Asthma and COPD

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which medication could potentially worsen asthma symptoms?

Antihistamines

Leukotriene modifiers

Beta blockers (correct)

Inhaled corticosteroids

What is a key characteristic of COPD, differentiating it from asthma?

Irreversible airflow limitation (correct)

Reversible airway inflammation

Association with environmental triggers

Predominant symptom of cough

A patient with COPD is likely to present with which set of symptoms?

Fever, chills, and productive cough

Wheezing, chest tightness, and reversible airflow

Nasal congestion, sneezing and sore throat

Dyspnea, cough, and sputum production (correct)

What is the importance of using a spacer with an inhaler?

To improve medication delivery to the lungs (C) Signup and view all the answers

Which test is considered the gold standard for confirming a diagnosis of COPD?

Spirometry pre- and post-bronchodilator (C) Signup and view all the answers

What is a key characteristic of asthma?

Episodic reversible narrowing of the airways (D) Signup and view all the answers

Which of the following is NOT a common trigger for asthma?

Pollen (A) Signup and view all the answers

A patient with asthma has a heart rate greater than 110 bpm, difficulty speaking in sentences and is using accessory muscles to breathe. Which is MOST concerning?

Difficulty speaking in sentences (A) Signup and view all the answers

Which of these findings is NOT a hallmark clinical presentation of asthma?

Excessive drooling (C) Signup and view all the answers

What is a key criterion for the diagnosis of asthma?

Demonstration that airflow obstruction is at least partially reversible (A) Signup and view all the answers

A patient has asthma symptoms less than 2 times a week, normal lung function tests and 1 exacerbation per year. Which classification of asthma fits best?

Intermittent Asthma (D) Signup and view all the answers

A patient with persistent asthma uses a low dose ICS with a LABA. The patient presents with daily symptoms and mild reduction in FEV1, based on the text which medication would be used?

Medium dose ICS plus LABA and Albuterol prn (A) Signup and view all the answers

Which of the following is considered an ominous sign in a patient with asthma?

Fatigue (D) Signup and view all the answers

Which of the following is NOT a typical finding in a chest X-ray of a patient with COPD?

Elevated diaphragm (B) Signup and view all the answers

A patient has an FEV1/FVC ratio of 65% and an FEV1 of 75% predicted. Based on these results which statement is most accurate?

The patient has COPD and the airflow limitation is likely not fully reversible (C) Signup and view all the answers

Which diagnostic test is MOST important in evaluating a patient with suspected COPD?

Pulmonary Function Tests (PFTs) (D) Signup and view all the answers

A patient presents with a chronic cough, sputum production, and is a smoker. His FEV1 is 90% of predicted. According to the classification provided, this patient can be classified as having which stage of COPD?

Stage 1 Mild COPD (B) Signup and view all the answers

Which of the following is a common distinguishing characteristic of Bronchiectasis from other conditions on the COPD differential?

Large volumes of purulent sputum (A) Signup and view all the answers

In moderate COPD, what is the expected range for FEV1?

FEV1 < 50% and < 80% predicted (D) Signup and view all the answers

Which of the following best describes the role of anticholinergics for COPD?

First-line bronchodilators for daily symptom management (B) Signup and view all the answers

A patient with severe COPD has repeated exacerbations. According to the provided stages of COPD what FEV1 value would make this patient's prognosis worse?

FEV1 < 50% predicted (A) Signup and view all the answers

What is the typical daily dosage and duration for methylprednisolone used in COPD treatment?

40-48 mg daily for 3-4 days, divided doses (D) Signup and view all the answers

Which of these is indicative of Stage 4 COPD?

FEV1 < 30% predicted or < 50% predicted + chronic respiratory failure (B) Signup and view all the answers

Which medication is considered a short-acting beta 2 agonist (SABA) used as a reliever for asthma?

Albuterol (A) Signup and view all the answers

A patient with daily asthma symptoms and an FEV1 between 60-80% predicted falls into which asthma treatment step?

Step 4 (C) Signup and view all the answers

Which of the following is a combination medication containing a long-acting beta 2 agonist (LABA) and an inhaled corticosteroid (ICS)?

Advair (D) Signup and view all the answers

A patient uses their SABA more than twice a week. What does this suggest about their asthma control?

Their asthma is poorly controlled or they are having an exacerbation. (A) Signup and view all the answers

What is a primary goal in asthma management besides symptom control?

