throughout the day?

Answer 2

Non-productive (productive is generally with COPD) Generally the cough is worse at night and in the early morning with asthma, throughout the day with COPD

Question 3

Classification of Asthma Severity by Frequency of Symptoms (all ages)

Answer 3

Intermittent: < or = to 2 days/week
Mild Persistent >2 days/week but not daily
Moderate Persistent: Daily
Severe Persistant: Throughout the day

Question 4

Classification of Asthma Severity by Nighttime Awakening (age category 5-11 & >12 y/o)

Answer 4

Intermittent: < or = to 2 days/month
Mild Persistent: 3 or 4 times/month
Moderate Persistent: more than once weekly but not nightly
Severe Persistant: Often 7 times/week

Question 5

Classification of Asthma Severity by Nighttime Awakening (Age 0-4)

Answer 5

Intermittent: 0 times
Mild Persistent: 1 or 2 times/month
Moderate Persistent: : 3 or 4 times/month
Severe Persistant: more than once weekly

Question 6

Classification of Asthma Severity by SABA use (all ages)

Answer 6

Intermittent: < or = to 2 days/week
Mild Persistent >2 days/week but not daily
Moderate Persistent: Daily
Severe Persistant: Throughout the day/several times/day

Question 7

Classification of Asthma Severity by FEV1/FVC (age over 12 y/o)

Answer 7

Intermittent: Normal
Mild Persistent: Normal
Moderate Persistent: : Reduced 5%
Severe Persistant: Reduced > 5%

Question 8

Normal FEV1/FVC values

Answer 8

age 8-19 y/o: 85%
age 20-39 y/o: 80%
age 40-59 y/o: 75%
age 60-80 y/o: 70%

Question 9

Classification of Asthma Severity by FEV1 (age over 12 y/o)

Answer 9

Intermittent: >80%
Mild Persistent: >80%
Moderate Persistent: : >60-<60%

Question 10

Classification of Asthma Severity by Exacerbations requiring oral steroids (age over 12 y/o)

Answer 10

Intermittent: 0-1 /year
Mild Persistent: > or = 2 /year
Moderate Persistent: > or = 2 /year
Severe Persistant: > or = 2 /year

Question 11

Recommended Steps for Treatment Initiation based on Asthma Severity

Answer 11

Intermittent: Step 1
Mild Persistent: Step 2
Moderate Persistent & Severe Persistant: Step 3 and consider short course of oral steroids.

Question 12

FEV1

Answer 12

Volume of air exhaled forcefully in the first second of maximal expiration.

Normally greater than 80% of predicted value, asthma reversibility is shown by an increase in FEV1 > or = to 12% after SABA

Question 13

FVC

Answer 13

The maximum volume of air that can be exhaled after full inspiration. normal lungs can empty 80% of air in < 6 seconds.

Question 14

FEV1/FVC Ratio

Answer 14

Differentiates between obstructive and restrictive disease.
Decreased in obstructive disease (asthma/COPD)
Normal/high in restrictive disease (ex. pulmonary fibrosis)

Question 15

Assessing Asthma Control in Adults >12 y/o based on SX

Answer 15

Well Controlled:< or = to 2 days/week
Not Well Controlled: >2 days/week
Very Poorly Controlled: Throughout the day

Question 16

Assessing Asthma Control in Adults >12 y/o based on Nighttime Awakenings

Answer 16

Well Controlled: < or = 2 times/month
Not Well Controlled: 1-3 times/week
Very Poorly Controlled: > or = to 4 times/week

Question 17

Assessing Asthma Control in Adults >12 y/o based on Interference with Normal Activities

Answer 17

Well Controlled: None
Not Well Controlled: Some limitation
Very Poorly Controlled: Extremely Limited

Question 18

Assessing Asthma Control in Adults >12 y/o based on Short-acting B2 agonist use for Sx control

Answer 18

Well Controlled:< or = to 2 days/week
Not Well Controlled: >2 days/week
Very Poorly Controlled: Several times/day

Question 19

Assessing Asthma Control in Adults >12 y/o based on FEV1 or peak flow

Answer 19

Well Controlled: 80% of predicted/personal best
Not Well Controlled: 60-80% of predicted
Very Poorly Controlled: <60% of predicted

Question 20

Assessing Asthma Control in Adults >12 y/o based on ACT

Answer 20

Well Controlled: > or = to 20
Not Well Controlled: 16-19
Very Poorly Controlled: < or = to 15

