asthma and COPD Flashcards
(21 cards)
what are the signs and symptoms of asthma?
Symptoms: Intermittent dyspnea, wheeze, nocturnal cough, sputum
Signs: tachypnea, audible wheeze, hyperinflated chest
Q
If a patient presents with asthmatic like symptoms, what are some questions you need to ask in the history?
- Triggers: e.g cold air, exercise, pets, smoking, NSAIDs
- Diurnal variation: worse at night?
- Exercise tolerance
- Disturbed sleep?
- Other atopic diseases?
- Job?
- Days per week off school or work?
what does PEF depend on?
Age
Gender
Height
What investigations should you do if a patient is having an acute episode of asthma?
- PEF
Sputum culture and ?Blood culture
FBV, U+Es, CRP
- ABG
CXR to exclude infection or pneumonthorax
What factor means a patient with asthma will be responsive to steroids?
Eosinophillia
What is the general management of asthma in a primary care setting?
Avoid triggers
Stop smoking
PEF monitoring
Self management plan for emergencies
BTS pharmacological management
Treat correct inhaler technique
What is the pharmocological management of asthma using the BTS guidelines?
Start at step most appropriate to severity, moving up or down. Can move down after >3months of control
1st: SABA reliever when needed
2nd: Add low dose ICS
3rd: Add LABA with the ICS or LTRA or oral theophylline
4th: Increase ICS
5th: Add regular oral prednisolone with specialist input
How does aminophylline help asthmatics and what are some side effects of this?
Metabolised to theophylline. Inhibits phosphodiesterase so decreases bronchoconstriction.
Used as prophylaxis at night
SE: arrhythmias, GI upsets, seizures
Monitoring: theophylline levels, ECG monitoring
what is COPD?
Progressive airflow obstruction that is not reversible
Chronic bronchitis + Emphysema
Causes: smoking, alpha antitrypsin deficiency, industrial exposure e.g soot
What is the pathophysiology of COPD?
Mucous gland hyperplasia
Loss of cilia function
Emphysema
Chronic inflammation and fibrosis of small airways
What is the definiton of chronic bronchitis and emphysema?
Chronic Bronchitis: Cough and sputum production on most days for 3 months in 2 successive years
Emphysema: Enlarged air spaces with destruction of alveolar walls and loss of elasticity. Visualised on CT and diagnosed histologically
what are some consequence of COPD?
Pneumothorax due to ruptured bullae
Polycythemia
Acute exacerbations
Cor pulmonale
Lung carcinoma
What COPD patients are offered lung volume reduction surgery?
Pneumothorax due to ruptured bullae
Polycythemia
Acute exacerbations
Cor pulmonale
Lung carcinoma
How is a COPD exacerbation managed?
Salbutamol and Iptratropium Bromide NEB
Controlled oxygen therapy
PO prednisolone
Abx if evidence of infection
IV aminophylline if nebulisers didn’t work
Consider physiotherapy and NIPPV
what are some medications that can cause a cough?
ACEi
Beta blockers
NSAIDs/Aspirin
Methotrexate (pulmonary fibrosis)
what is an idiopathic cough?
Cough lasting >3 weeks in association with normal clinical exam, normal CXR and high resolution CT scan, normal lung function tests, negative methacholine inhalation test, normal PEF, normal sputum differential eosinophil count (<2%), and no GORD
differentials for acute asthma
Acute bronchitis
Pneumonia
Foreign body
PE
when should you use IV salbutamol in acute asthma
Airway obstruction so cannot use nebuliser
Tracheostomy making nebuliser difficult
Why is the half life of salbutamol important?
Peak onset of action 40 minutes after administration so do not need to give back to back if no response initially!
Can put them into acidosis
what advice should you given on discharge after a pneumothorax?
avoid smoking
cant fly for 2 weeks - absolute contraindication
permanently avoid scuba diving
