Respiratory

Question 1

What is the recommended Inhaler Advice?

Answer 1

1. SABA (Salbutamol)
2. SABA + ICS (Beclomethasone or Budesonide) ⇒ if patient reports symptoms 3 or more times per week, or night-time waking either at initial diagnosis or review
3. SABA + ICS + LTRA (Montelukast)
4. SABA + ICS + LABA (Salmeterol)
5. SABA + MART (ICS/LABA switched out for a MART, which includes a low dose ICS)

Question 2

What is the management plan for Bronchiectasis?

Answer 2

• Exercise and Improved Nutrition
• Airway Clearance Therapy (Chest Physiotherapy) → maintenance of oral hydration, postural drainage, percussion, vibration, and the use of oscillatory devices
• Inhaled Bronchodilator (Salbutamol)
• Mucoactive Agent → nebulised hypertonic saline
• Antibiotics → amoxicillin, vancomycin etc.
• Immunisations

Question 3

What is the management plan for fibrotic lung disease

Answer 3

• Supportive Care → oxygen therapy, pulmonary rehabilitation, vaccinations (influenza and pneumococcal vaccines)
• Pirfenidone → antifibrotic agent that may slow disease progression in Idiopathic Pulmonary Fibrosis
• Lung Transplantation → indicated in end-stage ILD. Only definitive treatment available.

Question 4

What are examples of typical CAP pathogens

Answer 4

• Streptococcus Pneumoniae → most common. May have rusty sputum.
• Haemophilus Influenzae → especially in COPD patients. Gram negative coccobacilli.
• Staphylococcus Aureus → IVDU and also occurs after influenza. Causes cavitating lesions (gas filled lesions) on CXR. Gram positive cocci found in clusters.
• Klebsiella Pneumoniae- alcoholics and diabetics. Causes cavitating lesions on CXR (typically upper lobe). Commonly causes lung abscess formation and empyema.