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Questions and Answers

What is the brand name for albuterol

Proair HFA

What does the upper respiratory tract consist of?

nasal cavity, larynx and pharynx

what does the lower respiratory tract consist of

trachea , bronchi and lungs

What structures make up the alveoli

<p>cilia, cartilage and smooth muscle</p> Signup and view all the answers

In the alveoli, which structures/components are NOT present?

<p>epithelial lining</p> Signup and view all the answers

The aortic and chemoreceptors are activated when?

<p>Ph decreases , Oxygen decreases and CO2 increases</p> Signup and view all the answers

Inflammatory changes in the airways are accompanied by

<p>Vasodilation Edema</p> Signup and view all the answers

Inflammatory changes in the airways are accompanied by

<p>Vasodilation edema recruitment of mast cells eosinophils Th2 lymphocytes Over production of mucous Fibrosis of airway walls</p> Signup and view all the answers

The recruitment mediators of the inflammation changes in the airways include?

<p>IL-3, IL-4, IL-5, and IL-13</p> Signup and view all the answers

Asthma is the syndrome in which there is irreversible , non recurrent obstruction of the airways n response to stimuli

<p>False</p> Signup and view all the answers

Asthma prevalence in the USA in 2021 consist of how many people?

<p>24.96 million</p> Signup and view all the answers

AirDuo Respiclick belongs in which class?

<p>ICS/LABA</p> Signup and view all the answers

Brand names for fluticasone/Salmeterol

<p>Airduo respiclick, Advair Diskus, Advar HFA</p> Signup and view all the answers

How should you use Ellipta?

<p>breathe out away from device , open until you hear a click, close lips tightly to form seal, inhale deep and quickly not covering the vent, wipe mouthpiece</p> Signup and view all the answers

FVC normal predicted range

<p>greater than 80% predicted</p> Signup and view all the answers

FEV1 normal predicted range

<p>greater than 80% predicted</p> Signup and view all the answers

FEV1/FEV normal range for adults

<p>greater than .75 or .80</p> Signup and view all the answers

FEV1/FEV normal range for peds

<p>greater than .85</p> Signup and view all the answers

Which values are important to conisder when evaluating a pt for an obstructive disease?

<p>FEV1 or FEV1/FVC</p> Signup and view all the answers

To determine if the results indicate bronchodilator reversibility what value is important?

<p>% change greater than 12%</p> Signup and view all the answers

This helps patients who have difficulty with inhaler use to ensure delivery of medication to the site of action and can reduce local adverse effects

<p>Spacers</p> Signup and view all the answers

When using a spacer how should you breathe in?

<p>slowly and deeply</p> Signup and view all the answers

When using a spacer device with the inhaler, how would you instruct the patient to take 2 puffs?

<p>Inhale 1 puff at a time. Wait 1 minute in between puffs. and Exacerbations</p> Signup and view all the answers

Yellow Zone range

<p>50-80</p> Signup and view all the answers

Green zone range

<p>80-100</p> Signup and view all the answers

red zone range

<p>anything less than 50</p> Signup and view all the answers

Asthma symptom control consist of

<p>daytime asthma symptoms more than twice a week any night wakenings due to asthma SABA reliever for symptoms more than twice a week any activity limitation due to asthma</p> Signup and view all the answers

Initial treatment for mild to moderate asthma exacerbations include

<p>O2, oral corticosteroids such as dexamethasone , prednisone/prednisolone and High dose SABA</p> Signup and view all the answers

O2 supplemental goal for adults

<p>93%-95%</p> Signup and view all the answers

O2 supplemental goal for children 0-11 years of age

<p>94-98%</p> Signup and view all the answers

Dose for albuterol used in moderate to severe asthma exacerbation initial treatment

<p>4-10 puffs q 20 mins then 6-10 puffs q 1-2 hours</p> Signup and view all the answers

dose for oral corticosteroid prednisone/prednisolone used for initial treatment of moderate-mild asthma exacerbation

<p>40-60mg po daily for 5-7 days for children 3-5 days with 40mg max</p> Signup and view all the answers

dose for oral coricosteroids for dexamethasone used for initial treatment of mild to moderate asthma exacerbation

<p>0.6mg/kg max 16 mg po daily for 1-2 days</p> Signup and view all the answers

What does the clinic or ED/inpatient treatment of asthma exacerbations consist of (hint there are 5 meds to start the patient on)

<p>SABA oxygen IV magnesium sulfate system steroids oral or Iv ipratropium</p> Signup and view all the answers

After an asthma exacerbation attack when should a pt follow up with their pcp provider?

<p>for adults 2-7 days and for children 1-2 days</p> Signup and view all the answers

When a pt has an asthma exacerbation attack and is admitted into the ER what signs should be monitored for improvement?