Maintain near-normal pulmonary function. (A) Signup and view all the answers

Which medication is an inhaled corticosteroid (ICS) used as a controller medication for persistent asthma?

Budesonide (A) Signup and view all the answers

A patient's asthma is severe, with daily, nonstop symptoms. What is the recommended step for managing this?

Step 5 : High dose ICS + LABA, with consultation recommended (B) Signup and view all the answers

Which additional medication is considered for patients with allergies experiencing severe asthma?

Omalizumab (B) Signup and view all the answers

Which of the following inhaled medications is considered a long-acting muscarinic antagonist (LAMA)?

Aclidinium bromide (B) Signup and view all the answers

A patient with a low CAT score and a low exacerbation frequency would likely be prescribed which of the following?

Formoterol via nebulization (B) Signup and view all the answers

A patient with COPD is prescribed the combination inhaler Formoterol/budesonide. What is the classification of this medication?

LABA/ICS (C) Signup and view all the answers

Which of the following is a characteristic more prominent in COPD vs asthma?

Persistent abnormal spirometry (C) Signup and view all the answers

What is the recommended frequency for administering the combination medication Ipratropium Bromide/Albuterol?

Every 6 hours (C) Signup and view all the answers

Which of these medications is LEAST likely to be used on a regular, daily basis for COPD?

Albuterol (C) Signup and view all the answers

What is a key non-pharmacologic intervention that should be encouraged for patients with COPD?

Smoking cessation (D) Signup and view all the answers

A patient with COPD presents with right heart failure. Which of the following assessment findings would be most consistent with this condition?

Jugular venous distention (JVD) (B) Signup and view all the answers

A patient's PFT results reveal significant airflow obstruction and limited reversibility with bronchodilators. Which disease is more likely?

COPD (A) Signup and view all the answers

What is the mechanism of action for roflumilast in the treatment of COPD?

Phosphodiesterase 4 Inhibitor (D) Signup and view all the answers

Which of the following strategies is essential for asthma management?

Education on individual environmental triggers (C) Signup and view all the answers

What is a critical symptom of worsening COPD exacerbation?

Increase in cough and dyspnea (A) Signup and view all the answers

Which of the following is a distinguishing characteristic of COPD compared to asthma?

Progressive airflow limitation (A) Signup and view all the answers

What is the primary purpose of using a peak flow meter in asthma management?

To monitor lung function and detect early signs of exacerbation (D) Signup and view all the answers

What are the common symptoms of late-stage COPD?

Dyspnea, cough, and sputum production (C) Signup and view all the answers

What does an FEV1/FVC ratio of less than 70% indicate?

Airway obstruction (C) Signup and view all the answers

Which imaging finding is commonly associated with patients who have COPD?

Low, flattened diaphragm (B) Signup and view all the answers

Which characteristic best differentiates COPD from asthma?

Age of onset (C) Signup and view all the answers

Which of the following conditions is NOT typically included in the differential diagnosis for COPD?

Pneumonia (A) Signup and view all the answers

In patients with suspected COPD, which test is essential for the evaluation?

Arterial Blood Gases (ABGs) (B) Signup and view all the answers

Which of the following medications is recommended as a last resort for severe asthma management?

Prednisone PO (B) Signup and view all the answers

What is a common adverse effect of inhaled corticosteroids?

Dysphonia (C) Signup and view all the answers

Which of the following conditions is NOT commonly associated with asthma?

Diabetes (A) Signup and view all the answers

What condition is indicated by a peak flow rate of less than 60 L per min initially?

Severe asthma exacerbation (D) Signup and view all the answers

What characterizes Stage 3 COPD in terms of FEV1 and symptoms?

FEV1 less than 50% with increased shortness of breath and repeated exacerbations (D) Signup and view all the answers

Which of the following medications is recommended as first-line therapy for daily symptoms in COPD?

Ipratropium bromide (B) Signup and view all the answers

Which diagnostic test would typically be used to confirm asthma diagnosis?

Spirometry (B) Signup and view all the answers

How are asthma symptoms characterized in terms of their onset?

Intermittent and exacerbated by allergens (B) Signup and view all the answers

What is a significant impact of repeated exacerbations in patients with Stage 3 COPD?

They decrease quality of life and worsen prognosis if FEV1 is less than 50% (A) Signup and view all the answers

What is the significance of an FEV1/FVC ratio of less than 30%?

