Asthma, COPD and Respiratory Failure Flashcards Preview

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Flashcards in Asthma, COPD and Respiratory Failure Deck (56)
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1

What are the three pathological factors involved in the asthma?

Bronchial muscle constriction - triggered by stimuli

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

Increased mucus production

2

Symptoms of asthma

Wheeze, SOB, coughing (nocturnal) and sputum

3

Precipitants of asthma

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

4

How do asthma symptoms vary daily?

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

5

Asthma patients can also get acid reflux

Yup

6

Questions to ask in hx

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

7

Signs of asthma

Tachypnoea, audible wheeze

Prolonged expiratory phase

Hyper inflated chest, hyper resonant percussion

Decreased air entry, polyphonic wheeze

8

Signs in asthma severe attack

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

9

Signs of life threatening asthma attack

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

10

Tests in acute attack

PEF to monitor
Sputum sample
ABG
Spirometry
CXR

11

General asthma management

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

12

Step 1 for treating asthma

Short acting b2-agonist when needed - salbutamol inhaler

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

13

Step 2 asthma treatment

Add standard dose inhaled steroid
Beclometasone 200-800ug daily

14

Step 3 asthma management

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

15

Step 4 asthma management

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

With previous therapy

16

Step 5 asthma management

Oral prednisolone - lowest possible dose and continue with inhaled

5-10mg/24hr

17

What can be added to treat acute attack

Oral prednisolone 40mg/24hr to treat acute attack

18

Side effects of b2 agonist

Tremor, tachyarrhythmia, hypokalaemia, anxiety

19

What % of the population are affected by asthma?

5-8%

20

What is COPD

Progressive disorder characterised by airway obstruction with little or no reversibility

21

3 features of COPD

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

22

What is bronchitis defined as clinically

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

23

Features favouring COPD diagnosis over asthma

Age of onset >35years
Smoking
Minimal diurnal variation
Chronic dyspnoea
Sputum production

24

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

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