NSG 6420 MIDTERM
COPD Stage I - ANSMILD
FEV1/FVC <70%
FEV1</80%
*Chronic cough/sputum production
*Pt unaware lung function is abnormal
COPD Stage II - ANSMODERATE
FEV1/FVC <70%
FEV1 50-80%
SOB with exertion
Cough and sputum production present
COPD Stage III - ANSSEVERE
FEV1/FVC < 70%
FEV1 30-50%
Greater SOB
Reduced exercise capacity
Fatigue
Repeated exacerbations with impact on QOL
COPD Stage IV - ANSVERY SEVERE
FEV1/FVC<70%
FEV1<30%
Resp. Failure
Cor Pulmonale (elevation of JVP and pitting ankle edema)
QOL very impaired
Exacerbations may be life threatening
How does FEV1 decrease? - ANSInflammation
Narrowing of peripheral airways
Airway collapse in severe emphysema
COPD diagnosis? - ANSSPIROMETRY is key
Primarily Inflammatory with superimposed bronchospasm - ANSAsthma
Most common chronic respiratory disorder among all age groups - ANSAsthma
Atophy - ANSexaggerated IgE mediated immune response; all atophic disorders are type I
hypersensitivity disorders
Type I hypersensitivity reaction - ANSImmediate hypersensitivity
IgE-mediated
, Antigen binds to IgE that is bound to tissue mast cells and blood basophils, triggering
release of preformed mediators (histamine, proteases, chemotactic factors) and synthesis of
other mediators (prostaglandins, leukotrienes, platelet-activating factor, cytokines)
-causes vasodilation, increased cap. permeability, mucus hypersecretion
**atopic disorders (allergic asthma, rhinitis, conjunctivitis), anaphylaxis, some cases of
angioedema, urticarial, and latex and some food allergies
**Develop <1h after exposure to antigen
Allergic triad of symptoms - ANSallergies, eczema, and asthma
Samter's Triad - ANSNasal polyps, asthma, and ASA allergy
Most common symptom of asthma - ANSwheezing
Common only symptom of asthma? - ANSCough
-can often delay dx of asthma
AKA cough variant asthma
Best way to confirm asthma dx? - ANSbronchial provocation
Intermittent asthma - ANSsx </2days/week
PM awakenings </2/month
SABA use </2 days/week
No interference with norm. activity
0-1 exacerbations requiring oral steroids / yr
Tx for intermittent asthma - ANSstep 1
Mild asthma - ANSSx >/2days/week but not daily
pm awakenings 3-4x/month
SABA use >2 days/week but not daily
minor limitation
Intermittent asthma lung function - ANSnormal FEV1 bt exacerbations
FEV1>80% predicted
FEV1/FVC normal
Mild asthma lung function - ANSFEV1>80% pred.
FEV1/FVC normal
Mild asthma tx - ANSStep 2
Moderate asthma - ANSSx: daily
PM awakenings: >1x/week but not nightly
SABA use: daily
some limiation
mod. asthma lung function - ANS60<FEV1<80 predicted
COPD Stage I - ANSMILD
FEV1/FVC <70%
FEV1</80%
*Chronic cough/sputum production
*Pt unaware lung function is abnormal
COPD Stage II - ANSMODERATE
FEV1/FVC <70%
FEV1 50-80%
SOB with exertion
Cough and sputum production present
COPD Stage III - ANSSEVERE
FEV1/FVC < 70%
FEV1 30-50%
Greater SOB
Reduced exercise capacity
Fatigue
Repeated exacerbations with impact on QOL
COPD Stage IV - ANSVERY SEVERE
FEV1/FVC<70%
FEV1<30%
Resp. Failure
Cor Pulmonale (elevation of JVP and pitting ankle edema)
QOL very impaired
Exacerbations may be life threatening
How does FEV1 decrease? - ANSInflammation
Narrowing of peripheral airways
Airway collapse in severe emphysema
COPD diagnosis? - ANSSPIROMETRY is key
Primarily Inflammatory with superimposed bronchospasm - ANSAsthma
Most common chronic respiratory disorder among all age groups - ANSAsthma
Atophy - ANSexaggerated IgE mediated immune response; all atophic disorders are type I
hypersensitivity disorders
Type I hypersensitivity reaction - ANSImmediate hypersensitivity
IgE-mediated
, Antigen binds to IgE that is bound to tissue mast cells and blood basophils, triggering
release of preformed mediators (histamine, proteases, chemotactic factors) and synthesis of
other mediators (prostaglandins, leukotrienes, platelet-activating factor, cytokines)
-causes vasodilation, increased cap. permeability, mucus hypersecretion
**atopic disorders (allergic asthma, rhinitis, conjunctivitis), anaphylaxis, some cases of
angioedema, urticarial, and latex and some food allergies
**Develop <1h after exposure to antigen
Allergic triad of symptoms - ANSallergies, eczema, and asthma
Samter's Triad - ANSNasal polyps, asthma, and ASA allergy
Most common symptom of asthma - ANSwheezing
Common only symptom of asthma? - ANSCough
-can often delay dx of asthma
AKA cough variant asthma
Best way to confirm asthma dx? - ANSbronchial provocation
Intermittent asthma - ANSsx </2days/week
PM awakenings </2/month
SABA use </2 days/week
No interference with norm. activity
0-1 exacerbations requiring oral steroids / yr
Tx for intermittent asthma - ANSstep 1
Mild asthma - ANSSx >/2days/week but not daily
pm awakenings 3-4x/month
SABA use >2 days/week but not daily
minor limitation
Intermittent asthma lung function - ANSnormal FEV1 bt exacerbations
FEV1>80% predicted
FEV1/FVC normal
Mild asthma lung function - ANSFEV1>80% pred.
FEV1/FVC normal
Mild asthma tx - ANSStep 2
Moderate asthma - ANSSx: daily
PM awakenings: >1x/week but not nightly
SABA use: daily
some limiation
mod. asthma lung function - ANS60<FEV1<80 predicted