<p>FEV/FEV1, O2 sat and the symptoms</p> Signup and view all the answers

asthma Exacerbation signs and symtoms for mild-moderate

<p>talks in phrases prefers sitting rather than lying down Accessory muscles not used RR&gt;16 but &lt;30 HR 100-120 O2 sat 90-95% on room air PEF or FEV1 &gt;50% person best or predicted</p> Signup and view all the answers

Signup and view all the answers

What are signs and symptoms of severe asthma exacerbation?

<p>Talks in words sits hunched forward accessory muscles used agitated RR&gt;30 HR&gt;120 O2 sat &lt;90% on room air PEF or FEv1 &lt; than or equal of best/predicted</p> Signup and view all the answers

What are the life threatening symptoms of asthma exacerbations

<p>Severe symptoms plus drowsy confused silent chest ( no breath sounds or no air movement)</p> Signup and view all the answers

What position are patients more prone to do during an exacerbationthat lowerers the diaphragm and allows greater lung expansion through gravity

<p>tripoding</p> Signup and view all the answers

What is the dosing regimen for nebulized ipratropium bromide in severe asthma exacerbation?

<p>0.5mg q 20 mins for 3 days then q h for 3 h</p> Signup and view all the answers

Dose for Intravenous magnesium sulfate for severe asthma exacerbations

<p>2 g infused over 20 mins</p> Signup and view all the answers

Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production, and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction.

<p>True</p> Signup and view all the answers

What are the causes of COPD

<p>Getomics</p> <p>Gene(G)-environment(E) interactions occurring over the lifetime(T) of the individual (GETomics) → structural lung damage and/or alter the development/aging processes</p> Signup and view all the answers

What is the FEV1/FVC that is mandatory for COPD diagnosis

<p>less than 0.7 or 70%</p> Signup and view all the answers

When using spirometry what is important to asses for COPD

<p>eosinophils</p> Signup and view all the answers

What is the COPD assessment test called?

<p>CAT</p> Signup and view all the answers

In COPD patients Gold 1 mild is what range for FEV1

<p>greater than or equal to 80% predicted</p> Signup and view all the answers

In COPD patients GOLD 2 moderate range for FEV1 is?

<p>50 to less than 80% predicted</p> Signup and view all the answers

In COPD pts Gold 3 severe range for FEV1?

<p>less that 50% to 30</p> Signup and view all the answers

In COPD pts Gold 4 very severe range for FEV1?

<p>anything less than 30% predicted</p> Signup and view all the answers

What isthe dose for albuterol when it is used as a rescue inhaler?

<p>1-2 puffs q 4-6 hours as needed for asthma</p> Signup and view all the answers

What is the dose for albuterol when used in a asthma exacerbation

<p>90 mcg 4-10 puffs q 20 mins for 3 doses</p> Signup and view all the answers

Brand name for DuoNeb?

<p>Ipratropium Albuterol</p> Signup and view all the answers

Duoneb dosing for mild-moderate COPD exacerbation

<p>100-200 mcg 1 puff q 4-6 h</p> Signup and view all the answers

Albuterol-Ipratropium dosing for severe COPD exacerbation

<p>100-200mcg 1 puff q 1h for 3 doses then 2-4h</p> Signup and view all the answers

Using these antibiotics long term can reduce exacerbations over 1 year

<p>Azithromycin and erythromycin</p> Signup and view all the answers

what is the dosing for azithromycin used to treat moderate or severe exacerbations?

<p>500 mg daily for 3 days or z pack for 5 days</p> Signup and view all the answers

When using antibiotics for moderate exacerbations what should be covered?

<p>Haemophilus influenzae, strep pneumoniae, moraxella catarrhalis</p> Signup and view all the answers

What is the recommended dose for prednisone for COPD exacerbation?

<p>40 mg PO daily for 5 days</p> Signup and view all the answers

What is the frequency dosing for trelegy ellipta

<p>1 inhaler daily (q 24 hours)</p> Signup and view all the answers

What is the frequency dosing for Breztri Aerosphere

<p>2 inhalations BID (q 12 h)</p> Signup and view all the answers

what is the frequency dosing for symbicort

<p>2 inhalations BID (q 12 h)</p> Signup and view all the answers

what is the frequency dosing for breo ellipta

<p>1 inhalation daily (q 24h)</p> Signup and view all the answers

what is the frequency dosing for spiriva handihaler

<p>1 cap daily (q 24 h)</p> Signup and view all the answers

what is the frequency dosing for spiriva respimat

<p>2 inhalations daily (q 24 hours)</p> Signup and view all the answers

what is the frequency for dexamethasone?

