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Questions and Answers
What percentage of community-acquired pneumonia cases are attributed to Streptococcus pneumoniae?
What percentage of community-acquired pneumonia cases are attributed to Streptococcus pneumoniae?
What is the percentage of atypical pneumonia in community-acquired pneumonia cases?
What is the percentage of atypical pneumonia in community-acquired pneumonia cases?
Which of the following is NOT a common cause of community-acquired pneumonia in healthy adults?
Which of the following is NOT a common cause of community-acquired pneumonia in healthy adults?
What is the definition of community-acquired pneumonia?
What is the definition of community-acquired pneumonia?
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What is the percentage of community-acquired pneumonia cases that require hospitalization?
What is the percentage of community-acquired pneumonia cases that require hospitalization?
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Which of the following is a common cause of community-acquired pneumonia in older adults?
Which of the following is a common cause of community-acquired pneumonia in older adults?
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What is the primary purpose of measuring lung function in asthma patients?
What is the primary purpose of measuring lung function in asthma patients?
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What is the evidence of consolidation on CXR?
What is the evidence of consolidation on CXR?
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What is the name of the guidelines for the treatment of community-acquired pneumonia?
What is the name of the guidelines for the treatment of community-acquired pneumonia?
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How is asthma severity typically assessed?
How is asthma severity typically assessed?
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What is a limitation of using lung function to adjust treatment?
What is a limitation of using lung function to adjust treatment?
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What is the recommended frequency of lung function measurement in most adults?
What is the recommended frequency of lung function measurement in most adults?
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What is an independent predictor of exacerbation risk in asthma patients?
What is an independent predictor of exacerbation risk in asthma patients?
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In which patients may long-term PEF monitoring be considered?
In which patients may long-term PEF monitoring be considered?
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What is the primary focus of assessing symptom control in asthma?
What is the primary focus of assessing symptom control in asthma?
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What is the purpose of asking about side-effects in asthma treatment?
What is the purpose of asking about side-effects in asthma treatment?
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Which of the following comorbidities is likely to contribute to symptoms and poor quality of life in asthma?
Which of the following comorbidities is likely to contribute to symptoms and poor quality of life in asthma?
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What is the definition of 'uncontrolled' asthma symptom control according to the GINA assessment?
What is the definition of 'uncontrolled' asthma symptom control according to the GINA assessment?
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What is the purpose of asking about a patient's attitudes and goals for their asthma?
What is the purpose of asking about a patient's attitudes and goals for their asthma?
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What is the significance of assessing reliever use in asthma control?
What is the significance of assessing reliever use in asthma control?
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What is the primary benefit of having a written asthma action plan?
What is the primary benefit of having a written asthma action plan?
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What is the purpose of assessing risk factors for poor outcomes in asthma?
What is the purpose of assessing risk factors for poor outcomes in asthma?
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What is a crucial aspect to consider when prescribing NSAIDs or beta-blockers to patients with asthma?
What is a crucial aspect to consider when prescribing NSAIDs or beta-blockers to patients with asthma?
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What is an indication for considering referral to an expert for patients with asthma?
What is an indication for considering referral to an expert for patients with asthma?
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What is a key component of guided asthma self-management and skills training?
What is a key component of guided asthma self-management and skills training?
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What percentage of patients believe that regular use of medications will reduce their effectiveness?
What percentage of patients believe that regular use of medications will reduce their effectiveness?
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What is a consideration to keep in mind when assessing patient adherence to treatment plans?
What is a consideration to keep in mind when assessing patient adherence to treatment plans?
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What is an indication for referral in patients with asthma and symptoms suggesting chronic infection or cardiac disease?
What is an indication for referral in patients with asthma and symptoms suggesting chronic infection or cardiac disease?
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What is an essential consideration when choosing an inhaler device for patients with asthma?
What is an essential consideration when choosing an inhaler device for patients with asthma?
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What is a potential consequence of patients underestimating the seriousness of asthma?
What is a potential consequence of patients underestimating the seriousness of asthma?
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What is a key aspect of remediation of dampness or mold in homes for patients with asthma?
