Obstructive Pulmonary Diseases + Smoking Cessation Flashcards by Giulia Uitenbosch

What is the main mechanism of asthma?

Hypersensitivity type 1 reaction

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what immunoglobulin is raised in asthma?

IgE (allergy)

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what are the two main physiological features which cause asthma?

inflammation

bronchoconstriction

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what types of cells mediate asthma?

mast cells

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what is the reaction cascade to asthma antigens?

antigens picked up by IgE
IgE + antigens binds to mast cells
mast cells release histamine
histamine causes inflammation/bronchospasm

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what are the main risk factors for asthma?

atopy/allergy
occupation
smoking

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what is the concept of grandmother effect in asthma?

if mother/grandmother smokes during pregnancy, child/grandchild higher risk of developing asthma

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what are some other potential risk factors for asthma?

obesity
diet
exposure (eg farms)

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what are the main symptoms of asthma in adults?

wheeze
cough (dry or productive)
dyspnea

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what can be other causes for obstructed airflow and asthma-like symptoms?

localised - tumour, foreign objects

generalised - COPD, bronchiectasis, bronchiolitis, CF

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what should be investigated in the PMH of suspected asthma patients?

previous asthma
childhood bronchitis
other allergies (eczema, hayfever)

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what should be investigated in the DH of suspected asthma patients?

if they are on inhalers, NSAIDS

what effects those drugs have/have had

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what should be investigated in the FH and SH of suspected asthma patients?

FH: atopy
SH: occupation, pets, smoking, psychosocial factors

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what is the MAIN investigation to be done in asthma patients?

spirometry

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what should be the next step in diagnosing asthma and why, if spirometry shows an airflow obstruction?

lung function tests (helium and carbon monoxide)

to help rule out COPD

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what investigation should be done after lung function tests and why, if the spirometry showed an obstructed airflow?

reversibility tests with salbutamol (short term) and prednisolone (long term)
to rule out COPD, which isn’t reversible

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what is the protocol for reversibility testing in asthma with beta agonists?

spirometry at baseline and 15 mins after beta agonist is given
inhaled salbutamol 400microliters
nebulised salbutamol 2.5-5mg

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what is the protocol for reversibility testing in asthma with inhaled corticosteroids?

spirometry at baseline and 2 weeks, along with PEF chart/meter
prednisolone for 2 weeks, 0.6mg/kg

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what investigation should be done next in asthma diagnosis if spirometry looks normal?

PEFR for two weeks, twice a day

occupational asthma testing

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how is occupational asthma tested?

PEFR for >5 days, every two hours

for specialist: FeNo, bronchial stimulation, colophony

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what is the best way to assess asthma severity and the measurements which allow Jr drs to address it?

HARPO
Heart rate <110
Ability to speak - yes
Resp rate <25
PEF >50%
O2 - sats >92%, PaO2 >8kPa

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What is a sign of a near fatal asthma attack?

raised CO2

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what are some of the signs of life threatening asthma?

cyanosis
extreme tiredness/not conscious
inability to speak (grunting)
extreme tachycardia or bradycardia 
low RR

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what are some other useful investigations in diagnosing asthma/ruling out other causes?

CXR
FBC (for eosinophils)
IgE levels (for atopy)
skin prick (for atopy)

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how are the investigations for COPD similar to the ones for asthma?

COPD investigations are the same as the ones done when spirometry for asthma diagnosis shows obstructed airflow

how can asthma be managed non-pharmacologically?

exercise stop smoking weight loss remove triggers

what is the approach of pharmacological asthma treatment?

stepped approach Short acting beta agonists (salbutamol) to relieve symptoms - inhaled ICS low dose - low dose ICS and/or add LABA - increase ICS +/- keep LABA - ICS + LABA + LAMA/theophylline/leukotriene receptor antagonist - add a fourth drug - long term prednisolone or other specialist therapies

what are options of specialist therapy in asthma?

long term oral prednisolone interleukin-5 antagonist IgE antagonist bronchial thermoplasty

what is the approach to mild/moderate acute asthma attacks?

increase inhaler they are already on oral steroid treat trigger review and follow up

what is the approach to severe asthma attacks?

``` nebulised salbutamol + ipratropium oral/IV steroid magnesium aminophylline treat trigger ITU care ```

what are the different types of inhalers available?

pMDI - meter dose inhalers pMDI with spacers DPI - dry powder inhalers

what is the name of the most commonly used ICS for asthma in adults and children?

beclomethasone

what are the commonly used SABAs in asthma?

salbutamol | terbutaline

why should long term (>3 weeks) prednisolone not be stopped suddenly?

because it may cause acute adrenal insufficiency (failure of the adrenal gland to make its own glucocorticoid)

what is a common brand of leukotriene receptor antagonist often used?

montelukast

what tests should be done for asthma in children?

none

what symptoms need to be present in paediatric asthma?

WHEEZE!! cough atopy (parents have asthma) SOB at rest

what should be given as trial for in children with potential asthma?

Salbutamol (SABA) as and when. | If SABA used more than 3x per week, ICS two months

what are other possible diseases in children which could mimic asthma?

``` if younger than 6mts/older than 4yrs: bronchitis pertussis cystic fibrosis normal cough congenital disease ```

how should asthma be treated in children?

stepped approach 1. SABA 2. ICS very low dose/LTRA 3. ICS + LABA/LTRA/increase ICS

what should be done if a child doesn't respond with dual treatment of ICS and long acting bronchodilators?

