Respiratory Diseases Flashcards
(39 cards)
ASTHMATIC PATIENT PROFILE
- Possibly a smoker but not necessarily
- Young < 35 years old
- Dry cough
- Variable breathlessness
- Night-time waking with breathlessness and/or wheeze - common
- Significant diurnal or day-to-day variability of symptoms - common
COPD PATIENT PROFILE
Smoker or ex-smoker 35+ years old Chronic Productive cough Persistent and progressive breathlessness Wheeze uncommon Symptoms constant
COPD characterised by:
COPD characterised by airflow obstruction, which is typically:
- Progressive
- Not fully reversible
- Does not change markedly over several months
Asthma =
= Chronic Inflammatory disorder of the airways.
In susceptible individuals, inflammatory symptoms usually associated with:
- Widespread but variable airflow obstruction
- Increase in airway response to a variety of stimuli
Obstruction is often reversible, either spontaneously or with treatment
Asthma characterised by:
Asthma = a chronic condition characterised by
- Chronic inflammation of the bronchi with oedema and increased mucus secretion
- Bronchial hyper-responsiveness leading to sudden, but reversible luminal narrowing and airway obstruction during an asthma attack.
Asthma symptoms:
- *Wheeze
- Shortness of breath
- Cough
- Chest tightness
Symptoms are:
- Variable
- Intermittent
- Worse at night
- Provoked by triggers including exercise.
NB: Wheeze = cardinal sign of asthma Typically: o Diffuse o Polyphonic o Bilateral o Particularly expiratory
Asthma triggers:
o Exercise
o Viral infections
o Iatrogenic - NSAIDs, Beta-blockers
o Occupational - common 9-15% of adult onset asthma.
Many triggers recognised - Isocyanates (paints), flour & grain dust, animals, colophony (pine resin) & fluxes (for soldering), latex, aldehydes & wood dust.
-> Affects:
Painters, chemical workers, bakers, forestry workers, electricians, welders, nurses, cleaners…
o Environmental - Dust, Pollens, Animal fur or feathers, Smoke e.g. tobacco…
Differential Diagnoses for some Asthma symptoms:
- Infections
- Pulmonary thrombo-embolic disease - Pulmonary embolus
- Restrictive lung disease
Asthma Drugs:
'Relievers' = Bronchodilators: - B2-agonist drugs - Anti-muscarinic drugs - Theophylline
'Controllers/Preventers' = Anti-inflammatory - Corticosteroids - Leukotriene-receptor agonists - Theophylline - Cromoglycates
Inhaled drugs 3 Methods of delivery:
- Metered Dose Inhaler (MDI) / MDI + spacer
- Dry powder devices
- Nebuliser
Types of Metered Dose Inhaler
Blue = Short-acting B2-agonist
Brown or Orange = Corticosteroid
Green = Long-acting B2-agonist or Iptratropium
Purple = Seretide (combination preparation)
Alpha-1 Antitrypsin Deficiency
Recessive pattern of inheritance - mutant alleles commonly carried in the population
Disease manifestations and severity depend on the underlying genetic mutation, but may include:
- Lung disease - COPD
- Liver disease - Cirrhosis
COPD Symptoms
COPD should be considered in pts >35 years old who have a risk factor (generally smoking); and who present with:
- Exertional breathlessness
- Chronic cough
- Regular sputum production
- Frequent winter bronchitis
- Wheeze
Pts with COPD may also experience
- Ankle oedema
- Cachexia (weakness and wasting of the body due to severe chronic illness)
- Depression and anxiety
Airflow obstruction should be confirmed by spirometry
Mild: FEV1 50-80%
Moderate: FEV1 30-49%
Severe: FEV1 <30%
COPD Management Aims
- Limit complications (secondary prevention)
- Remove factors driving disease progression - stop smoking
- Should be offered - pneumococcal vaccination & annual influenza vaccination - Control symptoms - no cure
COPD Drugs
Inhaled Bronchodilators:
**Anti-cholinergic bronchodilators (e.g. Atrovent) = first line drugs
(= Anti-muscarinic bronchodilator)
Combination Bronchodilators
- Combivent (MDI or nebuliser) - Ipratropium & salbutamol
- Duovent (nebuliser) - Ipratropium & fenoterol
COPD Management of Symptoms
- Inhaled bronchodilators: **Anti-cholinergic bronchodilators (e.g. Atrovent) = first line drugs
- Pulmonary Rehabilitation
- Mucolytics
- Ambulatory Oxygen Therapy
- Long-term Oxygen Therapy
- Non-invasive Ventilation
- Surgery
COPD Exacerbation Triggers
Infections e.g. Rhinoviruses (common cold), Influenza…
Common Pollutants " Nitrogen dioxide " Particulates " Sulphur dioxide " Ozone
** Cause of the exacerbation may be unidentifiable in up to 30% of exacerbations
COPD Exacerbation characterised by:
- Sustained worsening of the pt’s symptoms from his/her usual stable state that is beyond normal day-day variations
- Acute onset
Commonly reported symptoms: - Worsening breathlessness
- Cough
- Increased sputum production
- Change in sputum colour
Signs of a Severe COPD Exacerbation Include:
- **Marked dyspnoea
- **Tachypnoea
- **Purse lip breathing
- **Use of accessory muscles (sternomastoid and abdominal) at rest
- Acute confusion
- New onset cyanosis - bluish cast to skin and mucous membranes
- New onset peripheral oedema
- Marked reduction in activities of daily living
COPD Exacerbation Management
Escalation of management for stable COPD e.g.:
- ↑doses of bronchodilators
- Nebuliser rather than space
Short (e.g. 2 week) course of systemic corticosteroids (prednisolone) - Osteoporosis cover if steroids taken repeatedly
Antibiotics if indicated
Corticosteroids Risks
Inhaled
–> pts should rinse mouth with water after use to reduce chance of oral candidiasis
Good denture hygiene required
Systemic
–> increased risk of oral candidiasis
Morbidity associated with systemic steroids
‘Steroid cover’
Acute URT Infections
- Acute nasopharyngitis [common cold]
- Acute sinusitis
- Acute pharyngitis - including: Streptococcal sore throat
- Acute tonsillitis
- Acute laryngitis and tracheitis
- Acute obstructive laryngitis [‘croup’ - usually caused by a virus. Infection -> swelling inside the trachea, which interferes with normal breathing and produces the classic symptoms of “barking” cough, stridor, and a hoarse voice] & epiglottitis
Streptococcal Sore Throat
o Caused by: Streptococcus pyogenes = Group A beta-haemolytic streptococci (GABS) = part of the commensal oropharyngeal flora in some in health - do not always cause disease
o Common symptoms include: fever, sore throat, red tonsils, and enlarged lymph nodes in the neck
o Spread by close contact
o Mostly in children
o Symptoms last for approx.. 7 days in healthy people if left untreated
o Treatment typically includes Penicillin
Common Cold
- Caused by a range of viruses: Rhinoviruses - most Adenovirus Coronavirus Parainfluenza virus
- Viruses replicate at temperatures slightly lower than usual body temperature -> Start in upper airways - slightly cooler
- In otherwise healthy people no significant consequences
- In pt with underlying respiratory disease these viruses can precipitate significant acute exacerbations
