16 - asthma and COPD

Question 1

Hx risks for severe asthma

Answer 1

• poor control
• previsous admissions
• need for mech vent.
• multiple ER visits
• hypercapnic attacks
• poor med compliance
• relaince on bronchodilators
• Hx of need for oral steroids

Question 2

4 investigations

Answer 2

1. peak flow meter
2. CXR
3. ECG cardiac workup
4. ABG if deteriorating

Question 3

4 classes of asthma

Answer 3

1. mild
   - exertional
   - B2 with good response
2. moderate
   - Dyspnea at rest, cough, congestions, nocturnal Sx
   O2 >95
3. severe
   - labored resp.
   - tach cardy
   - agitated
   - no B2 releif
   - o2 90-95
4. pot. fatal
   - flailing HR
   - exhausted confused
   - O2

Question 4

**6 main Tx for acute asthma

Answer 4

1. O2
2. salbutamol
   - MDI is fine
3. ipatromium (atrovent)
4. steroids
   - systemic for mod. or severe
5. Mg
6. assissted vent.

Question 5

drugs without benefit

Answer 5

1. Abx
2. helium
3. aminophylline

Question 6

what is best predictor for dispo

Answer 6

response to Tx, not intial Sx

Question 7

when to DC

Answer 7

FEV1>60 - okay
FEV1 40-60 - possible
FEV1

Question 8

PT at risk for relapse

Answer 8

• previous near death episode
• frequent ED visits
• frequent hosp
• flash attacks
• steroid dependence

Question 9

what are 3 Sx that increase in COPD attack

Answer 9

1. dyspnea
2. cough freq/severity
3. sputum volume/purulence

Question 10

tests for COPD

Answer 10

• CXR
• ECG
• ABG
• CBC
• routine biochem

Question 11

6 main Tx for COPD

Answer 11

1. O2
   - sat of 88-92
   - venturi mask
2. bronchodilators
   - salbutamol
   - MDI fine
3. steroids
   - oral fine
   - no good evidence for inhaled
4. ABx
   - if have all 3 cardinal Sx
   - 2nd gen macrolide (azithro) or ceph,
5. ventilate
   - non-invasive PPV
6. intubation
   - if unable to tolerate NIPPV