Specialist referral for long term corticosteroid treatment

what is the main proven side effect of prolonged use of ICS in children?

growth suppression

what are the main considerations of LABAs in children?

never give without ICS | give in fixed-dose inhalers

what mechanism of inhalers should and should not be used in children?

pMDI with spacer, never without DPI (if older than 8) NO NEBULISER

when should montelukast be given in children and why?

when they are under 5 | tablet, easier to take so better compliance

what non-pharmacological measures should be taken to improve asthma in children?

stop exposure to smoke | stop exposure to allergens (pets etc)

how should acute treatment of asthma be treated and based on what?

use HARPO criteria SABA oral prednisolone/ipratropium hydrocortisol/aminophylline

what is the main difference in asthma between prescribing acute and long term oral corticosteroids?

acute - no need to refer | long term - refer to specialist

what route should corticosteroids be given in acute management of asthma and why?

always oral | inhalers won't help because they are PREVENTATIVE

what is the reasoning behind prescribing ICS and SABA in asthma?

ICS - preventative | SABA - symptom relief

should oral beta agonists be used in children with asthma?

should nebulisers be used routinely in children with asthma?

Which gender is more affected by COPD?

Males

What ranking does COPD have in UK and global for leading causes of death?

UK - 6th | Global - 5th

How many people in the UK have COPD and how many deaths occurs per year as a result?

1-2 million people | 30,000 deaths

How many acute hospitalisations in UK occur due to COPD?

10%

What is the main underlying mechanisms of COPD?

Chronic bronchitis | Emphysema

What are the main non-smoking causes of COPD?

Chronic asthma | Alpha 1 antitripsin deficiency

How do chronic bronchitis and emphysema contribute to symptoms?

Chronic bronchitis - long term inflammation | Emphysema - destruction and collapse of alveolar spaces, difficult breathing

How can COPD lead to cor pulmonale and RVF?

Hypoxaemia —> pulmonary vasoconstriction/polycythaemia —> increased resistance —> pulmonary hypertension —> RV enlargement and failure

What are the possible types of emphysema?

Centriacinar Panacinar Periacinar (bullae)

What are some signs of COPD?

``` Finger clubbing Cor pulmonale/RVF Peripheral oedema Reduced breath sounds Hyperinflated chest Pursed lip breathing Cyanosis CO2 flap/SABA tremor ```

What are some symptoms of COPD?

``` Cough Sputum Wheeze Recurrent RTI’s SoB on exertion/rest Weight loss Peripheral oedema ```

What are the main investigations?

Spirometry —> LFT —> reversibility tests (SABA and ICS)

What are other useful investigations in diagnosing COPD?

``` CXR ECG FBC/U&E Alpha1antitrypsin tests ABG ```

What is the main non-pharmacological management of COPD?

Stop smoking Nutritional support Respiratory physio Vaccinations

What are the main pharmacological treatments for chronic COPD?

Stepped approach: - SABA - LAMA/LABA - LAMA + LABA - ICS + the above (triple therapy) Other: Long term O2 therapy

What are the main differences in symptoms between asthma and COPD?

COPD not reversible and normally comes with sputum | Asthma reversible with treatment and doesn’t normally present with sputum

What is the management for acute exacerbation of COPD?

``` Nebulised SABA + SAMA oral prednisolone (or IV hydrocortisone) Antibiotics (if infection caused exacerbation) Aminophylline O2/NIV ```

What are some of the investigations to do in acute exacerbations of COPD?

``` FBC/U&E Blood/sputum cultures CXR Theophylline concentration (if pt takes it) ECG ABG ```

What are some possible symptoms of acute exacerbation of COPD?

``` Increased cough Lots of (purulent) sputum Severe SoB Cyanosis Altered consciousness Pyrexia (infection) ```

Why should you be careful when prescribing oxygen to patients with acute exacerbation of COPD?

Because they rely on hypoxic drive for breathing, giving too much oxygen can reduce RR

What are some of the risk factors for COPD?

``` SMOKING Alpha 1 antitrypsin deficiency Occupation Maternal/passive smoking Environmental exposure (pollution) Chronic asthma ```

What is nicotine responsible for in cigarettes?

Addiction

Is nicotine responsible for the damage caused by smoking?

No, other added chemicals are

How many people in scotland smoke as a percentage, and who are they likely to be?

20% of the population | Deprived areas, unskilled/unemployed, not well educated

What proportion of women smoke during pregnancy?

1 in 3

How many women are likely to start smoking again after pregnancy?

2 in 3

What are the risks of smoking during pregnancy?

Increased risk of miscarriage/neonatal death

what is an important law that was passed in scotland with regards to smoking?

Smoking, Health and Social Care Act (2005)

What are some of the strategies adopted to reduce smoking in the UK?

- Smoking, health and social care act 2005 - child protection - tobacco regulation - ban smoking in public places

By what percentage does stopping smoking reduce the chance of MI after 1 year and 15 years?

50% reduction

What is the benefit of smoking cessation in terms of heart and lung disease after 15 years?

MI and lung cancer chance same as a non-smoker

What percentage of a cigarette pack price is paid as tax?

77%

What are some of the diseases for which smoking is a risk factor?

``` Lung/RT cancer COPD Diabetes Osteoporosis Crohn’s disease Macular degeneration Psoriasis ```

Obstructive Pulmonary Diseases + Smoking Cessation Flashcards

(85 cards)