What is a key aspect of remediation of dampness or mold in homes for patients with asthma?
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What is an indication for considering referral in patients with asthma and features of both asthma and COPD?
What is an indication for considering referral in patients with asthma and features of both asthma and COPD?
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What is the primary goal of stepwise management in asthma?
What is the primary goal of stepwise management in asthma?
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What is a crucial aspect of asthma management, according to the diagram?
What is a crucial aspect of asthma management, according to the diagram?
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Which medication is not indicated for children?
Which medication is not indicated for children?
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What is a key factor in determining the appropriate step in asthma management?
What is a key factor in determining the appropriate step in asthma management?
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What is the primary focus of step 5 in asthma management?
What is the primary focus of step 5 in asthma management?
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Which of the following is not a consideration in determining the appropriate asthma medication?
Which of the following is not a consideration in determining the appropriate asthma medication?
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What is the purpose of non-pharmacological strategies in asthma management?
What is the purpose of non-pharmacological strategies in asthma management?
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What is the dosage range for Ciclesonide (HFA) in step 3?
What is the dosage range for Ciclesonide (HFA) in step 3?
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What is the primary focus of step 4 in asthma management?
What is the primary focus of step 4 in asthma management?
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Which of the following is a critical aspect of asthma diagnosis?
Which of the following is a critical aspect of asthma diagnosis?
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Study Notes
Community Acquired Pneumonia (CAP)
- Infection of the lung not acquired in the hospital, LTC, or other recent contact with a health care system
- Evidence of consolidation on CXR
- Treatment guidelines from IDS/ATS and management of CAP in older adults from TAID
Etiology
- Streptococcus pneumoniae (30-35%)
- Mycoplasma pneumoniae
- Chlamydophila pneumoniae
- Legionella
- Influenza viruses
- H. influenzae
- Atypical PNA accounts for 37% of CAP and 10% of those who are hospitalized
- Nosocomial gram negatives—often seen in elderly nursing home residents
Asthma Management
- GINA assessment of symptom control:
- Daytime asthma symptoms more than twice a week
- Any night waking due to asthma
- Reliever needed for symptoms more than twice a week
- Any activity limitation due to asthma
- Risk assessment:
- Low FEV1 is an independent predictor of exacerbation risk
- Measure lung function to monitor progress
- Adjusting treatment:
- Utility of lung function for adjusting treatment is limited by between-visit variability of FEV1 (15%)
Assessing Asthma Severity
- Asthma severity is assessed retrospectively from the level of treatment required to control symptoms and exacerbations
- Stepwise management:
- Symptoms
- Exacerbations
- Side-effects
- Patient satisfaction
- Lung function
- Patient preference
- Treat modifiable risk factors
Occupational Asthma
- Ask patients with adult-onset asthma about work history
- Remove sensitizers as soon as possible
- Refer for expert advice, if available
Additional Interventions
- Avoid medications that may worsen asthma
- Remediation of dampness or mold in homes
- Sublingual immunotherapy (SLIT) for adult HDM-sensitive patients with allergic rhinitis
- Consider referral for:
- Difficulty confirming the diagnosis of asthma
- Symptoms suggesting chronic infection, cardiac disease, etc.
- Suspected occupational asthma
- Persistent uncontrolled asthma or frequent exacerbations
- Risk factors for asthma-related death
Patient Considerations
- If the family/patient thinks asthma is not serious, they are less likely to follow the treatment plan
- Fears about medications:
- 39% believe medicines are addictive
- 36% believe medicines are not safe to take over a long period
- 58% believe regular use will reduce effectiveness
Guided Asthma Self-Management
- Essential components:
- Skills training to use inhaler devices correctly
- Encouraging adherence with medications, appointments
- Asthma information
- Guided self-management support
- Self-monitoring of symptoms and/or Peak Expiratory Flows
- Written asthma action plan
- Regular review by a health care provider
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Description
Learn about the causes, diagnosis, and treatment of community-acquired pneumonia, including guidelines for older adults. Test your knowledge of this common infection.
