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Respiratory Core Conditions > Asthma, COPD (a1antitrypsin), Bronchiectasis > Flashcards

Asthma, COPD (a1antitrypsin), Bronchiectasis Flashcards

1
Q

Risk factors for asthma

A
  • Atopy - asthma/eczema/hay fever
  • allergens, air pollution, smoking
  • isocyanates
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2
Q

Asthma

  • presentation of asthma
  • presentation of acute attack
A

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

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3
Q

Asthma
-diagnosis and investigations

A

17+
-refer to specialist if symptoms better away from work
-spirometry (FER U70%) + BDR (12%) + FeNO

5-16
-spirometry + BDR
-FeNO if normal/obstructive spirometry with -ve BDR

FeNO +ve = 40ppb+

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4
Q

Asthma
-Management (maintenance, reliever therapy)
-How does each drug work, SE

A

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

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5
Q

Moderate asthma attack
-classification
-management

A

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)

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6
Q

Severe asthma attack
-classification
-management

A

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
If no change - add SAMA, then IV MgSO34
Continue with normal meds

If no change/T2RF => escalate to ITU
-prep for intubation, ventilation

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7
Q

Life threatening asthma attack
-classification
-management

A

ANY OF THE FOLLOWING
PER - U33%
Silent chest, cyanosis, weak breathing
HR U110
BP - hypotensive
pCO2 - normal
SaO2 - U92% => ABG
Exhausted, confusion

ADMIT
15 NRM - downtitrated to 94-98%
SABA - O2 neb/metered dose
PO prednisolone - 50mg 5 days
If no change - add SAMA, them IV MgSO4
Continue with normal meds

If no change/T2RF => escalate to ITU
-prep for intubation, ventilation

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8
Q

Discharge criteria after asthma attack

A

Stable on discharge meds for 12-24hs without nebs or O2
Inhaler technique checked
PEF 75%+

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9
Q

COPD
-risk factors

A

Smoking
a1antitrypsin deficiency - COPD presentation in young with liver signs

Occupational exposures

  • cadmium
  • coal
  • cotton
  • cement
  • grain
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10
Q

COPD
-presentation, signs, symptoms
-

A

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
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11
Q

Pathophysiology of COPD

A

Emphysema
-oxidative stress => decreased recoil, capillary beds destroyed

Bronchitis
-increased goblet cells, abnormal tissue repair => mucus hypersecretion

BOTH LEAD TO AIRWAY OBSTRUCTION

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12
Q

Severity of COPD
-mild
-moderate
-severe
-V severe

A

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

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13
Q

COPD
-diagnosis, investigations

A

Clinical diagnosis

CONFIRMATION OF DIAGNOSIS - Post BD spirometry FER U70%

CXR
-hyperinflation, bullae, flat hemidiaphragm, RHF
-WANT TO EXCLUDE LUNG CANCER
FBC - polycythemia

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14
Q

COPD
-management (conservative, medical, prophylaxis, cor pulmonale, surgery)

A

Smoking cessation
Flu and pneumococcal vaccine
Pulmonary rehab

1st line - SABA/SAMA as required
2nd line - switch SAMA <=> SABA as required
3rd line - if no asthma/steroid response
-add LABA + LAMA to SABA as required
3rd line - if asthma/steroid responsive
-add LABA + ICS to SABA as required
-add LAMA if needed

Prophylactic azithromycin if
-3+ exacerbations needing CS
-1 exacerbation => admission

Cor pulmonale
- loop diuretics in edema
- O2 therapy

Surgery
-valves, coils, bullectomy

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15
Q

Acute COPD exacerbation presentation
-common causative organisms

A

Increased SOB, cough, wheeze
Purulent sputum
Hypoxia

Haemophilus influenza, resp viruses

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16
Q

Management of acute exacerbations of COPD
-O2
-meds
-when to admit

A

Target sats
- 94-98
- 88-92 if CO2 retainer, T2RF risk

BD, spacer, nebulizers
-SABA, SAMA
Pred 5/7
ABx if evidence of infection
-Amox/clarythromycin/doxy

If T2RF => NIV (bipap)
ICU for invasive vent if
-SaO2 U88 with max O2
-v acidotic
-unable to protect airway
-haemodynamic instability

17
Q

Bronchiectasis
- pathophysiology, epidemiology
- causes

A

More prevalent in females, older

Chronic infection/inflammation => permanent dilation of airways

  • post infection - TB, measles, pertussis, pneumonia
  • systemic AI
  • CF
  • bronchial obstruction - lung cancer, foreign body
  • Kartagner syndrome (ciliary dyskinesis)
18
Q

Bronchiectasis
-presentation, symptoms

A

Persistent purulent sputum
Persistent cough
Recurrent chest infections, frequent COPD/asthma exacerbations
SOB

Coarse crackles, wheeze
Inspiratory squeak
Clubbing

19
Q

Bronchiectasis
-diagnosis, investigations

A

DEFINITIVE DIAGNOSIS - High res CT (signet rings)

AIM TO IDENTIFY UNDERLYING CAUSE
-most common - H influenzae

  • Obstructive spirometry
  • Sputum culture - causative organism
  • CXR (tram tracking)
  • CF testing - sweat/gene test
  • Gross AB deficiency testing
20
Q

Alpha 1 antitrypsin deficiency
-pathophysiology
-presentation
-investigations
-management

A

Autosomal recessive/codominance
A1AT protects cells from neutrophil elastase

Lung and liver signs in young, non smokers
-Emphysema - marked in LL
-cirrhosis, hepatocellular carcinoma, cholestasis

A1AT conc
Obstructive spirometry

No smoking
Supportive
-BD
-physiotherapy
Medical - IV A1AT protein concentrate
Surgical - lung volume reduction, transplantation

21
Q

COPD - long term oxygen therapy
-who is suitable
-what does it involve

A

PO2 U7.3kPa OR
PO2 7.3-8kPa and
-2ndary polycythemia
-peripheral edema
-pulmonary HTN

Min 15hrs/day of supplementary O2
Must not be smoking
Assess
-risk of trips, burns/fires

22
Q

Asthma
-stepping down treatment

A

Asthma review every 3 months

No strict guidelines on what to do but consider treatment duration, SE and patient preference

Reducing ICS - 25-50% at a time

Respiratory Core Conditions (7 decks)

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