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42 Cards in this Set
- Front
- Back
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Spirometry, in the most basic sense, measures
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measures changes in lung volume during forced breathing maneuvers that are plotted against time.
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instructions for performing PFT's
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inhale maximally, then expire as rapidly as possible until no more air can be expelled, then inhale ....and done.
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FVC
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forced vital capacity - maximal effort ensures obtaining the unique max. rate of air flow for a given a lung volume of that person. (flow reaches its peak rate with moderate effort). Curve is highly reproducible. Maximal flow is very sensitive to pulmonary disorders (dictated by elasticity, size of airway, resistance to flow)
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What percent of asthmatics are atopic?
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80%
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name some asthma triggers
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URI, allergens, endocrine dysfunction, exercise, stress, beta blockers
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What is the asthma classification scheme
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Mild intermittent, mild persistent, moderate or severe.
Mild Int: sx < 2 x per week Mild Persistent: > or = 2 episodes or sx per week, but less than 1 x per day. (1/3 of asthma deaths in this category) Moderate - daily sx (using Beta Ag daily) Severe - multiple times per day |
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Rules of 2 in asthma
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using rescue inhaler 2 x per week, waking up with sx ? 2 x per month, or refilling rescue inhaler > 2 x per year.....indicates need to escalate therapy.
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What tests do you order to assess severity of disease and response to therapy?
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spirometry, Peak Exp Flow, or Bronchial Provocation test (methacholine challenge).
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How do you test Peak Exp Flow (PEF)?
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3 tries on meter. take the best result. Results will show in green, yellow, or red. Green is >80% function. Yellow is 60-80% function. Red is < 60% function
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What indicates bronchodilator responsiveness on spirometry?
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Greater than 12% change in FEV1. Consider looking a depressed FEV25-75.
False negative results occur with poor effort, remodeling of the airway, recent Beta Ag use. |
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The top of the Flow Volume loop is ? Below the X axis is?
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Expiration above. Inhalation below.
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Drugs for hyperactive airways
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SABA, LABA (never alone due to increased risk of death), Ipratropium, Inhaled corticosteroids, leukotriene inhibitors, cromolyn, theophylline, IgE inhibitors
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LABA/ICS combos
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Advair. Symbicort. Dulera
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LTI's
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anti-inflammatory, good for mild persistent asthma and in combination with ICS. ex montelukast
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What is Cromolyn?
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mast cell stabilizer. needs to be taken before an attack. good for exercised induced asthma.
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IgE inhibitors
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used when LABA and ICS are at max doses and patient is still symptomatic. Ex Xolair (omalizumab). Given subq every 2-4 weeks. Black box warning for Anaphylaxis with first administration. Need to observe patients after administration of drug.
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DLco - what does it mean when normal? low?
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normal is normal. Low suggests either parenchymal or vascular abnormality.
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Residual volume (RV) /TLC. What does it mean when elevated?
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high residual volumes suggest hyperinflation
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What does a "knee" at the midpoint of the curve mean?
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It's normal. Most commonly seen in healthy, nonsmoking women. Also called a "tracheal plateau."
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what does an equal reduction in maximal inspiratory and expiratory flow loops indicate?
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a fixed airway lesion
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most common cause of restrictive loop on spirometry?
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obesity. This reduces FVC and TLC. You will have a steep slope to the expiratory portion of the loop.
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Assymetric maximal inspiratory and expiratory loops indicate what?
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a variable airway lesion. (you need a bronch)
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which seasons correlate to which elevated pollen counts? which are perennial?
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spring - trees. summer - grasses. fall - weed allergies. Perennial - dust mite or mold. allergenic pollens range from 15 -50 micrometers
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environmental controls for dust mites in high risk infants have shown what?
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allergic rhinitis can be prevented for up to 2 years with environmental controls for only 1 year. (RCT, Hide et al)
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does tobacco smoke increase the risk of developing allergies in kids?
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yes. prospective study, Linden et al. Kids with no cat developed cat allergy at rate of 9%. increased with cat exposure.....but exponentially increased if damp house hold and TOB exposure.
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name some highly allergenic lab animals
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mice, rodents, rabbits. with unguarded exposure, risk of developing allergy is 46%
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what time of day are the pollen counts highest? what happens in the rain?
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morning pollen counts are highest. rain washes some pollen from the air dropping the counts for a couple of hours after the rain. (it however seems to kick up mold spore counts as the pollen counts come down)
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is pine allergenic
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Not very. the pollen is heavy and tends to coat the ground and your car instead of the more buoyant pollens
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name 3 common indoor mold allergens. then name 2 outdoor ones.
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Indoor: aspergillus, penicillium, rhizopus.
Outdoor: alternaria, cladosporium, helminthosporium |
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what can you do for a grass allergy?
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cut the grass, keeps the plan from pollenating.
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when are outdoor molds most bothersome?
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sunset. they peak in the evening. also, people who complain of symptoms while mowing the lawn, are typically not allergic to the grass (cutting it doesn't cause it to pollenate....) they're allergic to the mold that gets kicked up with the lawn mower.
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how do you keep indoor molds counts down?
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molds are everywhere, on your books, houseplants, shower curtain, in your basement, etc. Keep household humidity below 50% reduces growth and germination significantly. (low humidity also helps with dust mite control)
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house dust.....the older the dust, the...
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more allergenic it is. (very potent dermatophagoides feces, nice.)
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Dermatophagoides Farinae dominates in what kind of climate? D. pteronyssinus?
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Der f1 is more predominant in areas of 3 or more months of dry weather. Der p 1 is more common in humid climates (southern US and pacific northwest).
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what do patients need to know about dust mite covers
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they are impermeable to the mite, so prevent exposure when you lay down to sleep. They need to be washed, but not as often as sheets. Temperatures greater than 130 degrees will kill the mites, cold was will just decrease the antigen load. Airing and exposing upholstered items will kill the mites in 10 minutes, carpet needs 3 hrs.
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what is an acaricide?
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material put on carpets, etc to kill DM. baking soda works just as well as benzyl benzoate. Neither alters the allergen itself. Tannic acid denatures the allergen, but does not kill the mite (will also denature cat allergen)
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what percent of US population has cat allergy? what is the allergen? why is it a major problem?
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2%. Fel d 1 (comes from pelt and about 10% from saliva). The allergen is very small (not filtered out easily) and very sticky (to clothes and other items and travels with them). The allergen is also very potent resulting in symptoms with minute concentrations of the allergen. Washing the cat doesn't help.
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how effective is HEPA filter and HEPA vacuum? (high-efficiency particulate arrestor)
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Filter will eliminate about 50% of cat allergy if used for 3 months. Filter + vacuum results in 98% elimination of allergen.
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name some non-allergenic dogs...
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there are none, just hypoallergenic dogs. Like cats, the allergen comes from the coat and saliva and is found in many public places. Dog dander is easier to control than cat....
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describe cockroach allergen
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10 micrometer particle, settles quickly, Bla g 1 and Bla g 2 are the major antigens of german cockroaches.
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how does tobacco smoke increase risk of allergy?
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it increases the amount of particulate matter in the air (?suspended by the smoke?) and increases the sensitivity to allergy by generating inflammation in the airways which results in increased cell mediated exposure to antigen
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what particle size and % efficiency make a HEPA filter a HEPA filter?
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need to filter 99.7% of a 0.3 micrometer pore size (cat is 0.3). filters are changed approximately 1 x per year.
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