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Respiratory > Asthma and COPD > Flashcards

Asthma and COPD Flashcards

1
Q

What is asthma?

A

Chronic, obstructive, reversible inflammatory condition that causes bronchoconstriction

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2
Q

Typical triggers of asthma (7)

A 
Infection
Night time or early morning
Exercise
Animals
Cold/damp
Dust
Strong emotions
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3
Q

Typical presentation of chronic asthma (6)

A 
Episodic symptoms
Diurnal variability - worse at night
Dry cough with wheeze and sob
History of atopic conditions - eczema, hayfever and food allergies
Family history

Bilateral widespread “polyphonic” wheeze heard by a healthcare professional

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4
Q

Guidelines on diagnosis of asthma (BTS)

A

High probability: Try treatment

Intermediate probability: Perform spirometry with reversibility testing

Low probability: Consider referral and investigating for other causes

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5
Q

(NICE) First Line investigations forastma

A

Fractional exhaled nitric oxide

Spirometry with bronchodilator reversibility

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6
Q

Follow up investigations in asthma if first line uncertain

A

Peak flow variability - several times a day, 2-4 weeks

Direct bronchial challenge test with histamine or methacholine

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7
Q

Long Term Management of Astma

A 
SABA (also reliever in acute exacerbations)
ICS (Beclometasone) maintaner/preventer
LABA (Salmeterol)
LTRA (montelukast) 
MART
Increase doses or LAMA
Refer to specialist
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8
Q

Additional management of chronic asthma

A

Individual self-management programme for each patient
Yearly flu jab
Yearly asthma review
Advise exercise and avoid smoking

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9
Q

Presentation of acute asthma (5)

A

Progressively worsening sob
Use of accessory muscles
Tachypnoea
Symmetrical expiratory wheeze on auscultation
Chest can sound “tight” on auscultation with reduced air entry

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10
Q

Moderate grade acute asthma

A

PEFR 50-75% predicted

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11
Q

Severe grade acute asthma

A

PEFR 33-50% predicted
Resp rate >25
Heart rate >110
Unable to complete sentences

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12
Q

Life-threatening acute asthma

A 
PEFR <33%
Sats <92%
Becoming tired
No wheeze. This occurs when the airways are so tight that there is no air entry at all - “silent chest”
Haemodynamic instability (i.e. shock)
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13
Q

Treatment for acute exacerbation of asthma

A

Salbutamol nebs (as often as required)
Ipratropium bromide
IV hydrocortisone (5 days)
ABx if infection

O2
Aminophylline infusion
Consider IV salbutamol

Magnesium sulphate
HDU/ICU
Intubation

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14
Q

ABG readings in asthma

A

Intially resp alk (tachypnoea causes drop in CO2)
Normal pCO2 or hypoxia indicates tiring
Resp acidosis due to high CO2 is a very bad sign in asthma

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15
Q

Monitoring asthmatic response to treatment

A

Respiratory rate
Oxygen saturations

Respiratory effort
Peak flow
Chest auscultation

(Monitor K+ as salbutamol causes it to be absorbed into cells)

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16
Q

DIscharging after acute attack in asthma

A

Discharge with “asthma action plan”
Consider prescribing a “rescue pack”
Referral to a respiratory specialist after 2 attacks in 12 months

17
Q

Presentation of COPD

A 
Long term smoker with chronic: 
SOB
Cough
Sputum production
Wheeze
Recurrent respiratory infections, particularly in winter
18
Q

Differential diagnosis for COPD

A

Lung cancer
Fibrosis
Heart failure

(COPD does not cause clubbing, haemoptysis or chest pain)

19
Q

What is the dyspnoea scale?

A

5 point scale that NICE recommend for assessing the impact of their breathlessness:

Grade 1 – Breathless on strenuous exercise
Grade 2 – Breathless on walking up hill
Grade 3 – Breathless that slows walking on the flat
Grade 4 – Stop to catch their breath after walking 100 meters on the flat
Grade 5 – Unable to leave the house due to breathlessness

20
Q

How is COPD diagnosed?

