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Obstructive Lung Dz

Pulmonology

QuestionAnswer
Portion of air flow curve most affected by airway obstruction FEF (forced expiratory flow)
flow rate of inspired air during maximum inspiration. indicates large airway disease PIFR (peak inspiratory flow rate)
maximum airflow rate during forced expiration PEFR (peak expiratory flow rate)
typically used to detect the presence of hyperactive airway disease methacholine or histamine challenge
highlighted by perialveolar inflammation followed by fibrosis interstitial lung disease
Patients with COPD can be expected to have increased ______ RV and ERV
includes sleep walking, sleep talking, sleep terrors, REM disorders parasomnia
the most common type of sleep apnea obstructive
obstructive sleep apnea is caused by relaxation of the posterior pharyngeal muscles
____ sleep apnea is characterized by a simple cessation of breathing central
frequent and irreversible need for sleep during daytime hours narcolepsy
causes patients to act out their dreams, these patients can vividly recall dreams REM disorders
most common form of sleep disorder insomnia
In spirometry, decreased FEV1/FVC and MMFR are seen in: obstructive lung disease (asthma, chronic bronchitis, emphysema)
_____ impairments will have a flattened flow-volume loop obstructive
disease associated with increased elastic recoil lung fibrosis
diseases associated with increased elastic recoil are associated with _____ FRC decreased
disease associated with decreased elastic recoil emphysema
diseases associat with decreased elastic recoil are associated with _____ FRC increased
extrinsic cause of restrictive lung disorder obesity, pleural effusion
Pulse oximetry is not accurate in using to titrate O2 therapy in advanced COPD
Normal oxygen saturation for baby in the womb is between 30% and ___% 70
In spirometry, values greater than __% of predicted values are considered normal 80
Volume of air remaining in the lungs following forced expiration = RV (residual volume)
Amount of air left in lungs after normal expiration = FRC (functional residual capacity)
Maximal amount of air that can be expired after maximal inspiration = VC (vital capacity)
Volume of air inspired and expired with each normal respiration = TV (tidal volume)
Maximal volume of air that can be inspired from end of normal inspiration = volume) IRV (inspiratory reserve
Maximal volume of air that can be exhaled after normal exhalation = ERV (expiratory reserve volume)
Maximal rate of air flow through the pulmonary tree during forced expiration = MMFR (maximal midexpiratory flow rate)
Maximal volume of air a patient can breath in and out during 1 minute = MVV (maximal volume ventilation)
MVV is less than the predicted value in: both obstructive pulmonary disease and restrictive pulmonary disease
In restrictive lung disease, ______ should be measured FEV1/FVC ratio
MMFR volumes are lower than expected in: obstructive pulmonary disease
MMFR volumes are normal in: restrictive pulmonary disease
Amount of light absorbed by oxygen-saturated Hgb is measured by the sensor to determine saturation levels = oximetry
In PFTs, reduced lung VOLUMES (TLC, RV, VC, FRC) and NORMAL expiratory airflow (MMFR, FEV1/FVC) are seen in: restrictive lung disease (neuromuscular and chest wall diseases)
Prevalence of COPD in US 16M (another estimated 16M are undiagnosed)
COPD type: arterial pO2 preserved; pt pink, cachectic, increased WOB; rare cough or breath sounds, no edema; in pts >50 yo = pink puffer
COPD type: recurrent bronchitis, hypoxemia -> RV failure -> cyanosis, obesity, edema; productive cough, frequent exacerbations; wheezing / rhonchi; in pts 30-40 yo = blue bloater
Chronic bronchitis dx criteria cough & sputum production =/> 3 months of year for 2 consecutive years; wheezes, prolonged expiration; cyanosis, cor pulmonale
Emphysema dx DOE, nonproductive cough, pursed-lip breathing, thin, hyperresonant to percussion, decreased breaths sounds, wheezes, cor pulmonale
PFTs: chronic bronchitis reduced FEV1 +/- FVC; reversibility after SABA; normal-high TLC/RV; normal diffusing capacity
PFTs: emphysema fixed reduction in FEV1 +/- FVC; high TLC +/- RV; reduced diffusing capacity
Chronic bronchitis mgmt SABA, LABA/sympathomimetics (Foradil / Brovana), anticholinergics (Spiriva), O2 if PO2 >55, diuretics, postural drainage for excessive secretions
Emphysema mgmt SABA / LABA / anticholinergics , theophylline, AAT replacement if deficiency; lung volume reduction surgery; lung transplant for end-stage COPD; mechanical ventilation PRN; bullectomy for bullous emphysema
Chronic inflammatory dz with reversible airway narrowing / obstruction, hyperresponsiveness = asthma
Asthma epidemiology 3-5% of popn; 80% dev sxs <5 yo; 470K hospitalizations/yr; 5000 deaths in US/yr
Asthma RFs Atopy (+allergen / IgE testing), FH, environmental triggers; maternal smoking; NSAIDs
Asthma category: sxs <2 days/week; nocturnal sxs <2x/ month; <2 days/wk of SABA use; no interference with activity; PEF >70%, FEV1 >80% = mild intermittent
Asthma category: sxs >2 days/week; nocturnal sxs 3-4x/ month; >2 days/wk of SABA use; minor interference with activity; PEF 40-60%, FEV1 >80% = mild persistent
