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Respiratory > Asthma, COPD and Respiratory Failure > Flashcards

Asthma, COPD and Respiratory Failure Flashcards

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1
Q

What are the three pathological factors involved in the asthma?

A

Bronchial muscle constriction - triggered by stimuli

Mucosal swelling/inflammation - mast cell and basophil degranulation resulting in release of inflammatory mediators

Increased mucus production

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2
Q

Symptoms of asthma

A

Wheeze, SOB, coughing (nocturnal) and sputum

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3
Q

Precipitants of asthma

A 
Cold air
Exercise 
Allergens (dust, fur, pollen)
Some food
Emotion 
Infection
Smoking and passive smoking 
Pollution
NSAIDs 
B-blockers
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4
Q

How do asthma symptoms vary daily?

A

Diurnal variation - usually worse in the morning - AM dip in peak flow

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5
Q

Asthma patients can also get acid reflux

A

Yup

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6
Q

Questions to ask in hx

A

How much disturbing sleep - nights per week

Exercise tolerance

Acid reflux?

Other atopic disease - eczema, hayfever, allergies

Triggers at home? Pets, soft furnishings

Job - if symptoms remit at weekends then may be job related

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7
Q

Signs of asthma

A

Tachypnoea, audible wheeze

Prolonged expiratory phase

Hyper inflated chest, hyper resonant percussion

Decreased air entry, polyphonic wheeze

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8
Q

Signs in asthma severe attack

A

Can’t speak
Tachycardic >110/min
Tachypnoea RR >25/min
PEF 33-50% of predicted

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9
Q

Signs of life threatening asthma attack

A 
Silent chest 
Bradycardia 
Hypotension
Confusion
Exhaustion
Cyanosis 
PEFR less than 33%
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10
Q

Tests in acute attack

A 
PEF to monitor
Sputum sample
ABG 
Spirometry 
CXR
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11
Q

General asthma management

A 
Stop smoking
Avoid precipitants
Check inhaler technique 
Give written emergency plan 
Relaxed breathing teaching - papworth method
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12
Q

Step 1 for treating asthma

A

Short acting b2-agonist when needed - salbutamol inhaler

If more than once daily or at night - go to step 2

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13
Q

Step 2 asthma treatment

A

Add standard dose inhaled steroid

Beclometasone 200-800ug daily

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14
Q

Step 3 asthma management

A

Long acting b2 agonist - salmeterol inhaler

Can also increase steroid dose to 800ug/day

Leukotriene receptor antagonist (montelukast or zafirlukast) may be tried

As may oral theophylline - inhibits PDE - at night - prevent morning dip

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15
Q

Step 4 asthma management

A 
Trial of beclometasone up to 2000ug/day 
or
Oral Theophylline 
or
Oral b2 agonist 
or
Oral leukotriene receptor antagonist

With previous therapy

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16
Q

Step 5 asthma management

A

Oral prednisolone - lowest possible dose and continue with inhaled

5-10mg/24hr

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17
Q

What can be added to treat acute attack

A

Oral prednisolone 40mg/24hr to treat acute attack

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18
Q

Side effects of b2 agonist

A

Tremor, tachyarrhythmia, hypokalaemia, anxiety

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19
Q

What % of the population are affected by asthma?

A

5-8%

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20
Q

What is COPD

A

Progressive disorder characterised by airway obstruction with little or no reversibility

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21
Q

3 features of COPD

A

Airway obstruction
Chronic bronchitis
Emphysema - enlarged air spaces distal to terminal bronchioles and destruction of alveolar walls

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22
Q

What is bronchitis defined as clinically

A

Coughing with sputum production on most days for 3 months per year of 2 successive years - symptoms improve if stop smoking

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23
Q

Features favouring COPD diagnosis over asthma

Study These Flashcards
A 
Age of onset >35years
Smoking 
Minimal diurnal variation 
Chronic dyspnoea 
Sputum production
24
Q

Two types of COPD (not really a thing anymore?!)

Study These Flashcards
A

Pink puffers, SOB but no cyanosis - alveolar ventilation - near normal PaO2 and normal or low paco2 - will get type 1 resp failure

Blue bloaters - decreased alveolar ventilation - low pao2 and high paco2 - cyanosed but not breathless - may develop cor pulmonale - rely on hypoxia drive as relatively insensitive to co2 therefore careful when give O2

