asthma and COPD Flashcards
what are the signs and symptoms of asthma?
Symptoms: Intermittent dyspnea, wheeze, nocturnal cough, sputum
Signs: tachypnea, audible wheeze, hyperinflated chest
Q
If a patient presents with asthmatic like symptoms, what are some questions you need to ask in the history?
- Triggers: e.g cold air, exercise, pets, smoking, NSAIDs
- Diurnal variation: worse at night?
- Exercise tolerance
- Disturbed sleep?
- Other atopic diseases?
- Job?
- Days per week off school or work?
what does PEF depend on?
Age
Gender
Height
What investigations should you do if a patient is having an acute episode of asthma?
- PEF
Sputum culture and ?Blood culture
FBV, U+Es, CRP
- ABG
CXR to exclude infection or pneumonthorax
What factor means a patient with asthma will be responsive to steroids?
Eosinophillia
What is the general management of asthma in a primary care setting?
Avoid triggers
Stop smoking
PEF monitoring
Self management plan for emergencies
BTS pharmacological management
Treat correct inhaler technique
What is the pharmocological management of asthma using the BTS guidelines?
Start at step most appropriate to severity, moving up or down. Can move down after >3months of control
1st: SABA reliever when needed
2nd: Add low dose ICS
3rd: Add LABA with the ICS or LTRA or oral theophylline
4th: Increase ICS
5th: Add regular oral prednisolone with specialist input
How does aminophylline help asthmatics and what are some side effects of this?
Metabolised to theophylline. Inhibits phosphodiesterase so decreases bronchoconstriction.
Used as prophylaxis at night
SE: arrhythmias, GI upsets, seizures
Monitoring: theophylline levels, ECG monitoring
what is COPD?
Progressive airflow obstruction that is not reversible
Chronic bronchitis + Emphysema
Causes: smoking, alpha antitrypsin deficiency, industrial exposure e.g soot
What is the pathophysiology of COPD?
Mucous gland hyperplasia
Loss of cilia function
Emphysema
Chronic inflammation and fibrosis of small airways
What is the definiton of chronic bronchitis and emphysema?
Chronic Bronchitis: Cough and sputum production on most days for 3 months in 2 successive years
Emphysema: Enlarged air spaces with destruction of alveolar walls and loss of elasticity. Visualised on CT and diagnosed histologically
what are some consequence of COPD?
Pneumothorax due to ruptured bullae
Polycythemia
Acute exacerbations
Cor pulmonale
Lung carcinoma
What COPD patients are offered lung volume reduction surgery?
Pneumothorax due to ruptured bullae
Polycythemia
Acute exacerbations
Cor pulmonale
Lung carcinoma
How is a COPD exacerbation managed?
Salbutamol and Iptratropium Bromide NEB
Controlled oxygen therapy
PO prednisolone
Abx if evidence of infection
IV aminophylline if nebulisers didn’t work
Consider physiotherapy and NIPPV
