Respiratory Flashcards
Which vaccinations should a patient diagnosed with asthma be offered?
Influenza (flu jab)
Pneumococcal disease
When managing newly diagnosed asthma, what are the five stages of treatment escalation as according to the British thoracic society guidelines?
This all begins with a personalised asthma action plan.
(Note: three options in step 3 and two options in step 4)
Pre-diagnosis:
PRN SABA
consider low dose ICS
Step 1.
Low dose ICS
PRN SABA
Step 2.
Low dose ICS
PRN SABA
LABA
Step 3.
If no benefit from LABA:
MD ICS
Or: LD ICS PRN SABA LABA One extra drug (LTRA, SR theophylline, LAMA)
Or:
MD ICS
PRN SABA
LABA
Step 4. (Trials - we’re getting out of gp territory now) HD ICS PRN SABA LABA Refer to specialist
Or: LD ICS PRN SABA LABA Two extra drugs (LTRA, SR theophylline, LAMA or beta agonist) Refer to specialist
Step 5. HD ICS PRN SABA LABA Two extra drugs (LTRA, SR theophylline, LAMA or beta agonist) Oral corticosteroids
In an acute asthma exacerbation, what is the immediate treatment and the escalation steps?
- 6 puffs of bronchodilator inhaler or nebulised bronchodilator 5mg salbutamol (if life-threatening)
- If hypoxaemic: Add supplementary oxygen to nebuliser
- If poor response to bronchodilator: Add 0.5mg Ipratropium bromide 4-6 hours daily, to nebuliser
- Oral prednisalone 40-60mg once daily for five days or IV hydrocortisone
- If poor response to bronchodilator: MgSO4 one-off dose
- If potential coma*: Aminophylline
After discharge - appointment with GP within 2 days and review with hospital specialist in 1 month.
What kind of oxygen concentration do we expect in someone once someone is on 15L of oxygen?
Normal range is 10-15
> 20
What is the only respiratory cause of low CO2?
Hyperventilation
Remember all other ways of lowering CO2 take time, so this is the only acute way to change it
When should follow-up be arranged following discharge after a severe asthma attack?
GP appointment within two days of discharge
What should be covered within the GP follow-up after discharge following an asthma attack?
Inhaler technique
Give PEFR meter
Create written asthma plan
How do you objectively assess the success of asthma exacerbation treatment?
Take regular PEFR readings
What is the treatment pathway for COPD?
- SABA or SAMA
- (SABA + LABA) or LAMA
- (SABA + LABA + ICS) or (LAMA + LABA)
- (SABA + LABA + ICS + LAMA)
Adjuncts:
Vaccinations for influenza and pneumococcal bacteria
Oxygen therapy (15 hours per day if cor pulmonale)
Physiotherapy
Bullectomy, lung volume reduction or lung transplant
What are alternatives to sympathomimetics for bronchodilation?
Xanthines - theophylline etc - used much more often in COPD than In asthma
MOA; Inhibit phosphodiesterase, Increase cAMP and prolong its bronchodilation effect
Anticholinergics - ipratropium etc
MOA; prevent parasympathetic stimuli (to increase sympathetic relative influence)
Magnesium - not used in COPD
MOA; CCB action causes bronchodilation
What are the types of anti inflammatories used in asthma and COPD?
Corticosteroids, leukotriene receptor antagonists and sodium chromoglycate
CS inhaled: beclometasone, fluticasone and budesonide (combined = seretide and symbicort)
Leukotriene RA’s: ONLY for asthma; montelukast
Sodium chromoglycate: ONLY for asthma
Which kind of mask do you use when giving oxygen to someone who has COPD and is known to be in compensated respiratory failure type two?
Venturi mask - can control the oxygen content
Preserve hypoxic drive
What is the treatment for CAP?
Decided by CURB65 score:
1 = Amoxicillin, oral: FIVE DAY COURSE
2 = Amoxicillin, oral and Clarithromycin, oral: SEVEN TO TEN DAY COURSE
3+= CoAmoxiclav, IV and Clarithromycin, IV: SEVEN TO TEN DAY COURSE
What is the treatment for active TB?
Isoniazid with pyridoxine (vit B6), rifampicin and ethambutol
= 3 direct action drugs, one adjunct
(Then remove ethambutol after two months)
If there is CNS involvement: Add pyrazinamide
= 4 direct action drugs, one adjunct
