Lungs: Obstructive Conditions - Asthma, COPD, Bronchiectasis Flashcards
Risk factors for asthma
- Atopy - asthma/eczema/hay fever
- allergens, air pollution, smoking
- isocyanates
Asthma
- presentation of asthma
- presentation of acute attack
Early onset
Cough - worse at night/in cold/exercise
Variable SOB,
Wheeze, chest tightness
Often triggered by resp infection
-worsening SOB, cough, wheeze not responding to SABA
Asthma
-Investigations, diagnosis
Expiratory wheeze
Low PEF
Clinical diagnosis If symptomatic -obstructive spirometry (FER U70%) -FeNO if also adult//unsure -BD reversibility of 12%+
Management
- maintenance and reliever therapy
- how does each drug work, SE
1st line reliever - Salbutamol
- B agonist => SM relax
- SE => tremor
1st line maintenance - ICS (stops airways narrowing) if SABA not enough/frequent attacks
2nd line - +LRTA
3rd line- replace LRTA with LABA
ICS SE - oral thrust, children growth stunted
LABA - longer acting SABAs
LTRA PO SE - GI upset, headache
-stops airways narrowing
Moderate asthma attack
-management
PER - 50-75%
Normal speech
RR < 25
HR < 110
ADMIT - night, past near fatal, on PO CS, pregnant 15 NRM and downtitrated to 94-98% SABA - O2 neb/metered dose PO prednisolone - 50mg 5 days Add SAMA if no change Continue with normal meds
If no change/T2RF => escalate to ITU (intubate, ventilate)
What are the features of a severe asthma attack
Management
PER - 33-50%
Incomplete sentences
RR 25+
HR 110+
ADMIT if unresponsive to normal treatment 15 NRM - downtitrated to 94-98% SABA - O2 neb/metered dose PO prednisolone - 50mg 5 days Add SAMA if no change Continue with normal meds
If no change/T2RF => escalate to ITU
-prep for intubation, ventilation
What are the features of a life threatening asthma attack
- further investigations
- management
ANY OF THE FOLLOWING PER - U33% Silent chest, cyanosis, weak breathing HR < 110 BP - hypotensive pCO2 - normal SaO2 - U92% => ABG CXR Exhausted, confusion
ADMIT 15 NRM - downtitrated to 94-98% SABA - O2 neb/metered dose PO prednisolone - 50mg 5 days Add SAMA if no change Continue with normal meds
If no change/T2RF => escalate to ITU
-prep for intubation, ventilation
Discharge criteria after asthma attack
Stable on discharge meds for 12-24hs without nebs or O2
Inhaler technique checked
PEF 75%+
COPD
-causes and triggers
Smoking
a1antitrypsin deficiency - COPD presentation in young with liver signs
Occupational exposures
- cadmium
- coal
- cotton
- cement
- grain
COPD
-presentation
SOB (load capacity imbalance increases neural drive to breathe)
Wheeze
Sputum
Exercise limitation
High RR, tripod Decreased chest expansion, barrel chested (hyperinflation) Decreased BS Cyanosis, asterixis Cor pulmonale => RHF Cachexia
Pathophysiology
- emphysema
- bronchitis
Emphysema
-oxidative stress => decreased recoil, capillary beds destroyed
Bronchitis
-increased goblet cells, abnormal tissue repair => mucus hypersecretion
BOTH LEAD TO AIRWAY OBSTRUCTION
Classify the severity of COPD What results would indicate a -Mild -Moderate -Severe -V severe
FEV1/FVC <0.7, no change in BD test (U12% change)
Mild - FEV1 >80
Moderate - FEV1 50-79
Severe - FEV1 30-49
V severe - FEV1 <30
COPD
-investigations, diagnosis
Clinical diagnosis
CONFIRMATION OF DIAGNOSIS - Post BD spirometry FER U70%
CXR
-hyperinflation, bullae, flat hemidiaphragm, RHF
-WANT TO EXCLUDE LUNG CANCER
FBC - polycythemia
Management for stable COPD
- conservative
- medical
- prophylaxis
- cor pulmonale
- surgery
Smoking cessation
Flu and pneumococcal vaccine
Pulmonary rehab
1st line - SABA/SAMA 2nd line - switch SAMA => SABA 3rd line - if no asthma/steroid response -add LABA + LAMA 3rd line - if asthma/steroid responsive -add LABA + ICS -add LAMA if needed
Azithromycin in
- non smokers, optimised inhaler management
- no bronchiectasis/TB
Cor pulmonale
- loop diuretics in edema
- O2 therapy
Surgery
-valves, coils, bullectomy
Presentation of acute COPD exacerbations
-most common causes
Increased SOB, cough, wheeze
Purulent sputum
Hypoxia
Haemophilus influenza, resp viruses