Need for aggressive treatment (C) Signup and view all the answers

In which stage of COPD is chronic respiratory failure a concern, indicated by FEV1 values?

Stage 4 (D) Signup and view all the answers

Which symptom would be most typical for a patient with asthma during an exacerbation?

Cough that responds to SABA (A) Signup and view all the answers

What is the recommended dosage and duration for administering prednisone during acute exacerbations of COPD?

40 mg daily for 5 days (A) Signup and view all the answers

What should be prescribed for a patient with moderate asthma experiencing severely uncontrolled symptoms?

Medium dose ICS + LABA (B) Signup and view all the answers

Which combination medication includes formoterol and is used for mild persistent asthma?

Symbicort (A) Signup and view all the answers

When is it appropriate to consider high-dose ICS + LABA + oral corticosteroids for asthma management?

For severe asthma with daily symptoms (B) Signup and view all the answers

What is the primary goal of asthma management aside from controlling symptoms?

Minimizing pharmacotherapy (C) Signup and view all the answers

Which medication type is recommended for managing nocturnal asthma symptoms under the step 3 treatment plan?

Combination of low-dose ICS + LABA (B) Signup and view all the answers

A patient presents with asthma symptoms more than twice a week but less than daily. What is the correct management step?

Low-dose ICS (B) Signup and view all the answers

What is a potential recommendation for patients with asthma who also have allergies?

Omalizumab (Xolair) (A) Signup and view all the answers

For a patient with intermittent asthma who requires their SABA more than twice a week, what does this indicate?

Need for a step-up in management (A) Signup and view all the answers

What is a typical symptom of asthma during exacerbations?

Chest tightness (B) Signup and view all the answers

What is the purpose of phosphodiesterase 4 inhibitors in COPD treatment?

Reduce inflammation (B) Signup and view all the answers

Which of the following lung function test results is indicative of asthma?

Significant improvement after bronchodilator (A) Signup and view all the answers

Inhaled corticosteroids are often combined with which type of medication for better management of COPD?

Long-acting muscarinic antagonists (LAMA) (B) Signup and view all the answers

Which medication is considered a long-acting beta2 agonist (LABA) for managing COPD symptoms?

Salmeterol (B) Signup and view all the answers

What is a common characteristic of COPD compared to asthma?

Right heart failure signs, such as edema (C) Signup and view all the answers

Patients with mild/high risk COPD should be prescribed which combination of medications?

LABA + ICS (D) Signup and view all the answers

What role does pulmonary rehabilitation play in managing COPD?

Improves exercise capacity and overall health (B) Signup and view all the answers

Which medication is utilized as both a short-acting beta2 agonist (SABA) and in combination with Ipratropium for COPD treatment?

Albuterol (D) Signup and view all the answers

What assessment finding is least likely in a patient experiencing an asthma exacerbation?

Barrel chest (B) Signup and view all the answers

Which of the following would be LEAST useful in evaluating a patient with suspected COPD?

Echocardiogram (C) Signup and view all the answers

A patient has an FEV1/FVC ratio of 0.6 and an FEV1 of 65% predicted, but reports mild symptomatic improvement with bronchodilators. How does this inform your understanding of their condition?

Indicates COPD with some airflow obstruction present. (B) Signup and view all the answers

What is a common radiographic finding consistent with COPD?

A blunted costophrenic angle (B) Signup and view all the answers

Which characteristic is MOST useful in differentiating Bronchiectasis from other diseases on the COPD differential?

Large volumes of purulent sputum (B) Signup and view all the answers

A patient suspected of having COPD should NOT have Pulmonary Function Tests (PFTs) performed during:

During an acute exacerbation (A) Signup and view all the answers

Which of the following is a common side effect of inhaled corticosteroids?

Thrush (B) Signup and view all the answers

A patient with asthma presents with episodic wheezing, coughing, and shortness of breath. Which of the following diagnostic findings is MOST consistent with asthma?

Partially reversible airflow obstruction (A) Signup and view all the answers

Which of the following comorbidities is commonly associated with asthma?

Nasal polyps (A) Signup and view all the answers

A patient with asthma is admitted to the hospital. What FEV1 value after an hour of vigorous treatment would MOST likely warrant hospitalization, according to the provided criteria?