<p>q 24 hours for 1-2 days</p> Signup and view all the answers

What qualifys a patient to be well controlled according to the symptoms from the gina box 2-2a

<p>having none of the symptoms</p> Signup and view all the answers

What qualifys a patient to be partly controlled according to the symptoms from the gina box 2-2a

<p>1-2 of the symptoms</p> Signup and view all the answers

What qualifys a patient to be uncontrolled according to the symptoms from the gina box 2-2a

<p>3-4 of the symptoms</p> Signup and view all the answers

What are the 4 symptoms to determine whether a pt is controlled, well controlled or uncontrolled according to the gina box 2-2a

<p>-Daytime asthma symptoms more than twice a week -Night awakenings due to asthma -Using SABA reliever more than twice a week -Activity limitation due to asthma</p> Signup and view all the answers

If the patient has an exacerbation history of having 2 or more moderate exacerbations, or 1 or more that lead to hospitalization what category from the GOLD asssessment tool does this patient belong in.

<p>E</p> Signup and view all the answers

If a patient has 0 or 1 moderate exacerbations not leading to hospitalization and a mMrc of 0-1 and a CAT test less than 10 what category from the GOLD ABE assessment tool does the patient belong to

<p>A</p> Signup and view all the answers

If a patient has 0 or 1 moderate exacerbations not leading to hospitalization and a mMrc that is greater than 2 and a CAT test greater than or equal to 10 what category from the GOLD ABE assessment tool does the patient belong to

<p>B</p> Signup and view all the answers

GOLD initial pharmacological treatment for group E

<p>LABA+ LAMA</p> Signup and view all the answers

GOLD initial pharmacological treatment for Group A

<p>Bronchodiolator</p> Signup and view all the answers

GOLD initial pharmacological treatment for group B

<p>LABA+LAMA</p> Signup and view all the answers

Social determinants of health for asthma

<p>education access and quality health care access and quality neighborhood and built environment economic stability social and community context</p> Signup and view all the answers

Health disparities seen in asthma patients

<p>genetics housing location (urban, near lots of traffic and pollution) socioeconomic status (impact of affording healthcare and meds) Racism (Increased stress, mistrust of healthcare, discriminatory housing practices) Education level and employment opportunities</p> Signup and view all the answers

What is the BB warning for montelukast?

<p>Serious Neuropsychiatric events such as agitation, aggression, depression, sleep disturbances , suicidal thoughts</p> Signup and view all the answers

Discharge managemt for asthma exacerbations include which of the following

<p>SABA, ICS , OCS, MART ( ICS-formoterol prn )</p> Signup and view all the answers

Study Notes

Respiratory Tract

  • Upper respiratory tract consists of nose, mouth, pharynx, larynx, and trachea
  • Lower respiratory tract consists of bronchi, bronchioles, and lungs

Alveoli

  • Alveoli consist of type I and type II alveolar cells, macrophages, and capillaries
  • Structures/components not present in alveoli include aortic and chemoreceptors

Asthma

  • Asthma is a syndrome characterized by irreversible, non-recurring obstruction of airways in response to stimuli
  • Asthma prevalence in the USA in 2021: approximately 25 million people
  • AirDuo Respiclick belongs to the class of combination inhalers
  • Brand names for fluticasone/Salmeterol: Advair, Seretide
  • Ellipta should be used with a steady, deep breath in through the mouth, holding the breath for 3-5 seconds, and then exhaling slowly

Pulmonary Function Tests

  • FVC normal predicted range: 80-120% of predicted value
  • FEV1 normal predicted range: 80-120% of predicted value
  • FEV1/FEV normal range for adults: 0.7-0.8
  • FEV1/FEV normal range for pediatrics: 0.85-0.95
  • Important values to consider when evaluating a patient for obstructive disease: FEV1, FEV1/FVC, and FVC
  • Bronchodilator reversibility: important value is FEV1

Spacer Devices

  • Spacer devices help patients with difficulty using inhalers to ensure delivery of medication to the site of action and reduce local adverse effects
  • When using a spacer, breathe in slowly and deeply through the mouth, holding the breath for 3-5 seconds, and then exhaling slowly
  • To take 2 puffs using a spacer device, breathe out slowly, put the mouthpiece in the mouth, and inhale slowly and deeply through the mouth, holding the breath for 3-5 seconds, and then exhaling slowly; repeat the process for the second puff

Asthma Zones

  • Yellow Zone range: 50-80% of predicted personal best
  • Green Zone range: 80-100% of predicted personal best
  • Red Zone range: <50% of predicted personal best

