RESPIRATORY - Asthma, COPD Flashcards
(94 cards)
1
Q
Functions of the respiratory system (5)
A
Gas exchange Homeostasis of the body Protection from inhaled pathogens Vocalisation Olfactory sense
2
Q
FEV 1
A
Forced exp volume
Volume that has been exhaled at the end of the 1st s of forced expiration
3
Q
Normal FEV1 value
A
> 80%
4
Q
FVC
A
Forced vital capacity
Volume that has been exhaled after max exp, following a full insp
5
Q
KCo
A
Diffusion capacity of lung per unit area for CO
6
Q
TLco
A
Diffusion capacity of the total lung for CO
7
Q
Obstructive pattern
A
Norm/Incr FVC
FEV1:FVC <0.7 (reduced)
8
Q
Restrictive pattern
A
Reduced FVC (<80%)
9
Q
What does decreased TLco/Kco indicate
A
Issue w/ gas exchange
hence rules out chest wall/diaphragm pathology
10
Q
Def asthma
A
Chronic inflammatory condition of the airways, characterised by airway hypersensitivity
11
Q
What % adults have asthma
A
5%
12
Q
What % children have asthma
A
10%
13
Q
Sx asthma (5)
A
Wheeze SOB Morning dipping Subjective feeling chest tightness Nocturnal cough
14
Q
O/E asthma
A
Widespread expiratory wheeze
15
Q
Pulmonary function test results asthma
A
Decreased FEV1
Relieved by B2 agonists
16
Q
Common precipitants asthma
A
Enviro Viral infections Cold air Emotion Dx (NSAIDS/B blockers) Atmospheric pollution Occupational pollutants
17
Q
How is occupational asthma diagnosed
A
Using peak flows before /after work/ at weekends
18
Q
Important Hx points asthma
A
Known precipitants Diurnal variation Acid reflux Sx Atopy Hx Occupation Days off work/school Hx exaccerbations Did they req hospitalisation/ITU
19
Q
Can asthma be diagnosed on clinical diagnosis aloone?
A
Yes
If B2 commenced and improvement of Sx
20
Q
If poor response to bronchodilators, how is asthma diagnosed
A
Spirometry
FEV1:FVC < 0.7 +bronchodilator reversbility = diagnostic
21
Q
What time of HS reaction is extrinsic asthma
A
T1HS
22
Q
Clinical picture extrinsic asthma
A
Atopic indiv
w/ positive skin prick tests to common allergens
23
Q
Clinical picture intrinsic asthma (4)
A
Middle aged indiv
With no causative agents ID’d
Generally > severe
+ quicker deteriorations in lung fct
24
Q
Early phase of acute asthma attack
A
Bronchospasm b/c spasmogen production (Histamine, PG + LT)
SM contraction narrows airways
25
Late phase of acute asthma attack
Chemotaxins attract eosinophils +mononuclear cells
| Infiltrate + mucosal oedema narrow airway
26
Which type of asthma is more likely to develop chronic asthma
Intrinsic astham
27
Changes in chronic asthma
Bronchoconstriction b/c incr responsiveness bronchial SM + hypersecretion mucus --> plugs
28
What 2 things ddoes the sputum contain in chronic asthma
Charcot-Leyden crystals
| Curshman spirals
29
Effect on vascular system - chronic asthma
Pulmonary HTN
30
Features of life-threatening asthma attack (5)
-PEF <33% of best
-SpO2 <92%
-Silent chest, cyanosis or feeble respiratory effort
Bradycardia, hypotension or dysrhythmia
Exhaustion or confusion
31
ABG markers - life threatening asthma attack
Normal PaCO2 (b/c no longer hypoventilating)
Severe hypoxia <8
Low pH
32
What does raised PaCO2 indicate in acute asthma attack
Almost fatal
33
Mx life threatening asthma attack (8)
```
15L O2 NRB mask
Salbutamol 5mg via nebs (every 15-30 mins)
Ipratropium bromide 0.5mg via nebs
PO prednisolone 50mg or IV HC 100mg
No sedatives
CXR
Call ICU
+ MgSO4
```
34
What must you do prior to discharge for an acute asthma attack patient
Check inhaler technique
35
Step 1 Mx asthma
salbutamol prn
36
Step 2 Mx asthma
+ ICS 200-800microg
37
Step 3 Mx asthma
+ LABA
If response - continue
If no response - stop and increase dose of ICS to 800microg/day
38
Step 4 Mx asthma
Persistent poor control
Can incr Inhal ICS up to 2000microg /day
Add 4th Dx e.g. LTRA, Theophylline etc
39
Step 5 Mx asthma
Continuous or freq use of PO steroids
Maintain 2,000 microg ICS
Lowest dose daily oral steroid
40
Inhaler technique
1 - Remove cap and shake inhaler to ensure consistency of dose
2 - Pt - breath fully out
3 - Pt - breath in slowly and steadily press down on the inhaler device
4 - On inhalation, pt should hold breath for count of 10
5 - pt - slowly breathe out, repeat dose + replace mouthpiece cover. Clean device if necess after use
41
Role of Beta-agonists
Relax bronchial SM --> bronchodilation
42
SE Beta-agonists
TachyC (Beta 1)
| Tremor, cramps, hypokalaemia (Beta 2)
43
How long does a SABA work for?
4-6hrs
44
How long does a LABA work for?
