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NancyPHARM205 > Tut5: Respiratory > Flashcards

Tut5: Respiratory Flashcards

1
Q

What is Asthma?

A

Chronic inflammatory disorder of the airways

Results in widespread obstruction of the airways that is reversible either spontaneously or with treatment

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2
Q

What are the effects of Asthma?

A
  1. Bronchoconstriction
  2. Inflammation
  3. Airways hyper responsiveness
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3
Q

What is the key diagnostic criteria of Asthma?

A

History of (NZGG2002)

  • Cough
  • Wheeze
  • shortness of breath

Evidence of REVERSIBLE airflow obstruction either

  • spontaneously over time or
  • in response to treatment
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4
Q

What is the difference between Asthma and COPD as seen by the Expiratory flow rate vs. volume curves?

A

Asthma is reversible airflow obstruction, this is seen by the dashed curve rising towards normal after treatment

In the COPD graph this dashed curve does not rise. This indicates no reversibility of airflow obstruction after treatment

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5
Q

What does spirometry measure?

A

The amount and rate of air a person breathes, in order to diagnose illness or determine progress in treatment

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6
Q

What is tidal volume?

A

The volume breathed in each breath

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7
Q

What is Expiratory Reserve Volume?

A

The maximal amount of air that can be exhaled from the lungs after a normal expiration

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8
Q

What is Residual Volume?

A

The volume of gas left in the respiratory system after exhaling maximally

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9
Q

What is Vital Capacity

A

A measure of the maximum volume of gas in the respiratory system that can be exchanged with each breath

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10
Q

What is total lung capacity

A

a measure of the volume of gas in the respiratory system at the end of a maximal inspiration

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11
Q

What is the difference between a volume and a capacity?

A

A capacity is the sum of at least two volumes

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12
Q

What is Forced Expired Volume in 1 second?

A

Provides a measure of the resistance of the airways to flow

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13
Q

What is the formula for Vital Capacity

A

VC = IRV+ERV+Vt

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14
Q

How does Peak expiratory flow rate help diagnose asthma?

A

Asthma attacks with acute wheezing + Reduced peak expiratory flow rate = highly specific for asthma

Single PEFR recordings have little diagnostic, but a variability of >15% is highly specific for asthma

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15
Q

What is the difference between peak expiratory flow and spirometry?

A

PEF = more simple measurement.
Can be performed by patient at home using hand held peak flow meter
Not a sensitive enough measure for detecting the small changes characteristic of COPD

Spirometry = provides an objective measure of lung function as it records the whole of the FVC manoeuvre

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16
Q

What are the values for diagnosis of asthma using PEFR?

A

If day to day PEFR range is >15% indicative of asthma

Disadvantages of this method:

  • Mild airflow obstruction not detected in normal PEFR readings
  • Validity dependent upon patient effort and coaching
  • No calibration so may lead to variation
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17
Q

What are the values of PEFR for Bronchodilator response to therapy?

A

> 15% improvement with either:
40mg oral prednisone for 2 weeks OR
Inhaled corticosteroids at 400mcg beclomethasone or equivalent, 2x daily, for four weeks

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18
Q

How is bronchial hyper-responsiveness treated?

A

with methacholine, histamine or saline challenge when diagnosis is unclear or exercise
(15% fall in PEFR)

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19
Q

How is asthma diagnosed in spirometry?

A

If FEV1/FVC ratio <70%, indicative of asthma

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20
Q

What is FEV1/FVC ratio?

A

Measurement of forced expiratory volume in one second and forced vital capacity.

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21
Q

How is acute reversibility of airflow obstruction tested?

A

by administering 2-4 equal puffs of B2 agonist and repeating spirometry 10 to 15 mins later

22
Q

If PEFR variability is <20% and Spirometry is normal, what does this indicate?

A

Mild asthma. Presents clinically as

  • intermittent, brief symptoms less than 1-2 times/week
  • minimal nocturnal symptoms
  • few exacerbation and asymptomatic in between
  • no emergency medical requirements
23
Q

If PEFR variability is between 20%-30% and Spirometry is abnormal with obstructive pattern but >60% predicted, what does this indicate?

A

Moderate asthma. Presents clinically as

  • Daily symptoms
  • Nocturnal symptoms>2times/month
  • Occasional acute episodes
24
Q

If PEFR variability > 30% and FEV1 < 60% predicted and there is poor reversibility to inhaled bronchodilator, what does this indicate?

A

Severe Asthma. Presented clinically as

  • Daily persistent symptoms
  • Frequent nocturnal symptoms
  • Limited physical activities
  • school or work absence
  • acute severe episode requiring emergency treatment or admission to hospital
25
Q

What are the two hypothesis of drug targets?

A

Inflammation and Bronchoconstriction

26
Q

What are the two classes of medications that are used to treat asthma?

A

β2 agonists and corticosteroids

27
Q

How do β2 agonists work?

A

Dilate bronchi by direct action on the β2 adrenoreceptors of the smooth muscle

Secondary action: inhibit mediator release from mast cells (as mast cells release histamine -> hypersensitivity)

28
Q

What are examples of short acting β2 agonist?

A

Salbutamol, terbutaline

  • available inhaled, nebulised, IV and PO (salbutamol)
  • Adverse effects: tremor, hypokalaemia
29
Q

What are examples of long acting β2 agonist? (LABA)

A

salmeterol, eformoterol

-available as inhalers

30
Q

How do inhaled corticosteroids work.?

