Unit 2 Pulmonary

Unique characteristics of asthma

episodic, eosinophil driven, ICS is good for this

unique characteristics of COPD

irreversible, caused by noxious stimuli, neutrophil driven response, ICS not as good, bronchodilators good

Sx of asthma exacerbation

wheezing, chest tightness, cough, decreased lung function

Sx of COPD exacerbation

dyspnea, cough, sputum

Causes of COPD exacerbation

viral infection, bacterial infection, air pollution

Causes of asthma exacerbation

viral infection, allergens, air pollution, seasonal changes, poor ICS adherence

Risk factors for asthma related death

recent hospitalization, no ICS/poor adherence, OCS use, over-use of SABAs, no action plan, psychiatric conditions, food allergies

General treatment for Asthma exacerbation

SABA, systemic OCS, O2; SAMA, magnesium, ICS in emergent situations

General treatment of COPD

SABA/SAMA, systemic OCS, O2, antibiotics in emergent situation

Symptoms for Mild/Moderate asthma exacerbation classification

Talks in phrases, prefers sitting to lying, not agitated, RR increased, accessory muscles not used, Pulse 100-120, O2 sat 90-95%, PEF > 50%

Symptoms for Severe Asthma Exacerbation Classification

Talks in words, sits hunched forward, agitated, RR > 30, accessory muscles used, Pulse >120, O2 sat less than 90, PEF less than 50%

Treatment for mild/moderate asthma exacerbation in the primary care setting

4-10 puffs of SABA every 20 minutes for 1 hour, prednisolone, O2 if available or needed

Prednisolone dosing

1 mg/kg daily max of 50 mg in adults, 1-2 mg/kg daily max of 40 mg in children

Treatment for Severe asthma exacerbation in primary care setting

transfer to acute care facility, give SABA and ipratropium, O2, systemic corticosteroid while waiting

Treatment for mild/moderate asthma exacerbation in acute care setting

SABA, consider ipratropium, O2, oral corticosteroids

Treatment for severe asthma exacerbation in acute care setting

SABA, ipratropium, O2, oral/IV corticosteroids, consider IV magnesium, consider high dose ICS

Review Asthma/COPD from ILE 2 (OK)

OK

Treatment for COPD exacerbation

SABA/SAMA, systemic corticosteroids, antibiotics in certain cases, oxygenation via nasal cannula or mechanical ventilation

What consideration is made with SABAS in ECOPD treatment?

They can cause tachycardia/arrhythmias, drop to SAMA only if issues arise

Dosing of systemic corticosteroids in ECOPD

Prednisone 40 mg qd x 5 days

What symptoms does a patient have to make antibiotics indicated for ECOPD?

yellow/green and thick sputum, increased sputum volume, increase dyspnea

What antibiotics are most common for ECOPD

Azithromycin, Doxycycline, Augmentin; Pip/tazo, cefepime in severe cases