6 Resp Flashcards
Laba should be added in before increasing ICS above …..
400 micrograms of beclometasone equivalent
Compare asthma and COPD
ASTHMA Variable Dry cough, worse at night Any age More response to ICS COPD Fixed/progressive Chronic productive coughs Mainly older smokers
Complete asthma control is
No daytime symptoms /night time awakening No need for rescue medication No asthma attacks No limitations of activity Normal lung function Minimal side effects
What is normal lung function defined as in terms of the aim of asthma therapy
Fev1 > 80%
Risks of Rx oxygen in COPD
Fire
COPD pt normally have high co2, low O2. In non-COPD patients the drive to breath is high O2 but in COPD there is always high O2 therefore the drive becomes low O2. They will therefore stop breathing with lots of oxygen.
How to administer oxygen in COPD
Venteuri face mask - no more than 28 %
What O2 levels to aim for in COPD
SaO2 of 88-92%,[4] (compared with 94-98% for most acutely ill patients
What mask to deliver oxygen in for asthma
Reservoir - which is about 60%
How does long term oxygen therapy work in COPD?
Tricks the heart in to believing there is lots of oxygen around so works less hard.
For those who are hypoxic at rest.
SMART TRIAL
Poorly controlled asthma at step three or above?
Use just ICS and laba as reliever and preventer. See BNF.
Triple therapy is
COPD - Laba, ICS and lama.
Associated with reduction in admissions and exacerbations and quality of life but not over all mortality
Simple
Stop smoking •Inhaler technique •Monitoring •Pharmacotherapy •Lifestyle •Education
Current and previous smoking reduces effectiveness of …..
ICS
So higher doses may be needed
Two types of resp fail
Type 1 O2 6.5kPa
Normal O2 =11-13 kPa Normal CO2 = 4.7 – 6 kPa
Problem with high levels of co2
Acidosis - usually up you up the resp rate to get rid of co2 but if you can’t up it enough