Asthma Symptoms and Treatment

  • Asthma symptom control consists of: day and nighttime symptoms, need for rescue medication, and limitation of daily activities
  • Initial treatment for mild to moderate asthma exacerbations: oxygen therapy, inhaled beta2 agonists, and oral corticosteroids
  • O2 supplemental goal for adults: maintain O2 saturation >90%
  • O2 supplemental goal for children (0-11 years): maintain O2 saturation >90%
  • Dose for albuterol used in moderate to severe asthma exacerbation initial treatment: 2.5-5mg every 20 minutes for 3 doses, then 2.5-5mg every 1-4 hours as needed
  • Dose for oral corticosteroid prednisone/prednisolone used for initial treatment of mild to moderate asthma exacerbation: 40-50mg/day for 5-7 days
  • Dose for oral corticosteroids for dexamethasone used for initial treatment of mild to moderate asthma exacerbation: 12-16mg/day for 5-7 days
  • Clinic or ED/inpatient treatment of asthma exacerbations: oxygen therapy, inhaled beta2 agonists, oral corticosteroids, anticholinergics, and magnesium sulfate

COPD

  • COPD is a heterogeneous lung condition characterized by chronic respiratory symptoms and airflow obstruction due to abnormalities of the airways and/or alveoli
  • Causes of COPD: cigarette smoking, air pollution, occupational exposures, and genetic factors
  • FEV1/FVC mandatory for COPD diagnosis: <0.7
  • When using spirometry, important to assess for COPD: FEV1, FEV1/FVC, and FVC
  • COPD assessment test: COPD Assessment Test (CAT)
  • In COPD patients, GOLD 1 mild: FEV1 ≥80% of predicted value
  • In COPD patients, GOLD 2 moderate: FEV1 ≥50% and <80% of predicted value
  • In COPD patients, GOLD 3 severe: FEV1 ≥30% and <50% of predicted value
  • In COPD patients, GOLD 4 very severe: FEV1 <30% of predicted value
  • Dose for albuterol when used as a rescue inhaler: 2-4 puffs every 4-6 hours as needed
  • Dose for albuterol when used in asthma exacerbation: 2.5-5mg every 20 minutes for 3 doses, then 2.5-5mg every 1-4 hours as needed
  • Brand name for DuoNeb: ipratropium bromide/albuterol
  • Duoneb dosing for mild-moderate COPD exacerbation: 3 inhalations every 6-8 hours as needed
  • Albuterol-Ipratropium dosing for severe COPD exacerbation: 3-4 inhalations every 4-6 hours as needed
  • Using macrolide antibiotics long-term can reduce exacerbations over 1 year
  • Dosing for azithromycin used to treat moderate or severe exacerbations: 500mg for 3 days, then 250mg for 4 days
  • When using antibiotics for moderate exacerbations, cover for: Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis
  • Recommended dose for prednisone for COPD exacerbation: 40-50mg/day for 5-7 days

Medication Frequency

  • Frequency dosing for Trelegy Ellipta: 1 inhalation daily
  • Frequency dosing for Breztri Aerosphere: 1 inhalation daily
  • Frequency dosing for Symbicort: 2 inhalations twice daily
  • Frequency dosing for Breo Ellipta: 1 inhalation daily
  • Frequency dosing for Spiriva HandiHaler: 1 inhalation daily
  • Frequency dosing for Spiriva Respimat: 1 inhalation twice daily
  • Frequency dosing for dexamethasone: 4-6 hours as needed

GINA Classification

  • Well-controlled according to GINA: symptoms 2-3 days/week, nighttime symptoms 2-3 times/month, and no limitations of daily activities
  • Partly controlled according to GINA: symptoms >3 days/week, nighttime symptoms >3 times/month, and some limitations of daily activities
  • Uncontrolled according to GINA: symptoms most days, nighttime symptoms most nights, and significant limitations of daily activities
  • 4 symptoms to determine controlled, well-controlled, or uncontrolled according to GINA: daytime symptoms, nighttime symptoms, need for rescue medication, and limitation of daily activities

GOLD Assessment

  • If a patient has 2 or more moderate exacerbations, or 1 or more that lead to hospitalization, they belong to Category D
  • If a patient has 0 or 1 moderate exacerbations not leading to hospitalization, an mMRC of 0-1, and a CAT test <10, they belong to Category A
  • If a patient has 0 or 1 moderate exacerbations not leading to hospitalization, an mMRC >2, and a CAT test ≥10, they belong to Category B

GOLD Initial Pharmacological Treatment

  • Group E: triple therapy with ICS, LABA, and LAMA
  • Group A: short-acting bronchodilators as needed
  • Group B: short-acting bronchodilators as needed, and/or LABA, and/or LAMA

Social Determinants and Health Disparities

  • Social determinants of health for asthma: poverty, housing, education, and access to healthcare
  • Health disparities seen in asthma patients: socioeconomic status, race, and ethnicity

BB Warning

  • BB warning for montelukast: neuropsychiatric events, including suicidal thoughts and behavior

Discharge Management

  • Discharge management for asthma exacerbations: patient education, medication reconciliation, and follow-up appointment scheduling

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