>12hrs
45
SE ICS (main)
PO candidiasis
| Pneumonia
46
Advice for ICS
Rinse mouth afterwards
47
SE - LTRA (3)
Thirst
GI disturbances
V rarely Churg Strauss
48
SE Theophyilline
```
Dose related b/c narrow therapeutic window
headache
Insomnia
Nausea
TachyC
Arrhythmias
```
49
Def COPD
A disease of progressive airflow limitation that is not fully reversible, associated w/ an abnormal inflammatory resposne to the lungs to noxious particles of (g), predominantly inhaled cigarette smoke
50
Def Emphysema
Dilation of any part of respiratory acinus w/ destructive changes in the alveolar walls
51
What is tissue destruction caused by in emphysema?
Increased secretion + activation of extracellular proteases by inflammatory cells
(which are stim'd by noxious particules)
52
Centrilobar emphysema
changes Limited to central part of lobule directly around terminal bronchiole, w/ norm alveolar everywhere
53
What is the most common type of emphysema
Centrilobar emphysema
54
What is centrilobar emphysema assocated with
Smoking
55
What is panacinar emphysema
Destruction + distention of whole lobule
56
Who gets panacinar emphysema
a-1-antitripsin deficiency
57
What is a bullae
Dilated air space >1cm
58
Def chronic bronchitis
Daily cough + sputum for at least 3 months /yr for 2 years
59
What is the primary abnormality seen in chronic bronchitis?
Abnormal amount of mucus, which --> plugging of airway lumen
60
What index is used to show hypersecretion in chronic bronchitis?
Reid index
Ratio fland:wall thickness in the bronchus
(Incr in chronic bronchitis)
61
What is bronchiolitis?
Inflammation in airways <2mm in diameter
| + macrophage + lymphoid cell infiltration
62
What is the first pathological change in COPD
Bronchiolitis
63
RF COPD (6)
```
Cigarette smoke
Occupational exposure to dusts
A-1-antitrypsin deficiency
Recurrent infections - childhood
Low SE status
Asthma/Atopy
```
64
PS COPD (4)
Productive morning cough
Increased frequency LRTI
Slowly progressive dyspnoea + wheezing
Resp failure
65
Signs COPD - severe dsiease
```
Tachypnoea
Cyanosis + flapping
Hyperinflation
Intercostal recession insp
Lip pursing on exp
Signs resp distress
Raised JVP if cor pulmonale
Poor chest expansion
Hyper-resonant throughout + loss cardiac/hepatic dullness
Decr breath sounds
Prolonged expiratory phase
Polyphonic wheeze
```
66
Complications COPD (6)
```
Acute exacerbations
Polycythaemia
Resp failure
Cor pulmonale
Pneumothorax
Lung carcinoma
```
67
What are 'Blue bloaters'
Pt w/ sever COPD who are insensitive to CO2
| Rely on hypoxic drive
68
How do Blue Bloaters ps
Not particularly breathless
| But = cyanosed + oedematous
69
ABG results Blue Bloaters
T2RF
70
What treatment must be given with caution w/ Blue Bloaters
O2
71
What are 'Pink puffers'
Pt remains sensitive to CO2
72
ABG features'Pink puffers'
Low CO2
Norm O2
But can --> T1RF
73
Appearance of 'Pink puffer'
Uses accessory mm to increase their ventilation
Breathless
Pt v thin due to large amount of kcal used to breath
74
Does Pink Puffer or Blue bloater have > emphysema
Pink puffer
75
When can diagnosis of COPD be clinical?
If typical Sx in >35y/o in presence of RF
76
Ix for anyone suspected of COPD
Post-bronchodilator spirometry
CXR
FBC
77
Post-bronchodilator spirometry - stage 1 (mild)
FEV1 80% predicted value
78
Post-bronchodilator spirometry - stage 2 (mod)
FEV1 50-79% predicted
79
Post-bronchodilator spirometry - stage 3 (severe)
FEV1 30-49% predicted
80
Post-bronchodilator spirometry - stage 4 (v severe)
FEV1 <30% predicted
81
CXR features COPD (5)
```
Hyperinflation (>6ant/10post ribs)
Flattened hemidiaphragm
Large central pulm aa
Reduced peripheral vascular markings
Bullae
```
82
Further Ix COPD (4)
Sputum culture
EC
ABG
DLCO
83
Mx stable COPD (4)
Rx to resp specialist if any doubt on diagnosis
Pt education
Lifestyle advice
Medication
84
Medicine pathway COPD if FEV1 >50:
1 - SABA prn or SAMA prn
2 - LABA or LAMA
3 - LABA + ICS
4 - LAMA + LABA + ICS
85
Medicine pathway COPD if FEV1 <50:
1- SABA prn or SAMA prn
2 - LABA + ICS or LAMA
3 - LABA + LAMA + ICS
86
Specialist Tx COPD (6)
```
Pulmonary rehab
PO aminophylline
Mucolytics
Nutritional supplement
LTOT
Surgery
```
87
Aims of pulmonary rehab in COPD
Increases exercise capacity
Decreases breathlessness
Improves QOL
88
How often is pulmonary rehab
3 sessions/week for 6 weeks
89
When is a patient w/ COPD started on aminophylline?
If still symptomatic after triple therapy
90
Who gets LTOT in COPD>
If SPO2 <92% OA
FEV1 <30%
Cyanosis
Cor pulmonale
91
Cause of acute exaccerbation COPD (2)
Virus
Bacteria
Pollutants
92
If a patient is having acute COPD exaccerbations frequently, what changes need to be made to their current Mx
++ rescue meds (azithromycin)
93
When to admit someone w/ acute exacc COPD (7)
```
Severe breathlessness
Rapid Sx onset
Acute confusion
Cyanosis
Low O2 sats
worsenning peripheral oedema
```
94
Outpt Mx acute exacc COPD (5)
```
Incr SABA + spacer
30mg prednisolone 7-14 days
PO ABx if purulent sputum/signs pneumonia
Safety net
Follow up 6w
```