Less than 40% of predicted value (D) Signup and view all the answers

Which of the following is a possible differential diagnosis to consider in a patient who presents with shortness of breath, a dry cough, and wheezing?

Croup (C) Signup and view all the answers

Which of the following laboratory findings is MOST consistent with a patient who has poorly controlled asthma?

Elevated eosinophils (D) Signup and view all the answers

A patient is experiencing symptoms including central adiposity, hypertension, ecchymoses, and muscle weakness. Which medication is MOST likely causing these side effects?

Oral corticosteroids (D) Signup and view all the answers

A patient experiences heartburn after large meals, worsens in the supine position, and has a history of asthma. What condition, besides asthma, should be considered?

Gastroesophageal reflux disease (GERD) (C) Signup and view all the answers

A patient with known asthma is being educated on how to prevent exacerbations. Which of the following recommendations would be MOST important to include?

Identification and minimization of exposure to environmental triggers. (B) Signup and view all the answers

What physiological process underlies the episodic nature of asthma symptoms?

Reversible narrowing and inflammation of the airways. (B) Signup and view all the answers

A patient has a new diagnosis of COPD. What should patients be educated about regarding their condition?

Their condition is progressive and not fully reversible. (C) Signup and view all the answers

A patient with asthma presents with fatigue, absent breath sounds, and paradoxical chest/abdominal movement. These findings are indicative of?

An ominous asthma exacerbation. (B) Signup and view all the answers

A patient has a chronic cough and produces sputum. The patient also has trouble breathing. These symptoms have progressively gotten worse over the last 6 months. Which of these findings would be MOST suggestive of COPD?

Symptoms have been worsening over time and are associated with mucus production. (A) Signup and view all the answers

A patient has asthma symptoms more than twice a week but not daily. The patient also has greater than 2 exacerbations per year. Which classification of asthma fits best?

Persistent Mild Asthma. (C) Signup and view all the answers

Which is the PRIMARY goal of spirometry when performed for COPD?

To determine if airflow limitations are reversible. (C) Signup and view all the answers

A patient with asthma is using their inhaler and the medication reaches the back of their throat but does not improve symptoms. Which of the following would be MOST likely to improve medication delivery?

Using a spacer with the current inhaler. (A) Signup and view all the answers

A patient with moderate persistent asthma is using a low dose ICS and LABA with a PRN SABA. They present with laboured breathing, diaphoresis and extreme breathlessness. According to the asthma classifications, what is the next step for their treatment?

Classified as severe asthma and treated accordingly (A) Signup and view all the answers

Which of the following best describes the role of a short-acting beta 2 agonist (SABA) in asthma management?

To provide quick relief of acute symptoms. (A) Signup and view all the answers

According to the information provided, what is the primary criterion for diagnosing asthma?

Demonstration of episodic symptoms of airflow obstruction and its partial reversibility. (A) Signup and view all the answers

A patient with asthma presents with a heart rate of 120 bpm, respiratory rate of 30 breaths per minute, and increased use of accessory muscles. Based on the provided content. This patient is MOST likely experiencing

A severe asthma exacerbation. (A) Signup and view all the answers

What is the primary goal of a physical examination for a patient presenting with asthma symptoms?

Assess severity, determine diagnosis, and rule out others. (A) Signup and view all the answers

Which medication is used as a short-acting anticholinergic reliever for asthma?

Ipratropium (B) Signup and view all the answers

A patient with persistent asthma is using a low-dose ICS. After an evaluation, it's determined they have symptoms most days and some nocturnal symptoms. Which step of asthma management should this patient be in?

Step 3 (D) Signup and view all the answers

What is the recommended approach for managing a patient with severely uncontrolled asthma, daily symptoms, and an FEV1 between 60-80% predicted?

Step 4: Medium-dose ICS + LABA (A) Signup and view all the answers

If a patient with asthma is using their short-acting beta-2 agonist (SABA) more than twice a week, what does this suggest?

Their asthma is poorly controlled or they are having an exacerbation (C) Signup and view all the answers

Which of the following is NOT a goal of asthma management?

Complete eradication of all potential triggers (D) Signup and view all the answers

For a patient with severe asthma (daily, nonstop symptoms), which treatment step is typically recommended?

High-dose ICS + LABA (B) Signup and view all the answers

A patient with allergies and severe asthma is being considered for additional therapy. Which of the following is a medication that may be added?

Omalizumab (C) Signup and view all the answers

Which is an example of a combination medication that contains fluticasone and salmeterol?

