Chronic Resp disease Flashcards
(32 cards)
Examples of obstructive lung conditions
COPD
Asthma
Bronchiectasis
Cystic Fibrosis
Obsutructive sleep apnoea
Difference in spirometry readings in obstructive vs restrictive conditions
Obstructive : FEV1 reduced and FVC normal.
FEV1/FVC = <0.8
Restrictive : FEV1 reduced AND FVC REDUCED
FEV1/FVC = 0.8
Examples of restrictive lung conditions
Interstitial lung disease - asbestosis, pulmonary fibrosis, sarcoidosis
Chest wall - ankylosing spondylitis, kyphosis, scoliosis
Drugs over long period of time - amiodarone, methotrexate, nitrafurantoin
Neuromuscular disorders - ALS, GBS, myasthenia gravis
Examples of COPD
Bronchitis
Emphysema
What is bronchitis
Inflammation of airways in lungs caused by infection (if acute gets better around 3 weeks and if productive cough lasts longer than 3 months = COPD)
Causes of COPD
smoking
occupation exposures
air pollution
Symptoms and clinical signs of COPD
SOB esp on exertion
Chronic productive cough
Frequent LRTIs
Wheeze
Reduced exercise tolerance
NO CHEST PAIN
Cyanosis
Accessory muscle use / pursed lip breathing
High RR
Hyperinflated chest
Cachexia
Distended JVP + peripheral oedema - shows cor pulmonael
Crackles and wheeze on auscultation
Weight loss and fatigue in advances cases
Ix for COPD
Exercise tolerance
Spirometry - post bronchodilator
Bloods - FBC, Hb, Polycythaemia or anaemia (from chronic hypoxaemia), WCC, CRP
Chest X ray - rule out other casues e.g. lung cancer or bronchiectasis. May also see hyperinflation of chest and flattened diaphragm
If acute - ECG and BNP to look for right sided heart failure (cor pulmonale), sputum mcs for antibiotic therapy
COPD management
1) smoking cessation
pulmonary rehabilitation
annual influenza and pneumococccal vaccination
2) start SABA (salbutamol) or SAMA (ipratropium) inhaler
If they have asthmatic features or steroid responsiveness add LABA (formoterol) + ICS (beclomethasone)
If they do not have asthmatic features or not responsive to steroids add LABA (formoterol) and LAMA (tiotropium)
If patient still not responding adequately add get patient on all of following SABA/SAMA + LABA + LAMA, + ICS
Mucolytics and prophylactic abx - if chronic productive cough
Long term oxygen therapy (LTOT) ONLY for ppl with chronic hypoxia and COPD:
- O2 stats less than 90%
- cyanosis or peripheral oedema or raised JVP
- polycythaemia
if acute exarcebation:
bronchodilator therapy
oral prednisolone
antibiotics (if infective cause)
Give rescue pack to take before going to A+E (contains abx - amoxicillin and steroids - prednisolone)
What is bronchiectasis
OBSTRUCTIVE CHRONIC LUNG CONDITION characterised by persistent progressive chronic inflammation in airways causing damage to elastic components leading to permanent dilatation of airways
Sx and clinical signs of bronchiectasis
persistent cough over 8 wks
large volume of sputum
dyspnoea / SOB
HAEMOPTYSIS
fatigue
weight loss
chest pain
Past history of LRTI
acute exacerbations present as:
- fevers
- worsening breathlessness
- low O2 stats
Clinical signs
- low BMI
- palpable secretions
- high pitched inspiratory squeaks
- lower coarse crackles
- wheeze
Causes of bronchiectasis
COPD
Asthma
IBD
Congenital defects of cilia
H. influenza
P aeruginosa
Ix for bronchiectasis
O2 stats for hypoxia
Sputum MC&S
FBC for WCC
CXR
HRCT - RING SHAPES
Bronchiectasis management
IV antibiotics if cyanosis, confusion, febrile, hypoxic or severe SOB
Monitor symptoms and antibiotics depending on sputum MC&S
Chest physiotherapy for airway clearance
Smoking cessation
What is the cause of cystic fibrosis
autosomal recessive CFTR gene defect
Sx of cystic fibrosis
In neontaes - failure to thrive, ileus (intolerance of oral intake), rectal prolapse
Others - cough, infections, bronchiectasis, pneumothroax, cor pulmonale, resp failure, malabsorption syndromes and less growth
Ix for cystic fibrosis
sweat test - if chloride higher than sodium = CF
genetic screening
Management of cystic fibrosis
Prophylactic abx
Bronchodilators
Chest physio
Oxygen, ventilation, lung transplant
PREVENT CROSS INFECTIONS OF PTS WITH PSEUDONOMAS (CF PTS RESISTANT TO MANY ABX)
Risk factors of OSA
Male
Obesity
Smoking
Hypothyroidism
Sx of OSA
Excessive day time sleepiness
Snoring
Fatigue
Apnoea / gasp / choke while sleeping
Poor sleep
Poor concentration
Diagnosis rules for OSA
Sx of OSA
Stopband or epworth calc
Refer to sleep clinic
At least 5 episodes of apnoea, hypopnoea or both lasting a minimun of 10 seconds per hour of sleep
Obstructive sleep apnoea management
Lifestyle - stop smoking and lose weight
CPAP (continuous positive airway pressure) - keeps airways open
Mouth guards
Surgery
Risk factors for pulmonary fibrosis
50-70 yrs
Smoking
PMH - drug use e.g. radiotherapy in that area
Family history
Male
Symptoms and clinical signs of pulmonary fibrosis
Cough
SOB
Clinical signs
- cyanosis
- clubbing
- reduced chest expansion
- inspiratory crackles
