Asthma and COPD Flashcards
How is asthma diagnosed in a primary care setting?
- Obstructive spirometry, FEV1:FVC <70%
- Reversible symptoms with a bronchodilator
- Reduced PEFR
- Exhaled nitric oxide test
- Sx - cough, wheeze, chest tightness, SOB,
What is a FENO?
- Measures nitric oxide levels in exhaled breath = will be increased in active airways inflam
- Levels affected by smoking and inhaled corticosteroids and not always raised in people with asthma
RF of asthma
- FH of asthma
- Hx/FH of atopy - hayfever, asthma, eczema
- Allergens eg. worse in cold weather, exercise, pets, smoking, occupational exposure
- Resp infections in infancy
- Premature birth/low birth weight
- Obesity
- Social deprivation
What is the pharmacological management of asthma?
Stepwise:
- SABA - salbutamol reliever inhaler
- Low dose ICS, x2 daily
- Low dose ICS + LABA or +LTRA eg. montelukast or LAMA eg. tiotropium or theophylline
- Med dose ICS + LABA
- High dose ICS + LABA + oral corticosteroid
- Severe uncontrolled asthma - omalizumab
What is the non pharmacological management of asthma?
- Routine vaccinations
- Self education and personalised asthma action plan
- Avoiding triggers
- Weight loss and smoking cessation
- Assess for anxiety and depression
- ## Give a peak flow meter and teach how to monitor
How do you treat asthma exacerbations if patient needs admission but you’re waiting for transfer?
- Determine the severity of exacerbation
- Supplementary O2 for 94-98% sats
- NEB salbutamol, repeat every 15 mins
- Then consider NEB ipratropium
- Quadruple dose ICS/IM prednisolone/IV hydrocortisone
When does a pt need to be admitted to hospital w exacerbation of asthma?
- Pt w features of life threatening asthma
- Severe asthma attack persisting after bronchodilators
- Pt who have had a previous near fatal asthma attack
- <18 yo
- Recent hospital admission
- Pregnancy
How do you treat an asthma exacerbation that doesn’t require hospital admission?
- SABA via large vol spacer
- Quadruple ICS and for up to 14 days, might not help pt who are highly adherent
- Short course oral pred if increased ICS wont help
- Need a follow up w/i 48 hours of presentation
What are the RF of COPD?
- Smoking
- Occupational exposure - fumes and chemicals
- Environmental exposure - air pollution, second hand smoke, dust
- a1 deficiency (causes emphysema)
- History of childhood resp infection
How is COPD diagnosed in a primary care setting?
Suspect COPD in pt >35 w RF and one or more sx:
- SOB - wake at night, reduced exercise tolerance, do MRC dyspnoea score
- Chronic/recurrent cough
- Sputum production
- Freq LRTI
- Wheeze
- Ankle swelling
Will need IX - CXR, FBC, spirometry
Maybe will need - sputum culture, PEFR measures, ECG, echo, CT
Pharmacological management of COPD
- SABA/SAMA for breathlessness
- LABA + LAMA if no asthmatic features
- LABA + ICS if they have asthmatic features
- Oral theophylline after trial of short andlong acting bronchodilators
- Oral mucolytics
- Oral prophylactic abx but need speciality input
Non pharmacological management of COPD
- SMOKING CESSATION
- Pt info, British Lung Foundation, NHS website
- Pneumococcal and flu jabs
- Personalised self management plan
- Optimise treatment for comorbidities
How do you treat exacerbations of COPD in pt who doesn’t need admission?
- Increase doses/freq of SABA
- Oral prednisolone for 5 days
- Abx if sputum purulence or thickness
When is hospital admission appropriate for COPD exacerbations?
- Severe breathlessness
- Rapid onset or deterioration
- Impaired consciouness
- Cyanosis
- <90% sats
- Worsening peripheral oedema
- New arrythmia
- Failure of response to treatment
- Safety net
What are the palliative approaches in end stage COPD?
- Advance care plan
- May need opiates and oxygen, need to discuss w a specialist and consider admission to a hospice is sx aren’t controlled or this is the preferred place of death
- DNR form ?