Question 21

Assessing Asthma Control in Adults >12 y/o based on Exacerbations requiring oral steroids

Answer 21

Well Controlled: 0 or 1 per year
Not Well Controlled: > or = to 2 per year
Very Poorly Controlled: > or = to 2 per year

Question 22

Recommended Action for treatment based on Asthma Assessment

Answer 22

Well Controlled: Maintain current step, regular follow-up every 1-6 months, consider step-down if well controlled >3 months
Not Well Controlled: Step up 1 step, re-evaluate in 2-6 weeks
Very Poorly Controlled: Consider short course of oral steroids, step up 1 or 2 steps. Reevaluate in 2 weeks.

Question 23

Treatment Guideline Steps (age >12 y/o)

Answer 23

Step 1: No Controller needed/only SABA PRN
Step 2: Preferred Low dose ICS
Step 3: Preferred Low dose ICS plus LABA or medium dose ICS
Step 4: Medium dose ICS plus LABA
Step 5: High dose ICS plus LABA and consider omalizumab for patients with allergic asthma.
Step 6: High dose ICS plus LABA plus systemic corticosteriods and consider omalizumab

Question 24

Inhaled Corticosteriod Daily Dosing in Adults-Budesonide

Answer 24

Low: 180-600 mcg/day
Med: 600-1200 mcg/day
HIgh: >1200 mcg/day

Question 25

Inhaled Corticosteriod Daily Dosing in Adults-Fluticasone

Answer 25

Low: 88-264 mcg/day Med: 264-440 mcg/day HIgh: >440 mcg/day

Question 26

Inhaled Corticosteriod Daily Dosing in Adults-Beclomethasone

Answer 26

Low: 80-240 mcg/day Med: >240-480 mcg/day HIgh: >480 mcg/day

Question 27

Inhaled Corticosteriod Daily Dosing in Adults-Mometasone

Answer 27

Low: 200 mcg/day Med: 400 mcg/day HIgh: >400 mcg/day

Question 28

Inhaled Corticosteriod Daily Dosing in Adults-Ciclesonide

Answer 28

Low: 160 mcg/day Med: 320 mcg/day HIgh: 640 mcg/day

Question 29

Inhaled Corticosteriod Daily Dosing in Children-Budesonide Suspension for nebulization

Answer 29

Ages 0-4/Ages 5-11 (mg/day) Low: 0.25-5 mg/0.5 mg Med: >0.5-1 mg/1 mg High: >1 mg/2 mg

Question 30

COPD Definition

Answer 30

Chronic bronchitis consists of persistent cough plus sputum production for most days of 3 months in the last 2 consecutive years. Spirometry FEV1/FVC less than 70%

Question 31

Gold Guidelines Assessment of COPD Severity (A-D)

Answer 31

A- low risk/less symptoms. FEV1 50-80% (moderate) or >80% (mild) or = 2 exacerbations per year D: High risk, more symptoms, same FEV1 as C, > or = 2 exacerbations per year Questions to ask low symptoms or more symptoms FEV1 >/= 50% A or B FEV1 /=10 high Sx, <10 low Sx

Question 32

Pharmacotherapy for COPD based on Staging

Answer 32

A: SA ANC PRN or SABA PRN B: LA ANC or LABA C & D: ICS + LABA or LA ANC ANC= Anticholinergic

Question 33

When do you use antibiotics in COPD Exacerbation?

Answer 33

1. Should be given if all three cardinal Sx of COPD are present (dyspnea, increased sputum volume, increased sputum purulence) 2. If 2 of 3 cardinal sx are present and if increased purulence is one of the symptoms 3. If patients require mechanical ventilation Treatment duration is generally 5-10 days

Question 34

Duration of therapy for Nicotine Patch (Including Step-downs)

Answer 34

21 mg/24 hours X 4 weeks 14 mg/24 hours X 2 weeks 7 mg/24 hours X 2 weeks

Question 35

Nicotine Gum Dose

Answer 35

1-24 cig/day= 2 mg 25+ cigarettes/day =4 mg gum up to 24 pieces/day Can use up to 12 weeks, longer term use up to 6 months may be helpful.

Question 36

True or False...Single therapy is favored over combination therapy in Smoking Cessation

Answer 36

False: Combination therapy is more effective, only combo to avoid is varenicline and NRT d/t higher incidence of side effects such as nausea/headache.