Advair (D) Signup and view all the answers

Which of the following is a long-acting beta-2 agonist (LABA) that is administered via dry powder inhaler (DPI)?

Salmeterol xinafoate (B) Signup and view all the answers

A patient with a high CAT score (>10) and frequent COPD symptoms would MOST likely benefit from which of the following combination therapies?

LABA and LAMA (D) Signup and view all the answers

What is the recommended frequency of administration for aclidinium bromide?

Twice daily (D) Signup and view all the answers

Which of the following is a common finding in COPD but NOT in asthma?

Pursed lip breathing (D) Signup and view all the answers

A patient's pulmonary function test reveals an FEV1/FVC ratio of 60%. Which of the following is the best interpretation of this result?

Obstructive lung disease (A) Signup and view all the answers

For a patient with frequent COPD exacerbations, which of the following medications might be considered in addition to standard therapies such as LABA, LAMA and ICS?

Roflumilast (B) Signup and view all the answers

A COPD patient experiences weight loss. What nutritional advice is MOST appropriate?

Eat small, frequent meals (C) Signup and view all the answers

What clinical finding would differentiate moderate COPD with a low exacerbation frequency from moderate COPD with high exacerbation frequency?

Use of Roflumilast (D) Signup and view all the answers

Which of the following findings on a physical examination is MOST suggestive of right heart failure in a patient with COPD?

Jugular Venous Distension (JVD) (D) Signup and view all the answers

A patient with moderate COPD needs a short-acting bronchodilator for breakthrough symptoms. Which of the following is MOST appropriate?

Combivent (B) Signup and view all the answers

A patient with COPD has an FEV1 of 25% predicted and experiences frequent exacerbations that threaten their life. Which stage of COPD does this patient likely have?

Stage 4 (B) Signup and view all the answers

Which of the following medications is a short-acting muscarinic antagonist (SAMA) used for the treatment of COPD?

Ipratropium bromide (B) Signup and view all the answers

What is the typical daily dosage of prednisone used for treating acute exacerbations of COPD?

40 mg for 5 days (A) Signup and view all the answers

A patient with COPD experiences shortness of breath with exertion and has an FEV1 of 40% predicted. Which stage of COPD is this patient likely in?

Stage 2 (B) Signup and view all the answers

Which of the following is a common distinguishing characteristic of COPD compared to asthma?

Airflow limitation that is primarily obstructive (C) Signup and view all the answers

Which pulmonary function test measures the total volume of air expelled after maximum inspiration?

FVC (B) Signup and view all the answers

Which of the following findings is a common characteristic seen on a chest X-ray of a patient with COPD?

Flattened diaphragm (B) Signup and view all the answers

In which stage is a patient classified if their FEV1 is greater than 80% predicted?

Stage 1 - Mild COPD (D) Signup and view all the answers

What is the significance of performing CBC and ABGs in patients suspected of having COPD?

To detect cor pulmonale and other complications (D) Signup and view all the answers

What is a key characteristic of COPD that differentiates it from asthma?

COPD is characterized by airflow limitation that is generally irreversible, while asthma is typically reversible. (A) Signup and view all the answers

What is the gold standard test for confirming a diagnosis of COPD?

Pulmonary function testing (spirometry) (D) Signup and view all the answers

Which of the following is NOT a typical clinical presentation of COPD?

Wheezing (D) Signup and view all the answers

What is a characteristic feature of COPD that contributes to airflow limitation?

Loss of small airways (A) Signup and view all the answers

What is a clinical indicator that suggests a COPD exacerbation is worsening?

Increased dyspnea lasting more than 6 seconds (B) Signup and view all the answers

What is the initial management step for a patient with asthma experiencing severe, constant symptoms and more than 2 exacerbations per year?

High dose inhaled corticosteroids plus LABA and Albuterol as needed (A) Signup and view all the answers

Which adverse effect is associated with inhaled corticosteroids in asthma treatment?

Thrush (C) Signup and view all the answers

Which of the following lab findings is typically observed in patients with asthma?

Eosinophilia (A) Signup and view all the answers

What is one of the first components needed to diagnose asthma?

Evidence of airflow obstruction that is partially reversible (D) Signup and view all the answers

In which situation might hospitalization be indicated for a patient with asthma?