Asthma category: sxs daily; nocturnal sxs >1x/week, not nightly; >2 days/wk of SABA use; interference with activity; FEV1 60-80%, FEV1/FVC reduced 5% = moderate persistent
Asthma category: sxs throughout day; almost nightly sxs; daily+ SABA use; severe interference with activity; FEV1 <60%, FEV1/FVC reduced >5%, PEF <60% of personal best = severe persistent
Mild persistent asthma tx = low dose ICS (Step 2)
Moderate persistent asthma tx = Step 3: low dose ICS + LABA. Step 4: LABA + medium-dose ICS
Severe persistent asthma tx = Step 5: High dose ICS + LABA. Step 6: High dose ICS + LABA + oral steroids
Significant reversibility of airflow obstruction is defined as: increase of >12% and 200mL in FEV1 or >15% & 200mL in FVC after inhaling SABA
In asthma, bronchial provocation test (eg, methacholine challenge) is not recommended if: FEV1 is <65%
positive methacholine test is = >20% drop in FEV1 after exposure to concentration of 8mg/mL or less
Pros and cons of anticholinergic meds (eg Spiriva): reverse vagally mediated bronchospasm but NOT allergen- or exercise-induced asthma; decrease mucus gland hypersecretion
Culture is never indicated in: chronic bronchitis
In asthma, do not use LABA for: acute sxs (only for moderate-severe persistent sxs, and with ICS)
Asthma: mild persistent criteria Symptoms >2 days/week, >2 nights/month, SABA required >2days/week
Asthma: moderate persistent criteria Symptoms daily, >1 night/week, SABA required daily
COPD spectrum: proximal vs distal Proximal (large airways): cough/sputum, low resp drive, airway hyperreactive. Distal (small airways): low DLCO
PFT result interpretation: obstruction vs restriction Obstruction: low FEV1/VC (<50% is severe); restriction: low VC, low FEV1, normal FEV1/VC
Lung auscultation: long expiratory phase = COPD
Anticholinergic adverse effects dry mouth, dry eyes, mydriasis, urinary retention, constipation
onset of action 5-30 minutes, with relief for 4-6 hours SABA
Beta 2 agonists have no anti-inflammatory effects and therefore should not be use as the sole therapeutic agent for management of persistent asthma
patients achieving ____ consecutive months of improved asthma control may be considered for a reduction in inhaled corticosteroid dosing 3-6
Patients with severe exacerbation of asthma may require: IV injection of methylprednisolone or oral prednisone
Allows for modest reductions in doses of beta2 agonists and corticosteroids leukotriene antagonist (eg, montelukast)
Pretreatment with ____ blocks allergen and exercise induced bronchoconstriction cromolyn
blocks vagally mediated contraction of airway smooth muscle and mucus secretion ipratropium
not traditionally effective in the treatment of asthma unless COPD is also present ipratropium
Useful in patients with moderate to severe asthma that are poorly controlled with conventional therapy omalizumab
Foundation of therapy for COPD inhaled bronchodilators such as anticholinergic agents
liver function monitoring is essential for leukotriene modifiers
inhaled bronchodilators that have a duration of bronchodilation of at least 12 hours after a single dose LABA
the preferred ICS for pregnancy budesonide
Preferred Step 1 treatment for patients 12 and up SABA PRN
Preferred Step 2 treatment for patients 12 and up low dose ICS
Preferred step 3 treatment for patients 12 and up low dose ICS plus LABA or medium dose ICS
Preferred step 4 treatment for patients 12 and up medium dose ICS plus LABA
preferred step 5 treatment for patients 12 and up high dose ICS plus LABA and consider omalizumab for patients with allergies
preferred step 6 treatment for patients 12 and up high dose ICS plus LABA plus oral corticosteroids, and consider omalizumab for patients with allergies
regular tx with _____ does not modify long term decline in FEV1, but reduces frequency of exacerbations in COPD pts w/ FEV1 of <50%, and repeated exacerbations inhaled glucocorticosteroids
long term treatment with ______ is not recommended in patients with COPD oral glucocorticosteroids
reduces serious illness and death in COPD patients by 50% influenza vaccine
initiate oxygen therapy for very severe COPD if PaOx is at or below ___ kPa or SaO2 is at or below __% 7.3, 88
antibiotics should be given to COPD patients with: increased dyspnea, increased sputum volume, increased sputum purulence, or who require mechanical ventilation
carry a black box warning for asthma (especially when used as monotherapy) LABA
Leukotriene modifier Singulair
Approved for allergic rhinitis Singulair
effective for seasonal asthma and for prevention of exercise induced bronchospasm mast cell stabilizers
effective for seasonal asthma and for prevention of exercise induced bronchospasm Cromolyn sodium and nedocromil
Anticholinergic for COPD tiotropium (spiriva)
Anticholinergic for asthma Ipratropium (Atrovent)
Should be done in the AM and between noon and 2PM for 2-3 weeks to establish personal best, then QD peak flows
ultimate goal of COPD therapy prevention
oxygen, consider surgery very severe COPD (stage 4)
When to use inhaled corticosteroids in COPD severe (stage 3), and very severe (stage 4)
not recommended in COPD expectorants, mucolytics, antitussives, respiratory stimulants
only therapy to show mortality benefit in COPD oxygen
goal of oxygen therapy increase PaO2 to > 60 mmHg
Created by: Abarnard