Respirology

Question 1

What do you expect to see on a PFT of an asthma patient?

Answer 1

Obstructive pattern with decreased: FEV1, FEV1/FVC, FEF 25-75 and increased residual volume and RV/TLC, bronchodilator responsive

Question 2

What do you expect to see on a PFT of someone who is deconditioned?

Answer 2

Everything will be normal. No bronchodilator response.

Question 3

What do you expect to see on a PFT of someone who is obese?

Answer 3

Restrictive pattern with normal FEV1, FEV1/FVC, FEF 25-75, and a DECREASED FRC and TLC. No bronchodilator response.

Question 4

What is your DDx for an obstructive appearing PFT?

Answer 4

Asthma, CF, non-CF bronchiectasis, bronchiolitis obliterans

Question 5

What is your DDx for a restrictive appearing PFT?

Answer 5

ILD, pulmonary fibrosis, end stage CF, chest wall abN (scoliosis, obesity), neuromuscular abnormalities (DMD)

Question 6

What features on spirometry provide a diagnosis of asthma?

Answer 6

FEV1/FVC <0.8
FEV1 increase >/= 12% with bronchodilator
Methacholine: 20% fall in FEV1
Exercise: FEV1 decrease 10-15%

Question 7

List the criteria for well controlled asthma.

Answer 7

• Daytime symptoms <2 days/wk
• Nighttime symptoms <1night/wk
• PA normal
• Mild, infrequent exacerbations
• NO absence from school/work
• <2 doses/wk of fast acting beta agonise
• FEV1 or PEF >/= 90% personal best

Question 8

Name the risks for morbidity in asthma.

Answer 8

• Previous PICU/intubation/ventilation
• Recurrent hospitalizations or ED visits in last year
• Severe asthma
• Overuse of SABA (>2 in 1 mth)
• Poor adherence to treatment
• Failure to attend clinic appointments
• Psychiatric illness
• Substance use
• Obesity
• Stressors
• Denial of illness/illness severity