If forced expiratory volume in 1 second (FEV1) is less than 30% of predicted value (D) Signup and view all the answers

Which condition is NOT commonly associated as a comorbidity with asthma?

Valvular disease (A) Signup and view all the answers

What does an FEV1/FVC ratio of less than 70% generally indicate?

Obstructive lung disease (D) Signup and view all the answers

Which of the following explains the typical presentation of asthma symptoms?

Symptoms typically worsen at night and early morning (B) Signup and view all the answers

Which class of medication is primarily used for ongoing asthma control and prevention?

Inhaled corticosteroids (ICS) (D) Signup and view all the answers

What is the best classification for a patient experiencing daily asthma symptoms with an FEV1 between 60-80% predicted?

Step 4 (A) Signup and view all the answers

Which medication combination is used for mild, persistent asthma?

Low-dose ICS + LABA (C) Signup and view all the answers

At what point should referral to a specialist be considered for a patient with asthma?

When they are using a high-dose ICS + LABA (B) Signup and view all the answers

Which of the following medications is typically NOT used as a reliever for asthma?

Budesonide (D) Signup and view all the answers

What is a primary goal in the management of asthma aside from controlling symptoms?

Preventing symptoms and maintaining near-normal pulmonary function (C) Signup and view all the answers

Which treatment step is indicated for a patient with severe asthma, experiencing daily nonstop symptoms?

Step 6 – High-dose ICS + LABA + oral corticosteroids (A) Signup and view all the answers

What type of therapy may be considered for patients with allergies and severe asthma?

Monoclonal antibody therapy (omalizumab) (A) Signup and view all the answers

Which of the following inhaled corticosteroids can be used in combination with a long-acting beta-2 agonist (LABA)?

Mometasone furoate (B) Signup and view all the answers

In patients with mild/high risk COPD, what is the recommended treatment strategy?

LABA or LAMA + Inhaled Corticosteroids (A) Signup and view all the answers

What is the typical administration frequency for tiotropium in patients with COPD?

Once daily (B) Signup and view all the answers

What is the primary role of the Phosphodiesterase 4 Inhibitor, Roflumilast, in COPD treatment?

Reduces frequency of exacerbations (A) Signup and view all the answers

Which of the following best differentiates asthma from COPD regarding cough presentation?

Cough in asthma only occurs during exacerbations (D) Signup and view all the answers

What is the maximum number of inhalations allowed per day for SABA therapy?

4-12 inhalations (D) Signup and view all the answers

Which medication is categorized as a long-acting muscarinic antagonist (LAMA)?

Tiotropium (A) Signup and view all the answers

In asthma management, which treatment step is appropriate for a patient with severe, daily symptoms?

Combine high-dose ICS with a LABA (B) Signup and view all the answers

A patient with intermittent asthma is using Albuterol sulfate 90 mcg, how often can they take it?

As needed, maximum of 1-2 puffs every 4-6 hours (B) Signup and view all the answers

What type of gram bacteria are patient's with COPD more susceptible to?

Gram - (B) Signup and view all the answers

Which bacteria is gram negative in pneumonia?

HIB (A) Signup and view all the answers

What bacteria is a gram positive pneumoniae?

S. pneumoniae (B) Signup and view all the answers

What is the most common chronic respiratory disorder among all age groups worldwide

Asthma (C) Signup and view all the answers

Clinical hallmarks of asthma include:

episodic wheezing associated with dyspnea, cough, and sputum production (A) Signup and view all the answers

Ominous signs of asthma include:

fatigue, absent breath sounds, paradoxical chest/abdominal movement, inability to maintain recumbency, cyanosis (B) Signup and view all the answers

A 19 year old male presents to the clinic complaining of asthma symptoms of < 2 episodes/week. His BL PFTs are normal and has 0-1 exacerbations/year. What treatment is indicated?

SABA prn (A) Signup and view all the answers

A 25 year old female presents to the clinic with asthma symptoms associated with expiratory wheezing, has exacerbations 3-6 days/week and > 2 exacerbations/year. What treatment is indicated?

Formoterol+budesonide = Symbicort (Low dose ICS + LABA) (C) Signup and view all the answers

A 30 year old male presents to the clinic with wheezing. Upon exam, wheezing is heard both expiratory and inspiratory. He reports daily symptoms and has a mild reduction in FEV1 of 60-80% predicted. He reports > 2 exacerbations/year. What treatment is indicated?

