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Summary Respirology Key Points for PEBC Exam
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Key points on resp module required to be successful on the PEBC MCQ Exam.
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RESP QUICK LESSONObstructive lung disease FEV1/FVC <0.7
Asthma
Patho Severity based on level of tx required to achieve sx control
i. Mild: well controlled w short-acting BD PRN, low dose ICS or LTRA
ii. Mod: well controlled w low dose ICS/LABA
iii. Severe: high dose ICS/LABA
Sx: 12% FEV1 ↑ post-BD
Risk GERD, fam hx, atopic triad
Exacerbations high SABA use, inadeq CS, poor adherence, incorrect technique, comorbs
(obesity, chronic rhinosinusitis, GERD, allergy, preg), exposures (smoking,
allergens), major psych/SE, low lung fx, ever intubated/ICU, >1 severe
exacerbation in last 12mo, FEV1 <60%, high BD rev
Drug NSAIDs/ASA/COX-2, tartrazine, sulfites, BB (unless very well controlled
asthmatic cardioselective: metoprolol, bisoprolol, atenolol)
Nonpharm Avoid precip factors, smoking cess, treat modifiable risk (obesity, anx, depression, GERD, chronic
rhinosinusitis, OSA)
Flu, pneumo vax
Immunotherapy: mb useful for concomitant allergic rhinitis (mod-sev) >5yo
Treatment SABA monotherapy NR all adults/adols should have an ICS-containing regimen
SAMAs: can be used in addition to SABA for acute exacerbations, alt for those susceptible to
tremor/tachy
LAMA: add-on despite mtn
LTRA: add on for mod-sev w ICS, 2nd line mono after daily low-ICS or PRN ICS/LABA, add on to low
dose ICS in concomitant rhinitis
- Can be used >2yo
Adults
Adults: + LABA before ↑ ICS *no LABA monotherapy
Always: PRN low dose ICS-formoterol (other: SABA)
Step 1: PRN low dose ICS-formoterol (max 6inh on one occasion, max 8/day)
- >6yo
Step 2: daily low dose ICS or PRN low dose ICS-formoterol
- LTRA or low dose ICS whenever SABA is taken
Step 3: low dose ICS-LABA
- Med dose ICS or low dose ICS+ LTRA
- LABAs only for pts already taking ICS (mono ↑ death), may be ICS sparing
Step 4: medium dose ICS-LABA
- High dose ICS, add on tiotropium or LTRA
Pediatrics
Pediatrics: ↑ ICS dose before + LABA
Step 1: low dose-ICS whenever SABA is used
Step 2: daily low dose ICS
- LTRA or low-dose ICS when SABA used
Step 3: low dose ICS-LABA or medium dose-ICS
- Low-dose ICS + LTRA
Step 4: medium dose ICS-LABA
- High dose ICS or + tiotropium or + LTRA
Exacerbations
SABA (4-10 puffs) via spacer at ↑ doses q20min, PO pred (25-50mg x 7-14d), ↑ controller med/↑dose x
>2-4wks
- +/- ipratropium
Oxygenation
Monitoring Sx control over past 4 wks
- Daytime asthma sx >2x/wk, reliever needed >2x/wk
- Any nocturnal awakening
- Any activity limitation, missing school/work
- PEF <90% predicted
Step up: check inhaler technique, adherence, comorbs, exposure to irritants
- Inhaler technique: shake, hold breath 5-10s, if 2nd puff req wait 15-30s
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