Ambulatory Copd

Front 1

Chronic cough: 4 way differential

Back 1

asthma
COPD / chronic bronchitis

post nasal drip
GERD

Front 2

The absence of wheezing makes ? very unlikely.

Back 2

asthma

Front 3

What test and test value is diagnostic for asthma?

Back 3

lowered FEV1 / FVC
normal is > 75%

see if function is improved with bronchdilator

Front 4

Definition of asthma?

Back 4

episodic, REVERSIBLE airway constriction

Front 5

clinical difference between mild intermittent and mild persistent asthma

Back 5

mild intermittent: no more than 2 times per week, symptoms not present between episodes

mild persistent: > 2 times per week, but less than 1 time per day.
Night symptoms > 2 times per month.

Symptoms severe enough to interfere in daily activities.

Front 6

Differentiate between mild persistent and moderate persistent asthma.

Back 6

mild persistent: > 2 times per week, but less than 1 time per day.
Night symptoms > 2 times per month.
Lung function normal between episodes (>80% expected value)

moderate persistent: > 2 times per week
Night symptoms > 1 time per week.
Lung function tests abnormal between episodes (60-80% of expected value).

Front 7

What are the parameters of severe persistent asthma?

Back 7

occurs throughout day,
lung function tests < 60% expected between episodes.

Front 8

Tx for mild intermittent asthma?

Back 8

prn albuterol

Front 9

Tx for asthma above mild intermittent?
(first line)

Back 9

inhaled corticosteroids

Front 10

Tx for status asthmaticus?

Back 10

oxygen
continuous inhaled B agonist
continuous inhaled anticholinergic

IV corticosteroids
ICU monitoring
possible intubation and mechanical ventilation

Front 11

Name two principal SHORT ACTING B-agonists used to treat asthma and COPD.

Back 11

albuterol
pirbuterol

Front 12

Name two principal LONG ACTING B-agonists used to treat asthma and COPD.

Back 12

salmeterol
formoterol

Front 13

Name two principal anticholinergics used to treat asthma and COPD.

Back 13

ipratropium (short acting, stage 1)
tiotropium (long acting, stage 2)

Front 14

initial presenting sx of COPD

Back 14

cough, dyspnea

Front 15

By the time dyspnea develops in COPD, FEV1 has been reduced by ?

How long has COPD been present by the time dyspnea appears?

Back 15

one half

several years

Front 16

CXR of moderate COPD will likely show?

More severe COPD will show ?

Back 16

nothing -- normal xray

hyperinflation, increased PA diameter, flattening of diaphragms

Front 17

What is the FEV1 / FVC ratio in COPD?

Back 17

< 0.70

Front 18

What are the definitions of the four stages of COPD?

Back 18

They are defined by declining FEV1.
Stage 1 (mild): FEV1 > 80% of predicted
Stage 2 (moderate): FEV1 50-80% of predicted
Stage 3 (severe): 30-50% of predicted
Stage 4: (very severe): <30% of predicted, or <50% of predicted with chronic hypoxemia

Front 19

tx for stage 1 COPD

tx for stage 2 COPD

Back 19

short acting bronchodilator (albuterol, ipratropium)

long acting bronchodilator (salmetrol, tiotropium, i

Front 20

tx for stage 3 and 4 COPD

Back 20

add inhaled steroids for exacerbations, but long term steroid tx is not recommended

stage IV with hypoxemia (PaO2 < 55*, or pulseox < 88%): oxygen therapy

* <60 with pulmonary htn, PCV, or heart failure with peripheral edema

Front 21

tx for acute exacerbation of COPD

Back 21

1. short acting bronchodilators; can combine b-agonist and anticholinergic
2. systemic steroids, which shorten exacerbation course; prednisone 40 for 10-14 days is common.