Respiratory Flashcards
(58 cards)
What might patients experience when switching from pMDI to a dry powder inhaler?
Lack of sensation in the mouth and throat
Coughing
What is the MHRA warning for pMDIs?
risk of airway obstruction from aspiration of loose objects
How often should spacer devices be changes?
Every 6-12 months
What is the dilution for nebulisers?
Sodium Chloride 0.9%
What are the four indications for nebulisers?
- deliver beta2 agonist or ipratropium bromide to a patient with acute exacerbation of asthma or COPD
- deliver beta2 agonist, corticosteroid or ipratropium bromide on a regular basis to a patient with severe asthma or reversible airways obstruction when patient unable to use other devices
- deliver antibiotic or mucolytic to a patient with cystic fibrosis
- deliver pentamidine isetionate for prophylaxis of pneumocystis pneumonia
What is considered as moderate acute asthma in adults?
- Increasing symptoms
- Peak flow > 50-75% best or predicted
- No features of acute severe asthma
What is considered as severe acute asthma in adults?
One of the following;
- Peak flow 33-50% best or predicted
- RR ≥ 25/min
- HR ≥110/min
- Inability to complete sentences in one breath
What is considered as life-threatening acute asthma in adults?
Any one of the following;
- Peak flow <33% bets or predicted
- SpO2 <92%
- PaO2 <8kPa
- Normal PaCO2 (4.6-6kPa)
- Silent chest
- Cyanosis
- Poor respiratory effort
- Arrhythmia
- Exhaustion
- Altered conscious level
- Hypotensuin
What is considered as moderate acute asthma in children?
- Able to talk in sentences
- SpO2 ≥92%
- Peak flow >50% best or predicted
- HR ≤ 140/min in children between 1-5 years
- HR ≤ 125/min in children ages over 5
- RR ≤ 40/min in children 1-5 years
- RR ≤ 30/min in children over 5 years
What is considered as severe acute asthma in children?
- Cant complete sentences in one breath or too breathless to talk or feed
- SpO2 <92%
- Peak flow 33-50% best or predicted
- HH ≥ 140/min in children aged 1-5 years
- HH ≥ 125/min in children ages over 5 years
- RR > 40/min in children 1-5 years
- RR > 30/min in children ages over 5 years
What is considered as life-threatening acute asthma in children?
Any one of the following;
- SpO2 < 92%
- Peak flow <33% best or predicted
- Silent chest
- Cyanosis
- Poor respiratory effort
- Hypotension
- Exhaustion
- Confusion
What SpO2 level should be maintained?
94-98%
What is the treatment for acute asthma?
Severe/ life-threatening - Refer!!
Moderate:
1st line: high-dose inhaled SABA ASAP (e.g. salbutamol)
- in mild-moderate acute asthma - pMDI inhaler and spacer can be used
- in severe/ life-threatening asthma - oxygen driven nebuliser, if response poor, consider continuous nebulisation
In all cases of acute asthma - pt’s should be prescribed adequate dose of oral prednisolone while continuing usual ICS
- Alternatives: parenteral hydrocortisone or IM methylprednisolone
What is the treatment for acute asthma in children over 2?
- High flow oxygen via tight fitting mask or nose cannula given to all children with life-threatening acute asthma or SpO2 <94% to achieve normal 94-98%
1st line: inhaled SABA ASAP
- mild-moderate - pMDI and spacer
Severe/ life-threatening asthma:
- administration via oxygen driven nebuliser
In all cases:
- prescribe oral dose of prednisolone for 3 days
–> repeat dose in children who vomit or consider IV route in those who cannot retain oral medicatio
–> continue ICS as usual
If a child over 2 is having an episode of acute asthma, when should they seek urgent medical attention?
If symptoms not controlled after 10 puffs of salbutamol via spacer or if symptoms return within 3-4 hours
What can be added to nebulised beta agonists to provide greater bronchodilation?
nebulised ipratropium bromide
What is given as add-on treatment to bronchodilator therapy in patients with severe COPD with chronic bronchitis?
Roflumilast
How do you manage exacerbations of COPD?
Breathlessness: high-dose short-acting inhaled bronchodilator
Withhold LAMA if SAMA given
Short course prednisolone
- consider osteoporosis prophylaxis in those who require frequent oral corticosteroids
How is mild croup treated?
Single dose of corticosteroids e.g. dexamethasone
How do you treat moderate-severe croup?
Single dose oral corticosteroid (dexamethasone or prednisolone) while awaiting hospital admission
If child too unwell to receive oral medication: IM dexamethasone or budesonide by nebulisation
How do you treat severe croup not controlled with corticosteroid treatment?
Nebulised adrenaline/epinephrine solution 1 in 1000 (1mg/ml) - clinical effects should last 1 hour but usually subside 2 hours after administration
What are the side effects of antimuscarinics?
Arrhythmias
Constipation
Cough
Dizziness
Dry mouth
Headache
Nausea
Inhaled antimuscarinics end in ‘ium’
Name some LABA drugs?
Bambuterol hydrochloride
Fomoterol fumarate
Indacaterol
Olodaterol
Salmeterol
What are the cautions for beta2-adrenoceptor agonists, selective?
Arrhythmia
Cardiovascular disease
Diabetes - risk of hyperglycaemia and ketoacidosis, especially with IV use
Hypertension
Hyperthyroidism
Susceptibility to QT prolongation
Hypokalaemia - particular caution in severe asthma and COPD because this effect may potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, diuretics and by hypoxia
