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Obstructive Lung Dz
Pulmonology
| Question | Answer |
|---|---|
| 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
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