Resp Basics

Question 1

Features of an inspiratory wheeze?

Answer 1

Monophonic
upper airways
tracheal tumour/TB

Question 2

Features of expiratory wheeze?

Answer 2

Polyphonic
Bronchoconstriction
Asthma

Question 3

What is obstructive lung disease?

Answer 3

Narrowing of airways that prevents outflow from the lungs for gas exchange

Question 4

Types of obstructive lung disease? Features?

Answer 4

Asthma - reversible airway obstruction - mast cell degranulation of histamine

CODP - Irreversible airway obstruction, long term smoking damage

Question 5

What is SOB?

Answer 5

Difficulty breathing - use of accessory muscles and increased breathing rate
- ‘dyspnoea’

Question 6

What make SOB worse?

Answer 6

Blood loss
Ventilation problem - Choking
Heart failure

Question 7

Causes of SOB?

Answer 7

Lung problem:

• Asthma
• COPD
• Pulmonary fibrosis
• Interstitial lung disease
• Pneumonia

Heart problem:

• Failure = inadequate O2 supply
• MI

Blood problem:

• Anaemia (low Hb = low O2)
• Diabetic ketoacidosis = fast breathing = retention of metabolic acid from ketones

Joint cardiac and resp problems:

• Anxiety - fight/flight, hyperventilation, tachycardia
• PE - ventilation/perfusion problem

Question 8

What is the normal respiratory rate?

Answer 8

12-16 breaths/min

Question 9

What resp rate indicates tachypnoea?

Answer 9

20 breaths/min

Question 10

Criteria of an acute severe asthma attack?

Answer 10

Resp rate over 25/30 per min
Peak flow is 50% below expected
Cannot complete sentences
Hr >110/min

Question 11

When does an asthma attack become life threatening?

Answer 11

PEF <33%
SpO2<92%
Cyanosis
Exhaustion

Question 12

What is FEV1?

Answer 12

Forced expiratory volume over the 1st second of breathing out

Question 13

What is FVC?

Answer 13

Forced vital capacity = vol of air that can be forcibly blown out after a full insp

Question 14

What is the normal FEV1/FVC?

Answer 14

0.8 or more

Question 15

What is the FEV1/FVC for obstructive disease?

What indicates asthma?

Answer 15

0.7 or less

Asthma needs to demo reversibility - give bronchodilator and repeat (if improves FEV1/FVC = asthmatic)

Question 16

How to measure breathing?

Answer 16

Spirometer = measures volume breathed out in one forced breath (FVC)
Peak flow meter = breath out as far as you can as fast (how fast you breathe)

Question 17

How does an asthmatic’s breathing differ?

Answer 17

Cannot breathe out fast = peak flow (and FEV1) is lower but FVC is same

Question 18

What is a spirometer?

Answer 18

Measures volume of air breathed out in one forced breath (FVC)
(how much air)
Helps diagnose and monitor lung conditions
Compare results to someone their age, height and sex

Question 19

What is a peak flow meter?

Answer 19

Measures how fast someone can breathe out (PEF)
(how fast)
Helps diagnose asthma
Use at home twice daily when trying to diagnose asthma

Question 20

Characteristics of a restricted disease?

Answer 20

Lower FVC (lower vol)
FEV1 = same

Question 21

Inhalers: What do relievers do? Examples?

Answer 21

Manage attacks
Dilate bronchi to normal
Short acting beta agonists
Salbutamol
Ipratropium bromide

Question 22

Inhalers: What do preventers do? Examples?

Answer 22

Do not relieve attacks
Decrease number of attacks
Long acting beta agonists
Steroids - Beclometasone, budesonide, fluticasone

Question 23

What disorders require inhalers?

Answer 23

COPD and asthma

Question 24

What is resp failure I?

Answer 24

<8KPa PaO2
Low/normal PaCO2
Caused by pneumonia, asthma
Tx - give O2

Question 25

What is resp failure II?

Answer 25

<8PKa PaO2 >6KPa PaCO2 Caused by overdose, trauma, COPD, neuromuscular Tx - give O2, care in chronic

Question 26

What drives normal breathing?

Answer 26

CO2 as adapting receptor (increase CO2 = breathe faster)

Question 27

What drives breathing in COPD?

Answer 27

O2 = non-adapting factor = lack of O2 to tissues

Question 28

Define COPD

Answer 28

Airway obstruction as bronchial tubes inflamed = trapped air in lungs = decrease FVC and low FEV1 = FEV1/FVC = less than 70%

Question 29

How to calculate if smoking is significant?

Answer 29

Cigarettes a day x number of years Divided by 20 If more than 10PYH = significant

Question 30

Define asthma

Answer 30

Reversible airway obstruction due to crosslinking of receptor bound IgE antibodies = mast cell degranulation of histamine = - Mucus hypersecretion - Mucus plugging - Mucosal oedema - Bronchoconstriction

Question 31

What questions to ask when assessing asthma control?

Answer 31

``` Meds Last A&E visit for asthma attack ITU Freq of attacks Func limitations ```

Question 32

What is the acute tx for asthma?

Answer 32

Salbutamol through an O2 spacer (2 puffs) Systemic corticosteroids Ipatropium bromide

Question 33

Long term asthma tx?

Answer 33

Inhaled steroids

Question 34

How is asthma linked to dentistry?

Answer 34

Anxiety = asthma Inhaled allergens in practise Knowledge before tx = emergency prep Chronic use of bronchodilating inhalers and/or glucocorticoids = increase oral candidiasis

Question 35

How to manage asthma?

Answer 35

ABC approach and monitoring Salbutamol - how, spacer, how much O2 - what rate, 15 litres per min for 4 hrs Ambulance - if hypoxic, acute severe asthma or after initial therapy In hospital: - High flow O2 - Nebulisers - flow of O2 and add liquid of: salbutamol 5mg, ipratropium bromide 0.5mg Prednisolone 40mg PO = prevents late T cell response the next day No response to nebulisers/life threatening: - Mg - Aminophylline - can cause arrhythmia

Question 36

What is the BTS approach?

Answer 36

1. SABA (salbutamol, terbutaline) 2. Inhaled steroid (beclomethasone = brown inhaler) 3. LABA (salmeterol) 4. Antileukotrines 5. Oral steroids (prednisolone)

Question 37

How to treat asthma?

Answer 37

If PEF less than 75% = short acting bronchodilator 4 puffs via spacer then 2 puffs/2mins for up to 10 puffs OR salbutamol 5mg nebuliser (ideally by 6L/min O2) Consider oral steroids and referral to GP

Question 38

How to treat COPD?

Answer 38

If SOB/wheezy - Salbutamol ventolin 5mg dose and ipratropium bromide 500mg via nebuliser (if not to hand = 4 puffs of short acting beta agonist via spacer) If infective exacerbation - lower resp tract infec: - Aminopenicillin - Tetracycline - Macrolide

Question 39

How to give O2?

Answer 39

Initially: nasal cannulae 2-6L/min or simple face mask 5-10l/min Pt not at risk of hypercapnic resp failure who have saturation <85% = reservoir mask at 10-15l/min Recommended initial O2 saturation rate = 94-98%