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Flashcards in Pulmonology Deck (36):
1

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

12%

2

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

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

3

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

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

4

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

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

5

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

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

6

Classification of Asthma Severity by SABA use (all ages)

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

7

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

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

8

Normal FEV1/FVC values

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

9

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

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

10

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

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

11

Recommended Steps for Treatment Initiation based on Asthma Severity

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

12

FEV1

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

13

FVC

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

14

FEV1/FVC Ratio

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

15

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

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

16

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

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

17

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

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

18

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

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

19

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

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

20

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

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

21

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

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

22

Recommended Action for treatment based on Asthma Assessment

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.

23

Treatment Guideline Steps (age >12 y/o)

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

24

Inhaled Corticosteriod Daily Dosing in Adults-Budesonide

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

25

Inhaled Corticosteriod Daily Dosing in Adults-Fluticasone

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

26

Inhaled Corticosteriod Daily Dosing in Adults-Beclomethasone

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

27

Inhaled Corticosteriod Daily Dosing in Adults-Mometasone

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

28

Inhaled Corticosteriod Daily Dosing in Adults-Ciclesonide

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

29

Inhaled Corticosteriod Daily Dosing in Children-Budesonide Suspension for nebulization

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

30

COPD Definition

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%

31

Gold Guidelines Assessment of COPD Severity (A-D)

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

32

Pharmacotherapy for COPD based on Staging

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

ANC= Anticholinergic

33

When do you use antibiotics in COPD Exacerbation?

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

34

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

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

35

Nicotine Gum Dose

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.

36

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

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.