Exam (elaborations)
Pulmonary Disorder and Adult Immunizations
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Pulmonary Disorder and Adult Immunizations Pulmonary Disorder and Adult Immunizations Pulmonary Disorder and Adult Immunizations
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Pulmonary Disorder and AdultImmunizations
Asthma - ANS a chronic inflammatory disorder of the airways that causes recurrent episodes of
wheezing, breathlessness, cough and chest tightness especially at night or in morning.
During episodes there is variable airway obstruction, often reversible spontaneously or with treatment.
There is also increased bronchial hyperresponsiveness to a variety of stimuli
Diagnosis of Asthma - ANS Episodic symptoms of airflow obstruction are present
Airway obstruction is reversible (FEV1 improves by 12% or more after Saba treatment)
Asthma vs COPD - ANS Non productive cough (asthma) vs productive (COPD)
FEV1 reversible (asthma) vs irreversible (COPD)
Cough is worse at night and early in the morning (asthma) vs throughout the day (COPD)
Environmental trigger or allergy based (Asthma) vs smoking or other irritant based (COPD)
Asthma is reversible while lung damage from COPD is irreversible
Asthma-COPD overlap (ACO) - ANS Clinical phenotype with shared clinical features of 2 separate
diseases
Characterized by persistent airflow limitation and features associated with both asthma and COPD
Exercise induced bronchospasm - ANS Presents with cough, SOB, chest tightness, wheezing or
endurance problems during or after exercise
Diagnosis: exercise challenge, where 15% decrease in FEV1 or peak expiratory flow occurs before and
after exercise, measured at 5 minute intervals for 20-30 minutes
Treat as asthma if following symptoms present (chronic respiratory symptoms: dyspnea, cough, chest
tightness, wheeze) - ANS Symptoms vary over time and in intensity, triggers: laughing, exercise,
,allergens, seasonal; onset < 40 years old, symptoms improve within days - weeks after starting ICS or
bronchodilator
Variable expiratory airflow limitation or persistent airflow limitation may exist
ICS treatment essential, don't give LABA or LAMA without ICS, avoid maintenance OCS
Treat as asthma if features are present of both COPD and asthma symptoms present (chronic respiratory
symptoms: dyspnea, cough, chest tightness, wheeze) - ANS Intermittent or episodic symptoms, onset
before or after 40, hx of smoking or toxic exposures, low birth weight, respiratory illness (TB), any other
asthma features noted
persistent expiratory airflow limitations, with or without bronchodilator reversibility
ICS treatment is key, additional COPD treatments per GOLD guidelines, don't give LABA or LAMA without
ICS, avoid maintenance OCS
Treat as COPD if features of COPD are present (chronic respiratory symptoms: dyspnea, cough, chest
tightness, wheeze) - ANS Persistent dyspnea on most days, onset > 40 years old, limitation of physical
activity, preceded by cough or sputum, bronchodilator provides limited relief, history of smoking or toxic
exposure, low birth weight, respiratory illness (TB), no past asthma diagnosis
Persistent expiratory airflow limitation, with or without bronchodilator reversibility
Treat as COPD per GOLD recommendations, avoid high dose ICS or maintenance OCS, reliever containing
ICS not recommended
FEV1 - ANS Volume of air exhaled forcefully in first second of maximal expiration
Normal > 80%
Asthma, reversibility is shown by an increase in FEV1 > 12% or FVC > 200 mL after SABA
FVC - ANS Max volume of air that can be exhaled after full inspiration
Reported in liters and % predicted
Adults with normal lung function can empty 80% of air in < 6 seconds
, FEV1/FVC ratio - ANS Percentage of lung capacity able to be expelled in 1 second
Normal: within 5% of expected range, varies with age, 75-80% in adults, decreased in obstructive
disease (asthma, COPD) (<70%)
Intermittent asthma - ANS <2 days of the week symptom frequency
Nighttime awakening: <2 times/ month for 5->12 years, 0 times for 0-4 years old
SABA use: < 2 days/week
No interference with normal activity
FEV1/FVC: normal for > 12 years, or >85% if 5-11 years
FEV1: >80% of normal
0-1 exacerbations/year requiring oral steroids
Step 1 treatment
Mild persistent asthma - ANS >2 days of the week but not daily symptom frequency
Nighttime awakening: 3/4 times/month (5-11+) or 1-2 times/month (0-4)
SABA: >2 days/ week but not daily
Minor interference with normal activity
FEV1/FVC is normal (>12 years) and >80% (5-11)
FEV1 >80% (normal)
>2/yr exacerbations requiring OCS (>11-5) or ≥2 in 6 mo or ≥4 wheezing episodes lasting > 1 day per year
(0-4)
Step 2 treatment
Normal FEV1/FVC - ANS 8-19 yr old, 85%; 20-39 yr old, 80%; 40-59 yr old, 75%; 60-80 yr old, 70%
Moderate persistent asthma - ANS Daily symptoms
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