Cardio/Resp Exam 1

black box warning against use in asthma alone, increased risk of death

LABA

always used in SMART therapy

formoterol

not recommended as monotherapy in COPD

ICS

all LABA/LAMAs are used to treat

COPD

SABA/SAMA is used to treat

COPD

all ICS/SABA and ICS/LABAs are used to treat

asthma

all ICSs are used to treat

asthma

tidal volume (TV)

the amount of air inhaled or exhaled during normal, non-exertional breathing

inspiratory reserve volume (IRV)

the maximum additional amount of air that can be inhaled above the tidal volume

expiratory reserve volume (ERV)

the maximum additional amount of air that can be exhaled after a normal tidal expiration

residual volume (RV)

the amount of air remaining in the lungs after maximal forced expiration

total lung capacity (TLC)

TV + IRV + ERV + RV

normal FEV1/FVC ratio in adults

> 0.7

restrictive lung disease

• patient has difficulty getting air into lung

• TLC < 80% of predicted

obstructive lung disease

• patient has difficulty getting air out of lungs

• FEV1/FEC < 70% of predicted

normal FEV1/FVC ratio in children

> 0.9

FEV1

the maximum volume of air exhaled during the first second of forced expiration

bronchodilator reversibility

• increase in FEV1 or FVC > 12% of predicted value shows reversibility

• Asthma: reversible obstruction

• COPD: irreversible obstruction

peak flow meters

• small portable devices patients can use at home

• measure maximal forced expiration

• adults: 400-700 L/min

• children: 150-450 L/min

peak flow zones

• green: 80-100% of usual

• yellow: 50-80%

• red: <50%

type 2 mediated asthma

• allergic asthma

• eosinophilic asthma

• aspirin exacerbated respiratory disease

non-type 2 mediated asthma

• neutrophilic asthma

• paucigranulocytic asthma

characteristics/biomarkers found in allergic asthma

• childhood onset, allergen triggers, possible allergic rhinitis and/or atopic dermatitis (triad)

• elevated IgE

characteristics/biomarkers found in eosinophilic asthma

• adult onset, severe exacerbations

• elevated eosinophil count

characteristics/biomarkers found in neutrophilic asthma

• adult onset, insufficient response to ICS, history of smoking

• elevated sputum neutrophil counts

characteristics/biomarkers found in paucigranulocytic asthma

• bronchial hyperreactivity, insufficient response to ICS

• normal eosinophil and neutrophil counts

asthma control test - ACT

• well controlled: 20-25

• poorly controlled: 15-19

  • very poorly controlled: <15

peds-AIRQ

• well controlled: 0-1

• not well controlled: 2-4

• very poorly controlled: 5-8

SMART/MART therapy

• single inhaler for maintenance and rescue

• ICS/formoterol

anti-inflammatory reliever (AIR)

• ICS/SABA

• ICS/formoterol

max daily dose for budesonide/formoterol for ages 6-11

• 8 inhalations/day

• 36 mcg formoterol

max daily dose for budesonide/formoterol for ages 12+

• max 12 inhalations/day

• 54 mcg formoterol

bronchodilators

• beta-2 agonists

• muscarinic antagonists

• PDE3/4 inhibitors

only treatment documented to reduce risk of death in asthma

ICS

Primatene mist

• epinephrine 0.125 mg

• OTC for mild intermittent asthma symptoms

• not recommended due to excessive cardiac stimulation

after a new therapy, patients should be reassessed

in 2-6 weeks

oral corticosteroids in asthma

should be last line due to systemic effects

consider step down therapy when

• symptoms have been controlled for > 3 months

• no respiratory infection

recommended asthma therapy for patient < 5 yrs

• budesonide 1 mg BID for 7-10 days

• with PRN SABA

FeNO levels suggestive of asthma

> 40 - 50 ppb

GOLD 1

> 80%

GOLD 2

50-79%

GOLD 3

30-49%

GOLD 4

< 30%

COPD group E

one or more exacerbations - LABA/LAMA

COPD group A

• zero exacerbations

• mMRC 0-1 and CAAT < 10

• bronchodilator

COPD group B

• zero exacerbations

• mMRC > 2 and CAAT > 10

• LABA/LAMA

roflumilast is considered for COPD when

• exacerbations after triple therapy

• FEV1 < 50%

• chronic bronchitis

azithromycin is considered for COPD when

• exacerbations after triple therapy

• for former smokers only

biologics are considered for COPD when

• 2 moderate or 1 severe exacerbation after triple therapy

• blood eos > 300