Week 2 resp(most important parts) Flashcards
(77 cards)
1
Q
What is COPD a combination of?
A
Chronic bronchitis and emphysema
2
Q
What is FEV1
A
Forced expiratory volume in 1 min
3
Q
What is a moderate fall in the PEFR
A
50-80% of best
4
Q
What is a marked fall in the PEFR
A
<50% of best
5
Q
In Obstructive lung disease, what is reduced?
A
FEV1 <70%, FVC MAY be reduced
6
Q
Is bronchial asthma considered to be reversible?
A
Yes
7
Q
What may smoking exacerbate
A
Alpha-1-antiprotease deficiency
8
Q
What lung disease develops naturally over time?
A
Emphysema, (men>women, developing countries>developed)
9
Q
What is the clinical definition of chronic bronchitis?
A
Cough productive of sputum in at least 3 consecutive months for 2 or more consecutive years
10
Q
When does chronic bronchitis become complicated?
A
When FEV1 falls or sputum becomes infected
11
Q
Describe the morphological changes in the large ariways in chronic bronchitis
A
- Mucous gland hyperplasia
- Goblet cell hyperplasia
12
Q
Describe the morphological changes in the small airways in chronic bronchitis
A
- Goblet cells appear
- Inflammation and fibrosis in long standing disease
13
Q
What is the pathological definition of emphysema
A
Increase beyond the normal in the size of airspaces distal to the terminal bronchiole arising from either dilatation or from destruction of their walls and without obvious fibrosis
14
Q
What is an acinus?
A
Everything distal to terminal bronchiole
15
Q
What is a terminal bronchiole?
A
Last conducting airway that is completely lined by resp endothelium
16
Q
What is the most common pattern of emphysema
A
Centri-acinar
17
Q
What pattern of obstructive lung disease is commonly seen in smokers?
A
Periacinar and scar emphysema
18
Q
Describe how smoking causes emphysema
A
- Decreases anti-elastase
- Increases elastase
- Decreases repair mechanism for elastin synthesis
- Increases neutrophils and macrophages (just add to the elastase)
All come together to bring upon more elastase tissue destruction and cause emphysema
19
Q
Define asthma (Generally)
A
Increased responsiveness of trachea and bronchi to various stimuli by widespread narrowing of airways
20
Q
Describe the prevelance of asthma in children and adults with respect to gender
A
Children: 10-15%, M>F
Adults:5-10%, F>M
21
Q
Are you more likely to have asthma if your mother or your father has asthma?
A
Mother
22
Q
What are the symptoms of asthma?
A
- Wheeze
- Cough
- Dry sputum
- Chest tightness
23
Q
What are the typical asthma triggers?
A
Exercise, cold air, smoke, perfume, URTIs, pets, trees, grass, pollen, food, aspiriation
24
Q
What are the 3 types of variation seen in asthma?
A
- Daily
- Weekly
- Annualy
25
What are 2 factors which must be confirmed to diagnose asthma?
Airflow obstruction variability and reversibility
26
What are the diet risk factors for asthma?
- Decrease in anti-oxidants and N-3 polyunsaturated fatty acids
- Increase in N-6 polyunsatured FA
- Too much or too little Vit D
27
What signs may indicate a differential diagnosis?
- Cervical lymphadenopathy
- Stridor
- Assymetrical expansion
- Dull percussion note
- Crepitations
28
Describe the FEV1, FVC and FEV1/FVC in asthma
FEV1 <80%, FVC normal, FEV1/FVC <70%
29
What does FEV1 tell us about?
Airway diameter
30
What does FVC tell us about?
Lung capacity
31
What must be done after conformation of variability and reversibility
- Full pulmonary function tests
| - Conformation with B2 agonists and steroids
32
What do full pul function tests excludes?
COPD and emphysema
33
Describe the residual volume and total lung capacity in asthmatic patients
Residual volume and total lung capacity both increased
| RV/TLC > 30%
34
What is the effect of methacholine on the airways
Constricts
35
If bronchial provocation test is undertaken is more or less NO exhaled in asthma?