A

Clinical presentation + spirometry

21
Q

What will spirometry show in COPD?

A

Obstructive picture

Overall lung capacity is not as bad as ability to quickly blow air out of their lungs

FEV1/FVC <0.7

No dramatic respose to reversibility testing

22
Q

Measuring the severity of COPD

A

Stage 1: FEV1 >80% of predicted
Stage 2: FEV1 50-79% of predicted
Stage 3: FEV1 30-49% of predicted
Stage 4: FEV1 <30% of predicted

23
Q

Investigations in COPD (8)

A

CXR (exclude other pathologies)
FBC (exclude polychythaemia/anaemia)
BMI
Sputum culture
ECG/Echo
CT thorax (explore alternative such as fibrosis, cancer or bronchiectasis)
Serum alpha-1 antitrypsin - deficiency can lead to early onset and more severe disease
Transfer factor for carbon monoxide (TLCO) decreased in COPD

24
Q

Management of chronic COPD

A

Stop smoking
Pneumococcal and flu vaccines

  1. SABA or SAMA
  2. If no asthmatic or steroid responsive features - combined LABA + LAMA

If asthmatic or steroid responsive features - LABA + ICS

LABA + LAMA + ICS

25
Q

Examples of combined LABA + LAMA

A

Anoro Ellipta
Ultibro Breezhaler
DuaKlir Genuair

26
Q

Examples of combined LABA + ICS

A

Fostair
Symbicort
Seretide

27
Q

Examples of combined LABA + ICS + LAMA

A

Trimbo

Trelegy Ellipta

28
Q

Management of chronic COPD in more severe cases (5)

A

Nebulisers (salbutamol and/or ipratropium)
Oral theophylline
Oral mucolytic therapy to break down sputum (e.g. carbocisteine)
Long term prophylactic antibiotics (e.g. azithromycin)
Long term oxygen therapy at home

29
Q

When is Long term oxygen therapy used?

A

Severe COPD causing: chronic hypoxia
polycythaemia
cyanosis
heart failure secondary to pulmonary hypertension (cor pulmonale)

Can’t be used if they smoke as oxygen plus cigarettes is a significant fire hazard

30
Q

Triggers for COPD exacerbation

A

Usually bacterial or viral infection

31
Q

What does raised bicarb indicate on ABG in COPD?

A

Chronic retention of CO2

Kidneys have responded by producing more bicarbonate to balance the acidic CO2 and maintain a normal pH

32
Q

Types of respiratory failure

A

Low pO2 indicates hypoxia and respiratory failure

Normal pCO2 with low pO2 indicates type 1 respiratory failure (only one is affected)

Raised pCO2 with low pO2 indicates type 2 respiratory failure (two are affected)

33
Q

Investigations in COPD exacerbation (6)

A

Chest xray to look for pneumonia or other pathology
ECG to look for arrhythmia or evidence of heart strain (heart failure)
FBC to look for infection (raised white cells)
U&E to check electrolytes which can be affected by infection and medications
Sputum culture if significant infection is present
Blood cultures if septic

34
Q

Medical treatment for exacerbation of COPD at home (3)

A

Prednisolone 30mg once daily for 7-14 days
Regular inhalers or home nebulisers
Antibiotics if there is evidence of infection

35
Q

Medical treatment for exacerbation of COPD at hospital (4)

A

Nebulised bronchodilators (e.g. salbutamol 5mg/4h and ipratropium 500mcg/6h)
Steroids (e.g. 200mg hydrocortisone or 30-40mg oral prednisolone)
Antibiotics if evidence of infection (Amox, clarith[not in long QT], doxy)
Physiotherapy can help clear sputum

36
Q

Treatment options in severe COPD exacerbation that aren’t responding to first line treatment

A

IV aminophylline
Non-invasive ventilation (NIV)
Intubation and ventilation with admission to intensive care
Doxapram can be used as a respiratory stimulant where NIV or intubation is not appropriate

37
Q

What Abx is recommended prophylactically for patients with frequent exacerbations and optimised pharmacological management

A

Azithromycin

Respiratory (12 decks)

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