Pulmonary
Asthma & COPD
Pulmonary

Asthma & COPD

Asthma reversibility, AERD, exacerbation tx; COPD progression, AAT.

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◆Asthma diagnosis

  • •Obstructive PFTs with bronchodilator reversibility (↑FEV1 ≥12%)
  • •Methacholine challenge (↓FEV1 ≥20%) confirms if reversibility equivocal
  • •Episodic with symptom-free intervals

◆Asthma exacerbation management

  • •Mild–moderate: SABA + ipratropium + oral prednisone × 5–7 d
  • •Severe (PEF <40%, accessory muscles, can't speak in sentences): continuous SABA + IV steroids + magnesium + O₂; consider IM epi
  • •Life-threatening (silent chest, exhaustion, AMS, rising CO₂): intubate
  • •Discharge criteria: PEF ≥70%, taught inhaler technique, action plan

◆Aspirin-exacerbated respiratory disease (Samter)

  • •Asthma + nasal polyps + NSAID-induced bronchospasm
  • •COX-1 inhibition shunts to leukotrienes
  • •Avoid all NSAIDs; acetaminophen safe
  • •Leukotriene antagonists (montelukast)
  • •Aspirin desensitization for selected

◆COPD

  • •Smoking cessation slows progression more than any drug
  • •Pulmonary rehab improves QoL when meds optimized
  • •Acute exacerbation + AMS + ↑PaCO₂ = hypercapnic respiratory acidosis (target SpO₂ 88–92%)

◆Alpha-1 antitrypsin deficiency

  • •Young (<45) + progressive dyspnea + basilar emphysema + minimal smoking
  • •↓ AAT → unopposed neutrophil elastase
  • •Liver dysfunction (abnormal AAT accumulates in hepatocytes)
  • •Low serum AAT + genetic testing (PiZZ)
  • •Smoking cessation + AAT augmentation

◆Inhaler side effects

  • •ICS → oral thrush, hoarseness (prevent with spacer + mouth rinse)
  • •Albuterol → tremor, tachycardia, hypokalemia
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