Flashcards in Lung Deck (40)
What proportion of pregnant women have asthma?
Most severe asthma in which weeks of pregnancy?
24, 25 and 26
What is poorly controlled asthma in pregnancy linked with?
How many women experience dyspnoea in pregnancy?
What can you use to monitor asthma in asthmatic pregnant women?
FEV1 (doesn't change in pregnancy even though resp minute volume increases)
How many women experience improvement/no change/worsening of their asthma in pregnancy?
What improvement in FEV1 is expected after salbutamol therapy?
12% improvement or more
What are the differential diagnoses for breathlessness in pregnancy?
Dyspnoea of pregnancy
Amniotic fluid embolism
Post nasal drip (rhinitis)
Congestive heart failure/cardiomyopathy
Vocal cord dysfunction
Management of asthma in pregnancy
Eduction about SE and adherence
Control of environmental triggers
Management of existing conditions
What asthma treatments cannot/should not be used in pregnancy?
Leukotriene receptor antagonists
What is the advice for oral corticosteroids?
Small risk of cleft lip
Associated with low birth weight and pre-eclmapsia but possible confounding variable is severity of asthma
Benefits outweigh risks of uncontrolled asthma!
Is there any genetic link to maternal asthma?
ADAM33 gene is induced in allergic maternal asthma
Advice of how to avoid allergens?
Remove pets from home
Encase pillow and mattress with impermeable covers
Wash sheet and blankets weekly in hot water
Any advice for labour with maternal asthma?
Avoid carboprost, ergonovine and indomethacin
Instead use prostaglandin, MgSO4 or terbutaline
What other diseases are included in the COPD diagnosis?
Chronic bronchitis, emphysema and asthma
Spirometry diagnosis of COPD?
FEV1/FVC ratio less than 0.7
No reversibility with B2 agonists
What is LTOT?
Long term oxygen therapy
Increases survival for those with chronic respiratory failure
Lowers cardiac risk and improves cognition (not as hypocapnic)
What are the arguments for smoking cessation in COPD?
Improves mortality and health quality
Makes oxygen less risky
Inhalers work better
Improves mental and cardiovascular health
Treatment of COPD?
Inhaled antimuscarinics + LABAs + steroids
Stand by oral steroids and antibiotics
What can be offered for repeated infective exacerbations of COPD?
Long term macrolide antibiotics
What is interstitial lung disease?
Any disease that affects the space between alveolar epithelium and capillary endothelium
Inflammation, fibrosis and remodelling
Name 3 exposure related ILD causes
Environmental (dust mite hypersensitivity)
Name the major idiopathic pulmonary fibroses
Idiopathic pulmonary fibrosis
Idiopathic non specific interstitial pneumonia
Respiratory bronchiolitis interstitial lung disease
What is the most frequent ILD?
Idiopathic pulmonary fibrosis
Incidence is increasing
Median survival 3 yrs
Risk factors for idiopathic pulmonary fibrosis
Genetics (MUC58, TOLLIP, Telomerase)
Cigarette smoking > 20 pack years
Metal and woods dusts, farming, raising birds, stone cutting
Herpes viruses, EBV, CMV, Hep C
Presentation of idiopathic pulmonary fibrosis
Increases with age, males more than females
Diffuse inspiratory crackles
Diagnosis of idiopathic pulmonary fibrosis relies on:
Exclusion of other ILDs (CT diseases, environmental exposures, medications)
Presence of 'Usual Interstitial Pneumonia' (UIP) pattern on chest High Res Chest CT/surgical lung biopsy
What does the 'usual interstitial pneumonia' pattern if disease involve?
Bilateral patchy fibrosis
Reticular line and fibroblast foci
When is a lung biopsy taken?
In ILD if HR CT is nor diagnostic
Mortality is 1-3%
Can have serious complications (pneumothorax, pneumonia, empyema, haemothorax)