Low dose ICS- medium dose ICS + LABA + Albuterol prn (C) Signup and view all the answers

A 14 year old female presents to the clinic with labored respirations, diaphoresis, anxiety, and breathlessness (e.g. cannot finish a sentence). She reports constant symptoms, > 2 exacerbations/year, and there is moderate reduction in FEV1/FVC ratio. What treatment is indicated?

high dose ICS+ LABA + Albuterol prn, prednisone PO as last resort, and consult recommended (B) Signup and view all the answers

Asthma controller medications include:

ICS/LABA/systemic corticosteroids (A) Signup and view all the answers

Asthma reliever medications include:

SABA/low dose ICS-formoterol/SAMAs (A) Signup and view all the answers

for rhinitis symptoms, treat with

intranasal glucocorticoids Signup and view all the answers

A 68 year old male presents to the clinic with an acute onset of dyspnea and cough and sputum production that has worsened over the past three weeks. He has a history of a recent cold. What is he most likely presenting with?

COPD exacerbation (A) Signup and view all the answers

A 45 year old obese female presents to the clinic with mild dyspnea, blue lips, and a productive and purulent cough that has been around for the past four months in 2 consecutive years. Labs reveal an increased Hct. What is she most likely presenting with?

Chronic Bronchitis (B) Signup and view all the answers

A 72 year old thin appearing male presents to the clinic with constant dyspnea, use of accessory muscles, mild, clear sputum production, pink skin, and a barrel chest. Diagnostics reveal an increased AP diameter, normal Hct, and FEV1 < 70%. What is he most likely presenting with?

Emphysema (B) Signup and view all the answers

Forced expiratory time > 6 sec indicates what disorder?

COPD Signup and view all the answers

FEV1/FVC < 0.70 and FEV1 < 80% indicates

Irreversible disease (COPD) (A) Signup and view all the answers

A patient is suspected of having COPD. What will the CXR reveal?

Flattening of diaphragm, blunting of the costophrenic angle, enlarged retrosternal space , hyperinflation (A) Signup and view all the answers

first line treatment for daily COPD symptoms

SAMA (Ipratropium) and LAMAs (Aclidinium bromide, Tiotropium) (A) Signup and view all the answers

first line treatment for intermittent COPD symptoms

SABA (Albuterol) and LABA (Formoterol) (B) Signup and view all the answers

All are appropriate COPD treatments except:

Ipratropium bromide/Aclidinium bromide (SAMA + LAMA) (D) Signup and view all the answers

Study Notes

Asthma

A chronic inflammatory disorder of the airways, characterized by increased responsiveness of the tracheobronchial tree to various stimuli, leading to episodic reversible narrowing and inflammation of the airways.
Airflow obstruction is often spontaneously reversible or treatable.
Common causes include dust mites, pets, cockroaches, indoor molds, exercise, and cigarette smoke.
Asthma is the most common chronic respiratory disorder in all age groups worldwide.
Prevalence is highest among non-Hispanic children and poor adults.

Clinical Presentation of Asthma

Hallmark: Episodic wheezing associated with dyspnea, cough, and sputum production.
Respiratory distress at rest.
Difficulty speaking in sentences.
Diaphoresis.
Use of accessory muscles.
Respiratory rate > 28 bpm.
Heart rate > 110 bpm.
Pulsus paradoxus > 12 mm Hg.
Hyperresonance.
Cough.
Chest tightness.
Ominous signs include fatigue, absent breath sounds, paradoxical chest/abdominal movement, inability to maintain recumbency, cyanosis, and other symptoms.

Diagnosis of Asthma

Based on demonstration of episodic airflow obstruction (wheezing, cough, SOB).
Evidence that airflow obstruction is at least partially reversible.
Exclusion of other conditions from the differential diagnosis.
Assessment of asthma severity.
Intermittent asthma (<2 episodes/week, normal PFTs, 0-1 exacerbations/year, requires prednisone). Short-acting bronchodilator (SABA) as needed.
Persistent mild asthma (3-6 days/week, >2 exacerbations/year): low-dose inhaled corticosteroids or cromolyn or theophylline.
Moderate asthma (daily symptoms, mild reduction in FEV1, >2 exacerbations/year): Low dose ICS, medium dose ICS + LABA + SABA PRN.
Severe asthma (labored respirations, anxiety, breathlessness, inability to speak in full sentences, >2 exacerbations/year, moderate reduction in FEV1/FVC ratio): high dose ICS + LABA + Albuterol PRN, and prednisone PO as last resort.

