Asthma & COPD Flashcards
What is COPD?
Chronic Obstructive Pulmonary Disease (COPD)
Characterised by:
- Chronic Bronchitis
- Emphysema
What is the biggest cause of COPD?
Smoking
What are the main clinical features of COPD?
- Exertional dysponoea
- Cough
- Sputum production
- Wheeze
Symptoms are typically ‘fixed’ whilst the disease is progressive and relentless
Greater than a 20 pack per year smoking history is very common in patients
What are the main aims of COPD treatment?
Reduce breathlessness
Reduce exacerbation frequency
What impact does COPD have on daily activities?
Usually significant
What are the main risk factors for pneumonia in COPD?
Low BMI
Current smoking
Previous pneumonia
What are some of the main risks with long term ICS therapy?
Adrenal suppression
Increased risk of tuberculosis
Increased risk of type 2 diabetes
What are the main characteristics of an acute COPD exacerbation?
Increased SOB
Worsening cough
Increased sputum production
Change in sputum colour
What are the main measures to prevent COPD exacerbations?
Flu vaccine (& pneumonococcal)
Optimise inhaler therapy
Education
Emergency antibiotics/steroids at home
- increased cough/sputum production
- change in sputum colour
- increased breathelessness
What is ‘SIMPLE’ for asthma management in community phramacy?
Stop smoking Inhaler technique Monitoring Pharmacotherapy Lifestyle Education
How is asthma diagnosed?
Structured clinical history
Spirometry
- FEV1/FVC ratio less than 70% is a positive test
Bronchodilator reversibility test is FEV1/FVC is lower than 70%.
- An improvement in FEV1 of 12% or more, together with an increase in volume of 200mL is a positive test.
Asthma pathophysiology and treatment effects.
Look at separate sheet!
What test can be used to look at asthma control?
Asthma Control Test (ACT)
- Questionnaire
Or even just ask how long they need to use their blue inhaler
What is ‘difficult asthma’ for adults?
Asthma with symptoms despite treatment at steps 4 or 5 plus 1 of the following:
An event of acute severe asthma which is life threatening within the last 10 years
Requirement for maintenance oral steroids for at least 6 months at a dose over 7.5mg/day (or a dose equivalent calculated over 12 months)
2 hospitalisations within the last 12 months in patients taking and adherent to high dose inhaled steroids (dose higher than 1000mcg)
Fixed airway obstruction, with a post bronchodilator FEV less than 70%
What is the aim of Asthma therapy?
No daytime symptoms
No night time wakening
No need for rescue medication
No exacerbations
No limitations to QoL
Normal lung function (higher than 80%)
Minimal side effects from medicines
What are the main challenges of difficult to treat asthma?
Symptoms despite maximum treatment
High rates of alternative or co-existent diagnosis
High rate of psychological co-morbidities
Poor adherence to treatment
Need specialist assessment
What is ‘ACOS’?
Asthma and COPD Overlap Syndrome
- A condition that shares features of both asthma and COPD.
What are the important clinical aspects (in terms of history) that should be covered in patients with difficult asthma?
Smoking history Family history of respiratory disorders Past and present occupation Potential aggravating medical conditions Drugs Adherence to treatment Psychosocial circumstances
What are the main factors that can aggravate asthma?
Psychological e.g. depression
Upper airway disease
GORD (gastro-oesophageal reflux disease)
Adverse drug effects (e.g. NSAIDs, B-Blockers)
Allergy
Occupational factors
Cigarette smoking
Obesity
Non-adherence to medication
Co-existing conditions
- Dysfunctional breathing
- Bronchiectasis
- Severe COPD
- Vocal cord dysfunction
How can you identify non-adherence in asthma patients?
Surrogate measures
- Dispensing records
- Emergency supplies
Assess airway inflammation
- Sputum eosinophil count (raised more than 2%)
- Exhaled FeNO concentrations (raised more than 25% ppb at 50ml per second)
What pharmacological options are available to manage difficult to treat asthma?
Omalizumab
- Anti-IgE
Etanercept
- Tumour necrosis factor alpha
Others
- Ciclosporin
- Methotrexate
- Gold
- Terbutaline (monitor heart rate!)
How does Omalizumab work in difficult to treat asthma?
It is a recombinant humanised mouse monoclonal antibody that is anti-IgE
What are Cushing’s Symptoms?
Weight gain and fat deposits
- Slim arms/legs compared to torso
- ‘buffalo hump’
- ‘moon face’
Skin changes
- Thin skin, easily bruised
- Reddish-purple stretch marks
- Spots on upper body
- Oedema (swollen ankles)
- Excessive sweating
- Prolonged wound healing
Bones and muscles
- Backache
- Bone pain
- Fracturing
- Curved spine
Others:
- Depression
- Hypertension
- Hyperglycaemia
- Excessive hair
- Loss of libido
- Infertility in men
- Irregular periods in women
What are the main treatment considerations for cushing’s symptoms?
Osteoporosis
Depression
Hypertension/CV Risk
Pain