A

Relieve bronchial obstruction by improving the responsiveness of β2 receptors and by inhibiting numerous phases of the inflammatory response like arachidonic acid metabolism, cytokine production, neutrophil and eosinophil chemotaxis and migration

31
Q

What are some examples of corticosteroilds?

A

fluticasone, beclomethasone, budesonide

  • widely available as inhalers in multiple devices and some availability as nebules (budesonide)
  • Adverse effects include: oral candidiasis, horaseness, and at higher doses, some of the systemic problems of steroids, like adrenal supression, and decreased bone mineral density
32
Q

What is a nebula?

A

a spray

33
Q

How do oral corticosteroids work?

A

similar mechanism as inhaled corticosteroids, by increased systemic absorpbtion

34
Q

What is COPD and how is it characterised?

A

Chronic obstructive pulmonary disease
Characterised by airway inflammation and airflow limitation that is NOT FULLY REVERSIBLE

progressive disabling disease

35
Q

What causes COPD?

A

Chronic bronchitis and/or emphysema and/or asthma.

COPD due to 2 or the 3- causes does NOT include bronchietasis, asthma alone, or CF

36
Q

What happens to the airflow in COPD?

A

Airflow obstruction is generally progressive and may be accompanied by airway hyperactivity
It may be partially reversible

37
Q

What are the FEV1/FVC ratios and FEV1 values for the different severities of COPD?

A

Mild: FEV1/FVC 80% predicted

Moderate: FEV1/FVC<70%, FEV1predicted 30%-50%, PLUS chronic respiratory failure

38
Q

How is mild COPD clinically presented?

A

Mild: Few symptoms
No effect on daily activities
Breathless on moderate exertion
No complications

39
Q

How is moderate COPD clinically presented?

A

Increasing dyspnoea (laboured/difficult breathing)
Breathless on the flat
Increasing limitation of daily activities

Exclude complications, consider sleep apnoea if pulmonary hypertension

40
Q

How is Severe COPD clinically presented?

A

Dyspnoea on minimal exertion
daily activities severely curtailed

complications include:
hypoxaemia (PaO245mmHg)
Pulmonary hypertension 
Cor pulmonale
Polycythaemia
41
Q

What are the classes of medications used to treat COPD?

A

Antimuscarinic which are muscarinic receptor antagonists

42
Q

How do antimuscarinics work?

A

Relax bronchial constriction caused by increased tone due to parasympathetic stimulation.

This occurs in asthma caused by irritant stimuli

43
Q

What are some examples of antimuscarinic drugs used to treat COPD?

A

Ipratropium available in inhalers and nebules,

tiotropium available as a hand inhaler

Adverse effects: occasionally dry mouth and rarely, anticholinergic side effects

44
Q

What are the differences between COPD and Asthma?

A
  • Nearly all smokers or ex smokers will develop COPD whereas only a few will develop Asthma
  • It is rare to have symptoms of COPD but common to have symptoms of Asthma under 35 years of age
  • A chronic productive cough is common in COPD but uncommon in Asthma
  • Breathlessness is persistent and progressive in COPD but variable in Asthma
  • In COPD, it is uncommon to wake up at night with breathlessness and/or wheeze however this is common in Asthma
  • It is uncommon to have diurnal or day-to-day variabilities of symptoms in COPD, but common to have so in asthma
  • COPD is treated with β agonist (SA & LA), Inhaled corticosteroids and Anti-muscarinics (SA & LA)
  • Asthma is treated with β agonist (SA & LA) and inhaled corticosteroids
45
Q

What is acute respiratory failure?

A

An impairment of pulmonary gas exchange leading to hypoxaemia and/or hypercapnia

  • may be due to inadequate respiration or failure of oxygenation
46
Q

What level of oxygen saturation must be ensured?

A

> 80%

47
Q

What are the basic mechanical ventilation settings

A

Fraction of Inspired oxygen (FiO2) = % of oxygen contained in inhlaed gas.
Normally 0.6-1.0, adjusted accordingly.
-Due to toxic effects of O2 to the lung, the LOWEST FiO2 that will achieve satisfactory arterial oxygenation is 10.6-13.3kp, or arterial haemoglobin saturation exceeding 90% is used

Tidal volume (usually 5-15ml/kg)

Ventilation rate

Inspiratory flow rate (40-80l/min)

Inspiratory flow time.

48
Q

What causes Altitude sickness/Acute mountatin sickness?

A

Acute exposure to low partial pressure of oxygen at high altitude

49
Q

How high up does altitude sickness occur?

A

commonly occurs after 2400m

50
Q

What are symptoms of altitude sickness?

A

Initially:
Headache, fatigue, dizziness, sleep disturbance, peripheral oedema

May progress into:
High Altitude Cerebral Oedema (HACE)
High Altitude Pulmonary Oedema (HAPE)

51
Q

What is immediate action to remedy Altitude sickness?

A

Descend!

52
Q

What can be done to prevent/treat altitude sickness?

A
  • Slow ascent
  • Adequate hydration
  • Oxygen
  • Acetazolamide: 125-250mg twice per day for prophylaxis 24 hours before ascending until a few days at the highest altitude or on descending. NOT RELIABLE FOR TREATMENT
  • Dexamethasone: prophylaxis 4mg twice per day for three days a week. Treatment 4mg three times a day- decreases swelling and pressure within the skull, obvious improvement usually occurs within 6 hours.
  • Need to descend.

NancyPHARM205 (15 decks)

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