Adverse Effects of Medications

Beta 2 adrenergic and theophylline: tachycardia and tremors.
Inhaled corticosteroids: thrush and dysphonia.
Oral (systemic) corticosteroids: central adiposity, hypertension, ecchymoses, cataracts, kyphosis, muscle weakness, AMS.

Concomitant Medical Problems

Associated with asthma: nasal polyps, allergic rhinitis, sinusitis, eczema.
GERD, diabetes, glaucoma, hypertension are comorbidities.

Asthma Labs and Diagnostics

Diagnosis based on 3 components: demonstration of episodic symptoms (wheeze, cough, shortness of breath), evidence that airflow obstruction is partially reversible, and exclusion of other conditions.
CBC: slight elevation of WBC with eosinophilia.
PFTs, spirometry, peak flow: measurements aid in diagnosis of obstructive dysfunction and confirming asthma (reduced FEV1 and FEV1/FVC ratio).
ECG, sputum cultures, arterial blood and other serum analysis.
CXR usually normal, may show hyperinflation with severe exacerbation, not used in diagnosis unless being admitted to hospital.

Asthma Differential Diagnosis

Upper Respiratory System (Croup, vocal cord dysfunction (VCD)).
Lower Respiratory System (Pneumonia, COPD).
Cardiovascular system (Valvular disease, cardiomyopathy).
Gastrointestinal system (GERD).
Asthma is often misdiagnosed with COPD due to overlapping symptoms. Important to distinguish through careful history taking and diagnostic tests. Consider COPD diagnosis in smokers.

Preferred Asthma Treatment for Adults

Controller medication: ICS/LABA/systemic corticosteroids.
Reliever medication: SABA/low dose ICS-formoterol/short-acting anticholinergics.
Stepwise treatment approach depends on symptom severity and includes increasing controller medications.
Short-acting beta2 agonists (SABAs), inhaled corticosteroids (ICs), long-acting beta2 agonists (LABAs), and oral corticosteroids, are used as needed.

Overall Goals of Asthma

Provide ongoing maintenance and prevention (obesity, comorbidities such as GERD, OSA, rhinitis, and rhinosinusitis). Use intranasal glucocorticoids for rhinitis symptoms.
Preventing symptoms.
Maintaining near-normal pulmonary function.
Minimizing pharmacotherapy.
Minimizing the need for ED visits and hospitalizations.

Asthma Patient Education

Patients and families need education about the disease.
Monitoring symptoms and preventing exacerbations.
Environmental triggers and strategies to minimize them.
Individualized asthma management plan.
Possible side effects of medications to report to PCP.
Use of peak flow meter.
Proper inhaler technique (spacers to improve medication delivery).

Chronic Obstructive Pulmonary Disease (COPD)

A progressive, not fully reversible, lung disease, characterized by airflow limitation that is not fully reversible with bronchodilators.
Inflammatory response of the lungs leads to the loss of small airways and mucociliary dysfunction.
Common symptoms are productive cough, dyspnea, and sputum production.
Asthma is NOT a COPD subtype.

COPD Clinical Presentation

Existing COPD Clinical Presentation notes.

COPD History and Physical Exam

Existing COPD History and Physical Exam notes.

COPD Labs and Diagnostics

Existing COPD Labs and Diagnostics notes.

COPD Differential Diagnosis

Existing COPD Differential Diagnosis notes.

Pharmacologic Agents for COPD Therapy

Existing Pharmacologic Agents for COPD Therapy notes.

COPD Treatment and Patient Education

Existing COPD Treatment and Patient Education notes.

Asthma vs. COPD Comparison

Existing Asthma vs. COPD Comparison notes.

Comparison of Asthma and COPD Treatment

Existing Comparison of Asthma and COPD Treatment notes.

Asthma and COPD Summaries

Asthma is episodic and reversible, while COPD is progressive and largely irreversible. Key distinctions include age of onset, symptoms during exacerbations, and characteristic PFT results. Asthma management emphasizes controllers for prevention and relievers for symptoms. COPD management often involves a combination of inhaled medications and management of exacerbations.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on key characteristics and management of asthma and COPD with this comprehensive quiz. Learn about symptoms, diagnosis, and treatment options while exploring critical differences between these respiratory conditions.