Respiratory illness

Question 1

General asthma features and overview

Answer 1

-It’s a long-term inflammatory disease of the airways of the lungs
-There are two types; allergic (dust, mites, ect) and non-allergic (cold air, exercise, smoking)

Question 2

What are the causes and prevalence of general asthma?

Answer 2

• Arises at any age, but usually in childhood
• Genetic disposition, exposure to allergens
  -12% of the population
• More common in children
• 4 deaths a day due to it
• There are some medications some asthma patients cannot have. NSEDs eg ibuprofen

Question 3

what are the trends of allergic asthma?

Answer 3

• Normally begins in childhood
• often responds well to treatment
• may improve with age but may re-occur
• sometimes termed ‘childhood asthma’

Question 4

What are the trends of non-allergic asthma?

Answer 4

-tends to be more chronic and severe
-more common in adults
-often controlled with steroids

Question 5

What is the pathophysiology of an asthma attack?

Answer 5

• An exposure triggers the narrowing and obstruction of the bronchi
• muscle layer constricts (bronchospasm) as a defence mechanism against the pathogen being breathed in further. The pathogen gets trapped in the mucus.
• Antibodies attach to mast cells causing sensitisation and then degranulation, where histamine is released, which triggers an inflammatory response
  -histamine also increases vasodilation and permeability, causing swelling but also allowing more white blood cells into tissue
• increased permeability leads to more mucus in the airway
• mucosal cells also become inflamed

Question 6

What are the symptoms of an asthma attack?

Answer 6

• expiratory wheeze
• breathlessness (dyspnoeic)
• a tight chest
• coughing. Can be productive or on-productive
• Easier to breathe air in than out

Exacerbated symptoms:
-Unable to speak/unable to speak between breaths
- tachypnoeic
- tachycardia
- drowsiness/confusion /exhaustion/dizziness
- syncope (feinting)

Question 7

What is the presentation of asthma?

Answer 7

-sitting in the tripod position
-intercostal recession where the skin looks sucked in between ribs. More common in children as it is one of their only mechanisms. Can continue to tracheal recession

Question 8

How to assess an asthmatic patient?

Answer 8

-calm and reassuring manner as they may be panicking
-ABC approach
- Full set of obs, resp rate over a minute if possible. Peak flow pre and post treatment
-auscultate chest
-calm and coach breathing if necessary
- care for patients in a sitting position

Question 9

What are the peak flow reading percentages for asthma severity?

Answer 9

50-75% is moderate
33-50% is acute severe
<33% is life threatening

Question 9

What are the peak flow reading percentages for asthma severity?

Answer 9

50-75% is moderate
33-50% is acute severe
<33% is life threatening

Question 9

What are the peak flow reading percentages for asthma severity?

Answer 9

50-75% is moderate
33-50% is acute severe
<33% is life threatening

Question 10

What is the treatment for asthma?

Answer 10

-If able, use own inhaler, up to 10 puffs. use spacer
- oxygen if necessary, nebuliser on 6-8L for 10 minutes
-salbutamol. No limit, but if not working, use something else. It works by relaxing the muscle
-Ipratropium bromide (atrovent) one-off dose. Calms down mucus layer. Might cause a cough. Is slower acting
-Hydrocortisone, works on inflammatory response
-Adrenaline 1:1000 for life threatening patients. Its intramuscular and reduces bronchospasm. Very fast-acting

Question 11

What is the definition of anaphylaxis?

Answer 11

A severe, life threatening, systemic, hypersensitivity reaction.

Question 12

What are the signs and symptoms of anaphylaxis?

Answer 12

• shortness of breath, wheezes/stridor, hoarseness, pain on swallowing, coughing
  -light-headedness, loss of consciousness, confusion, headache, anxiety
  -swelling of the conjunctiva, runny nose, swelling of lips, tongue, throat
  -fast or slow heart rate, low blood pressure
  -hives, itching, flushing,
  -pelvic pain, crampy abdo, diarrhoea, vomiting, loss of bladder control

Question 13

What are the causes of of anaphylaxis?

Answer 13

-bronchoconstriction
-increased bronchial mucus secretion
-increased vascular permeability
-vasodilation
-same mechanisms as in asthma, but asthma only occurs in airways, this is entire body

Question 14

What is the treatment for anaphylaxis?

Answer 14

-ABCDE approach
-Early request for backup, or just move
-treat life threatening problems
-assess effects of treatment
-remove trigger
-oxygen
-Adrenaline 1:1000
-sodium chloride
-be aware of potential secondary reaction as drugs wear off

Question 15

What is the definition of chronic obstructive pulmonary disease (COPD)?

Answer 15

Lung disease with chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible. The two main types are chronic bronchitis and emphysema.

Question 16

What are the causes of copd? What is the prevalence in the population?

Answer 16

-Long-term exposure to harmful gases and particles
-smoking
-harmful chemicals/working environments
-can be predisposed due to other medical conditions

-5th leading cause of death
-2nd most common lung disease in the UK

Question 17

What is the definition of chronic bronchitis?

Answer 17

A persistent cough for over 3 months a year, for 2 consecutive years. A type of progressive inflammatory disease. As it gets worse, it falls under copd.

Question 18

What is the pathophysiology of chronic bronchitis?

Answer 18

-Nasties build up in the mucus, causing a cough, but the cough is too frequent for the body to cope with.
-mucus produces more mucus for protection, worsening cough
-the number of mucus producing cells in the airway increase; even more coughing
-the mucus can clog smaller airways, shutting them off
-as airways swell, cilia get damaged and less effective
-this all causes shortness of breath

Question 19

What is the definition of emphysema?

Answer 19

-a long-term disease causing shortness of breath due to alveolar destruction

Question 20

What is the pathophysiology of emphysema?

Answer 20

-nasties irritate the lining of the alveoli. This draws white blood cells to the area.
-neutrophil white blood cells produce elastase which breaks down the elastin in the alveoli walls
-due to the destruction of the elastin, the alveoli no longer hold shape after expiration, and become floppy. They become prone to collapsing, and its much harder to get air out without the elasticity.

Question 21

What are the signs and symptoms of copd?

Answer 21

-easily fatigued
-frequent respiratory infections
-use of accessory muscles to breathe
-orthopnea (difficulty breathing lying down due to fluid in the lungs)
-thin in appearance, barrel chested, digital clubbing
-wheezing, chronic cough, prolonged expiratory time, pursed-lip breathing
-bronchitis, increased sputum

Question 22

How may emphysema patients present/be characterised?

Answer 22

-older and thin, severe dyspnoea, quiet chest, hyperinflation with flattened diaphragm on x ray

Question 23

How may chronic bronchitis patient present/ be characterised?

Answer 23

-overweight and cyanotic, elevated haemoglobin, peripheral oedema,
-wheezing and rhonchi (rumbling, snoring sound caused by secretions in large airways)

Question 24

What is barrel chest and how does it happen?

Answer 24

-When the lungs become hyper-inflated with air. This keeps the ribcage open for a long time causing physiological changes, e.g. ribs become more horizontal
-more common with emphysema as lungs are permanently partially inflated. Intercostal muscles never completely relax.

Question 25

What is the treatment of copd exacerbations?

Answer 25

-salbutamol, especially for a wheeze
-ipratropium bromide
-nebulisation, but limited to 6 minutes due to co2 retention
-oxygen (88-92% target)
-hydrocortisone
-monitor capnography

Question 26

What are type 1 and 2 respiratory failures?

Answer 26

Type 1 is due to a lack of oxygen.
Type 2 is due to too much co2