Respiratory Flashcards
(36 cards)
What is the definition of asthma?
Asthma is a chronic inflammatory airway disease characterised by intermittent airway obstruction and hyper-reactivity.
What are the three pathological hallmarks of asthma?
- bronchoconstriction
- oedema
- mucus hypersecretion
What questions do you ask when taking an asthma history?
Symptoms: SOB, cough, wheeze
Severity: does it wake you up at night? How often do you take your puffer? Have you ever been hospitalised/intubated?
Social: how does it affect your life?
Medications: puffer, preventer, oral pred
Triggers: exercise, cold, pollutants
Atopy: eczema, hayfever, allergies
What signs will you find on examination of a patient with asthma?
Hyperinflated chest (gas trapping) Tachypnoea Use of accessory muscles Pursed lip breathing Cyanosis Prolonged expiratory wheeze Reduced breath sounds on auscultation Possibly decreased heart sounds (increased chest volume)
What are some triggers for asthma?
Allergens Pollutants Tobacco smoke Occupational exposure URTIs Exercise Cold air Medication: aspirin, beta blockers
How do we diagnose asthma?
Spirometry: airflow obstruction is when FEV1/FVC (FER) <70%
We need to prove that the bronchoconstriction is reversible, so look for an increase in FEV1 following Ventolin.
What are the goals of treatment for asthma?
Control symptoms
Prevent exacerbations
Maximise lung function and prevent future lung function decline
Maintain normal levels of activity
Lower dose of amedication to achieve suitable asthma control and minimise side effects
What are the pharmacological treatments for asthma?
Relievers: beta2 agonists (relax smooth muscle but do not change underlying inflammation)
Preventer: inhaled GCS (reduce inflamm and AHR)
Oral GCS
Combination inhalers (ICS + LABA)
LT-receptor antagonists (for aspirin-sensitive asthma)
Long-acting anticholinergics
Anti-IgE
What are the signs of an acute asthma attack?
Low oxygen
Respiratory muscle fatigue = no hyperventilation = not alkalotic
Silent chest
How do we treat an acute asthma attack?
Oxygen is essential.
Oral prednisolone or IV hydrocortisone
Regular bronchodilators
Urgent ICU assessment for observation - possible intubation
IV magnesium (bronchodilation properties)
What is the definition of COPD?
COPD is a preventable and treatable disease, characterised by airflow limitation that is not fully reversible.
What are the three major components of COPD?
- Emphysema
- Chronic bronchitis
- Small airways disease
What is emphysema?
Alveolar wall destruction with irreversible enlargement of the air spaces distal to the terminal bronchioles and without evidence of fibrosis
What would you find on examination for a patient with COPD?
Early (note: there are often not many signs early on in COPD):
- nicotine staining
- prolonged expiratory phase +/- wheeze on forced exhalation
Later:
- hyperinflation (barrel chest)
End stage:
- pursed lip breathing
- accessory muscle use
- cyanosis
- asterixis (metabolic encephalopathy due to high CO2 levels)
- engorged liver
- RV heave
- engorged neck veins due to increased intrathoracic pressure
What investigations should you perform to diagnose COPD?
Pulmonary function tests: spirometry, flow-volume loop, lung volumes
CXR
HRCT
ABGs
What would you see on CXR for a patient with COPD?
Hyperinflation: - flat hemidiaphragms - increased lucency - tapered vascular shadows peripherally Bullae - large cysts in the lung (increase risk of pneumothorax)
What are the management principles for patients with COPD?
Remember COPX:
C = confirm diagnosis
O = optimise function (smoking cessation, treat other comorbidities)
P = prevent deterioration (smoking cessation, flu vacc to decrease risk of exacerbations)
D: develop support network and self-management plan
X: management of exacerbations
What is the definition of pulmonary oedema?
Pulmonary oedema is the accumulation of fluid in the alveolar sacs of the lung.
What are some causes of pulmonary oedema?
Cardiogenic causes: - left heart failure - mitral regurgitation Non-cardiogenic causes: - fluid overload - pulmonary embolus - ARDS
What is the definition of pleural effusion?
Pleural effusion is the accumulation of fluid in the space between the visceral and parietal pleura.
What are some causes of pleural effusion?
Transudate: - left heart failure (increased pulmonary capillary pressure) - right heart failure (increased parietal pleural capillary pressure) - cirrhosis - pulmonary embolism - kidney failure - hypoalbuminuria Exudate: - pneumonia - malignancy
What might you find on history and examination of a patient with pleural effusion?
History 1. Pleuritic chest pain, worse on inspiration and movement 2. If caused by pneumonia, may be associated with productive cough. Transudative pleural effusions cause non-productive cough. 3. Dyspnoea Examination 1. Dullness to percussion 'stony dull' 2. Reduced breath sounds over effusion 3. Reduced vocal resonance 4. Reduced chest expansion
What are common causes of typical pneumonia?
Streptococcus pneumoniae Haemophilus influenzae Klebsiella pneumonia Staphylococcus aureus Moraxella catarrhalis
What are common causes of atypical pneumonia?
Mycoplasma pneumoniae Chlamydia pneumoniae Chlamydia psittaci Legional penumophila Coxiella burnetii