More NO exhaled than normal in asthmatics
36
What symptom must be had for a diagnosis of asthma?
A wheeze
37
Describe moderate acute asthma with reference to:
- HR
- RR
- PEF
- Oxygen Sat
- PaO2
- ability to speak
```
HR<110
RR<25
PEF: 50-70%
SaO2 > 91%
PaO2 > 8kPa
```
38
Describe severe acute asthma with reference to:
- HR
- RR
- PEF
- Oxygen Sat
- PaO2
- ability to speak
```
HR>110
RR>25
PEF: 33-50% of best/predicted
SaO2>92%
PaO2>8kPa
Inability to complete sentences in one breath
```
39
What are the symptoms/signs which make an acute asthma attack life threatening?
- Grunting
- Impaired conciousness/confusion
- Bradycardia/arrhythmia/hypotension
- PEF <33%
- Cyanosis
- Silent chest
- SaO2 <92%
- PaO2 <8kPa
- Normal or raised PaCO2 levels
40
What are the goals of treatment for the management of asthma in children?
- Limited need for reliver medication
- No attacks
- Minimal symptoms
- No limitation of physical activity
41
Describe how to assess a child's control of their asthma symptoms?
SANE
- Short acting beta agonist (how much is it used)
- Absence from school/nursery
- Nocturnal symptoms
- Exceptional symptoms
42
What is the 1st step of asthma treatment of a child?
Very low ICS or LTRA for <5 y/o
43
What is the 2nd step of asthma treatment of a child?
Very low ICS AND Inhaled LABA or LTRA if <5 y/o
44
What is the 3rd step of asthma treatment of a child
- If no response to LABA - stop and increase ICS dose dose to low dose
- if benefit from LABA but ocntrol is still inadequate - continue LABA and increase ICS dose to low. Can also keep ICS dose the same and consider trail of other therapy (LTRA)
45
What is the 4th step of asthma treatment of a child
consider trails of:
- Increasing ICS to medium dose
- Addition of 4th drug (SR therophylline)
46
What is the 5th step of the asthma treatment of a child?
Continuous or frequent use of oral steroids:
- Use daily steroid tablet in the lowest dose providing adequate control
- Maintain medium dose ICS
- Consider other treatments to minimise ICS
47
With reference to B2 agonists, what would be considered 'poorly controlled'
If used more than 2 days a week
48
What is an MDI?
Metered dose inhaler - co-ordinate taking a breath at the same time of administering medication
49
What are the types of administration for asthma medication?
MDI, DPI
50
What is salbutamol and how can it be administered?
Short acting beta agonist. MDI and DPI
51
What is terbutaline and how can it be administered?
SABA, DPI only
52
What would the treatment plan of mild to moderate acute asthma attack be?
```
Increased inhaler use
Oral steroids
Treat the trigger
Early follow up
Back up plan
```
53
What would the treatment plan of a moderate to severe asthma attack be?
Nebuliser - Salbutamol or terbutaline
Oral or IV steroid
Mg
Aminophylline
54
Define COPD
A lung disease characterised by chronic obstruction of lung airflow that interferes with normal breathing and is NOT fully reversible
55
Describe the relationship between smokers and COPD
- Have more respiratory symptoms and lung function abnormalities
- Greater rate of decline in FEV1
- Greater COPD rate than non-smokers
- <50% of smokers develop COPD in their lifetime
- After 25 years of smoking at least 25% of smokers will have clinically significant COPD (Stage 2 or worse)
56
What are the common symptoms of COPD?
```
Cough
Breathlessness
Sputum production
Frequent chest infections
Wheeze
```
57
What are uncommon symptoms of COPD?
