Asthma/COPD Flashcards
(29 cards)
Symptoms of asthma
More than one of:
Cough
Wheeze
SOB
Chest tightness
Factors increasing likelihood of asthma
Timing: Worse at night/early morning
Triggers: Allergens, cold, exercise
DHx: Worse with beta blockers, asthma
PMHx: Personal or family Hx of atopy
Ix: Unexplained eosinophilia
Factors reducing likelihood of asthma
Cardiac Hx
significant smoking Hx
Voice disturbance
Dizziness, tingling, light-head
Chronic cough w/o wheeze/breathlessness
Only with colds, no interval symptoms
Paediatric differential for asthma
CF
Structural tracheal abnormality
Bronchiectasis/TB
GORD (esp w/ vomiting)
Postnasal drip
Foreign body inhalation
Adult differential for asthma
Heart: IHD, HF
Airways: COPD, ILD, PF, bronchiectasis
Other: TB, malignancy, GORD
Factors making COPD more likely than asthma
Onset >40y
Significant smoking Hx
Progressive worsening, constant symptoms
Chronic cough/bronchitis preceded dyspnoea
Post-bronchodilator FEV1/FVC <0.7
Poor response to inhaled therapy (short-lived)
Stepwise management of asthma
PRN SABA inhaled
Regular inhaled CS, check inhaled technique
ICS + LABA
Increase ICS dose + LABA +/- consider other therapies (e.g. theophylline, LTRA (montelukast), LAMA)
Combination inhalers used to raise compliance
Screening for long-term oral steroid therapy
BP
glucose and lipids
Bone density
Growth (in children)
Cataracts (esp children)
Reversible reasons for inadequate control of asthma
Poor inhaler technique
Reduced compliance/concern w/ SEs
Alternative Dx
Trigger factors
Asthma annual review components
Symptoms - level of control (sleeping, daytime, ADLs)
Exacerbations/acute attacks - number, frequency, severity
Medication - compliance, technique, rescue prescriptions
Screening for SEs (Esp steroids)
Smoking - status and cessation
Vaccinations - pneumococcus, flu
Personal action plan - further goals
Non pharma therapy of asthma
Breathing exercises
Breastfeeding in babies
Avoidance of tobacco smoke
Weight loss in obese patients
Others (e.g. dust mite removal) not evidence based
Common co-morbidities adolescent asthma
Anxiety/depression
GORD
Obesity
Smoking
Features of acute severe asthma
PEF 33-50% of predicted
Cannot complete sentences
RR >25
HR >110
Sats >92%
Features of life-threatening asthma
PEF <33% of predicted/best
Cyanosis, silent chest, poor resp effort
Exhaustion, altered consciousness
Sats <92%
Normal PaCO2
Arrhythmia, hypotension
Management of acute asthma
Salbutamol nebuliser
Hydrocortisone/prednisolone
Fluids
If infx suspected, abx
If severe, ipratropium bromide
Reassess every 15min, incl. ECG/ABG
If unresponsive to therapy, magnesium sulfate (senior consultation)
If remains unresponsive, consider aminophylline (ICU)
Salbutamol dose acute asthma
5mg nebulisedrepeated every 15-30min or 10mg/h continuously
TTO for asthma
5-7d of 40-50mg oral prednisolone
GP f/u
Respiratory clinic f/u
Management of acute exacerbation of COPD
Salbutamol + ipratropium bromide
O2 > titrate to sats of 88-92%
Prednisolone
Antibioticsif infective
If unresponsive, consider aminophylline/NIV (not intubation unless haemodynamically unstable/unable to protect airway)
Management of moderate asthma in GP
Bronchodilator - 4 puffs then 2 puffs ever 2 mins up to 10 puffs
PO prednisolone 40-50mg - 5 days
Nebuliser (O2 driven) - 5mg salbutamol or 10mg terbutaline
Investigations for suspected COPD in 1ry care
CXR - rule out other pathology
FBC - esp eosinophilia
BMI - provide baseline, monitor disease progression
Spirometry - confirm airway obstruction
MRC dyspnoea scale
>3 –> pulmonary rehab referral
1: Strenuous exercise
2: Slight hill
3: Mild on level
4: Mild on level <100m
5: Unable to dress/leave house
Interventions modifying disease progression for COPD
Smoking cessation
Pulmonary rehab (physio for the lungs)
COPD subtypes and effect on management
Asthma-like: steroid responsive
Non-asthma: LABA + LAMA
Examples of LABAs
Salmeterol
Formoterol