25
Symptoms of COPD
Chronic cough with sputum | Then dyspnoea and wheeze
26
Signs of COPD
``` Tachypnoea Use of accessory muscles for breathing Hyperinflation Decreased cricosternal distance Decreased expansion Resonant or hyper resonant percussion Quiet breath sounds over bullae Wheeze Cyanosis Cor pulmonale ```
27
CXR in COPD
``` Hyperinflation >6 anterior ribs seen above diaphragm in midclavicular line Flat hemidiaphragms Large central pulmonary arteries Decreased peripheral vascular markings Bullae ```
28
Lung function tests
Obstructive FEV1 decreased and therefore decreased Fev1 :fvc ratio Increased total lung capacity
29
Non medical treatment
Stop smoking Nutrition Mucolytics O2 long term keep pao2 >8 for 15 hours a day
30
General medical treatment for COPD
Short-acting b2 agonist or short-acting anti-muscarinic (ipratropium) PRN
31
Mild to moderate COPD medical treatment
FEV1 >50%
32
Severe COPD treatment
FEV1 30-49% of predicted Combination long acting B2 agonist + corticosteroids Symbicort = budenoside and formoterol Or tiotropium
33
If COPD on treatment for severe remains symptomatic
Tiotropium + inhaled steroid + long acting B2 agonist
34
Causes of type 1 respiratory failure
Primarily ventilation/perfusion mismatch ``` Pneumonia Pulmonary Oedema PE Asthma Emphysema Pulmonary fibrosis ARDS ```
35
Causes of type 2 respiratory failure
Alveolar hypoventilation leading to raised PaCO2 Pulmonary disease: asthma, COPD, pneumonia, end-stage fibrosis, OSA Reduced respiratory drive: sedative drugs, CNS tumour or trauma Neuromuscular disease: cervical cord lesion, diaphragmatic paralysis, poliomyelitis, MG, GBS Thoracic wall disease: flail chest, kyphoscoliosis
36
Features of hypoxia in respiratory failure
Dyspnoea, restlessness, agitation, confusion, central cyanosis. Long standing can lead to pulmonary hypertension, cor pulmonale and polycythaemia
37
Features of hypercapnia in respiratory failure
Headache, peripheral vasodilation Tachycardia, bounding pulse Tremor/flap, papilloedema Confusion, drowsiness, coma
38
Management of type 1 respiratory failure
Treat underlying cause Give O2 (35-60%) by facemask Assisted ventilation if PaO2
39
Management of type 2 respiratory failure
Treat underlying cause Give O2 controlled therapy - start at 24% Recheck at 20mins (ABG) and if PaCO2 is steady or lower then you can increase to 28% If PaCO2 has risen >1.5kpa and patient is still hypoxic then consider assisted ventilation
40
Max flow rate with nasal cannulae
24-40% - relatively imprecise (1-4L/min relatively correlates with % given)
41
When use simple face mask
Flow rate faster but don't use in hypercapnia or type 2 respiratory failure because less precise than Venturi masks
42
Colours of venturi masks
``` Blue - 24% White - 28% Yellow - 35% Red - 40% Green - 60% ```
43
When use non-rebreathing mask
Deliver high concentration 60-90% therefore in emergency | Imprecise therefore not good for controlled O2 therapy
44
Presentation of acute asthma attack
Acute wheeze and SOB
45
Features of severe asthma attack
Unable to complete sentences RR > 25 Pulse >110 PEF 33-50% of predicted/best
46
Treatment of asthma attack
Salbutamol (or terbutaline) neb Hydrocortisone IV or prednisolone PO or both if very ill
47
If severe asthma attack carries on
Salbutamol Nebs every 15mins or 10mg continuously per hour Add ipratropium Single dose of magnesium sulphate IV
48
Maintenance after asthma attack
``` Prednisolone 5-7 days Need to have been stable on discharge meds for 24 hours Check inhaler technique PEF >75% of predicted Gp appointment within 1 week Resp clinic appointment within 4 weeks ```
49
Presentation of acute COPD exacerbation
Increasing cough, breathlessness or wheeze | Decreased exercise capacity
50
Treatment of acute COPD
Salbutamol and ipratropium nebuliser Controlled O2 therapy Steroids - IV hydrocortisone and oral prednisolone Antibiotics
51
If no response to initial acute COPD management
``` IV aminophylline Then NIPPV Then Intubation and ventilation Or respiratory stimulant drug eg. Doxazo ran short term ```
52
What is the MRC dyspnoea scale grade 1
Not troubled by breathlessness except on strenuous exercise
53
What is the MRC dyspnoea scale grade 2
Short of breath when hurrying or walking up a slight hill
54
What is the MRC dyspnoea scale grade 3
Walks slower than contemporaries on flat because of breathlessness or has to stop for breath if walking at normal pace
55
What is the MRC dyspnoea scale grade 4
Stops for breath after walking 100m on level ground or after a few minutes
56
What is the MRC dyspnoea scale grade 5
Too breathless to leave the house. Or breathless when dressing/undressing

Respiratory (7 decks)

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