Weight loss
COPD
Swollen ankles
58
Describe the MMRC dyspnoea scale
0 - breathless with strenuous exercise
1 - breathless when hurrying on level ground or up slight hill
2 - On level ground i have to walk slower than people my own age or have to stop for a breath when walking at my own pace
3 - I stop for breath after walking approx 100yards/a few mins on level ground
4 - I am too breathless to leave the house/I am breathless when dressing
59
Describe the Investigations/diagnosis of COPD
```
No single diagnostic test, rather a combo of symptoms, history and spirometry
Diagnose if meet the following criteria
- >35 y/o
- Presence of risk factors
- Absence of clinical features of asthma
```
60
Describe the spirometry of a patient with COPD
- Diagnosed airflow obstruction
- FEV1/FVC <70% post bronchodilator
- Lack of reversibility
61
Describe Stage 1 COPD
FEV1 of 80% best/predicted
62
Describe Stage 2 COPD (Moderate)
FEV1 between 50-79% of best/predicted
63
Describe Stage 3 COPD (Severe)
FEV1 between 30-49% of best/predicted
64
Describe Stage 4 COPD (Very severe)
FEV1 between <30% of predicted/best
65
What condition can arise as a severe exacerbation of COPD?
Cor Pulmonale
66
Describe Cor pulmonale
= Right sided HF due to Lung disease
Comes about because of smoking and hypoxia affecting pulmonary vessels:
- Causes vasoconstriction which shunts blood flow to healthy alveoli in the lungs
- However over time lung causes back pressure to occur in the pul arteries
- Chemical from smoking can also cause vasculature causing hf as increased muscle density on right side of heart and increased pressure on the left side of the heart including JVP
67
Compare the following factors in relation to how often the occur in COPD
- Smoker or ex smoker
- Symptoms under 35 y/o
- Chronic productive cough
- Breathlessness
- Night time waking with breathlessness/wheeze
- Variability of symptoms
Smoker or ex smoker: Nearly all
- Symptoms under 35 y/o: rare
- Chronic productive cough: Common
- Breathlessness: Often persistent and progressive
- Night time waking with breathlessness/wheeze: Uncommon
- Variability of symptoms: Uncommon
68
Compare the following factors in relation to how often the occur in Asthmatics
- Smoker or ex smoker
- Symptoms under 35 y/o
- Chronic productive cough
- Breathlessness
- Night time waking with breathlessness/wheeze
- Variability of symptoms
- Smoker or ex smoker: Possibly
- Symptoms under 35 y/o: Often
- Chronic productive cough: Uncommon
- Breathlessness: Variable
- Night time waking with breathlessness/wheeze: Common
- Variability of symptoms: Common
69
Is COPD more prevelant in men or women?
Women
70
Describe the non pharmacological management options for COPD?
- smoking cessation
- Vaccination (annual flu, pneumoccoal vaccine)
- Pulmonary rehabilitation
- Nutritional assessment
- Psychological assessment
71
Describe the 3 types of inhaled therapy possible for COPD?
Short acting bronchodilators
Long acting bronchodilators
High Dose ICS
72
Describe the use of short acting bronchodilators in COPD
SABA - salbutamol
| SAMA - iprotropium
73
Describe the use of long acting bronchodilators in COPD
LAMA - umeclidinium, totropium etc
| LABA - Salmeterol
74
Describe the use of high does ICS in COPD
Relvar (fluticasone/vilanterol)
| Fostair MDI
75
What are the requirements for long term oxygen therapy in COPD?
- Need to be hypoxic
| - Need to have quit smoking for 6 months
76
Describe the primary care management for emergency COPD?
```
Short acting bronchodilators
- Slbutamor or ipratropium
- Nebulisers if cannot use inhalers
Steroids
- Prednisolone 40mg per day fo 5-7 days
Abx
- Most exacerbations are secondary to viral infection
- If there is evidence of infection (fever, increase in volume/purulence of sputum)
Consider hospital admission if showing:
- Tachypnoea
- Low oxygen sat
- Hypotension
```
77
What are the treatment guidelines for COPD
1st - SABA
2nd - SABA + LAMA
3rd - SBA + LAMA/LABA combo
