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Primary Care HG > Asthma + COPD > Flashcards

Asthma + COPD Flashcards

1
Q

Pathology of asthma

A

Bronchial muscle contraction, triggered by stimuli

Mucosal swelling caused by mast cell and basophil degranulation, releasing inflammatory mediators

Increased mucus production

Hyper-responsiveness of airways Reversible airway obstruction

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2
Q

S+S of asthma

A

Episodic - diurnal variability (worse at night or early morning)

Wheeze

Atopy

SOB

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3
Q

Pathway if pt is likely to have asthma

A

Initiate carefully monitored treatment (6 weeks inhaled corticosteroids)

FEV1 test

If good response to meds, diagnose asthma

If poor response, check technique + adherence + consider alternative diagnosis

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4
Q

Investigations for asthma

A

Spirometry with bronchodilator reversibility (improvement of FEV1 >12% or >200ml increase in volume)

Peak flow + reversibility to diagnose (using 4 puffs of salbutamol inhaler, 15 min pause)

FeNO (fractioned exhaled nitric oxide) - higher level of nitric oxide in exhaled air = asthma

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5
Q

Supported self management for asthma

A

Education on triggers

Smoking cessation

Weight loss

Breathing exercises

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6
Q

What is defined as ‘controlled’ asthma?

A

No daytime symptoms

No night time waking

No need for rescue meds

No asthma attacks

No limitations on activity

Normal lung function

Minimal side effects

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7
Q

Ladder for management in adults

A

Short acting B2 agonist (salbutamol)

+ Low dose ICS (beclametasone/ budesonide) - brown, called Clenil

Add inhaled LABA (salmeterol) - stop if no effect

Increase ICS dose (max 2g a day)

or add: +LTRA (leukotriene receptor antagonist eg Montelukast), SR theophylline, LAMA (tiotropium bromide)

+ daily steroid tablet

+ refer

Don’t give LABA without ICS

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8
Q

What medications can be added in specialist centres for asthma?

A

Omalizumab (anti IgE mAb)

Given by SC injection

Immunosuppressants = methotrexate

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9
Q

RF for developing fatal asthma

A

Previous hosp admission

Requiring >3 medications

Heavy use of B2 agonist

Adverse behavioural features eg non-adherance, mental illness, stress, drug abuse

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10
Q

Adult classification of severe asthma

A

PEF 33-50%

Resp rate >25

HR >110

Inability to complete sentences in one breath

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11
Q

Adult classification of life threatening/ fatal asthma

A

Altered consciousness, arrhythmias, hypotension, cyanosis, silent chest

PEF <33%

O2 <92%

PaO2 <8 kPa

Near fatal = Raised PaCO2

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12
Q

Child classification of severe asthma

A

Can’t complete sentences

SpO2 <92%

PEF 33-50%

HR >140 (1-5 y/o) >125 (>5 y/o)

RR >40 (1-5 y/o) >30 (>5 y/o

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13
Q

Child classification of life-threatening asthma

A

Silent chest, cyanosis, hypotension, confusion

Sp02 <92%

PEF <33%

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14
Q

Acute asthma management in adults

A

O2 Salbutamol 5mg nebs

Ipratropium bromide nebs

Hydrocortisone IV

Magnesium sulphate IV

Aminophylline/ IV salbutamol

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15
Q

What to give on discharge of acute asthma?

A

Prednisolone for 5-7 days

Weaning plan for salbutamol

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16
Q

What should be monitored in primary care for asthma?

A

Asthma control

Lung function assessed by spiromatry/ PEF

Inhaler technique

Adherence

Bronchodilator reliance

17
Q

What are the 3 questions to ask (RCP) in an asthma pt?

A

Any difficulty sleeping?

Any symptoms during the day?

Has it interfered with activities?

18
Q

S+S COPD

A

Exertional SOB, chronic cough, regular sputum production, frequent winter bronchitis, wheeze

19
Q

RF for COPD

A

Smoking

Pollutants in work place

Alpha-1 antitrypsin deficiency

20
Q

Investigations for COPD

A

CXR - hyperinflation, flat diaphragms, bullae

Spirometry

21
Q

Staging of COPD

A

Stage 1 = <0.7 FEV1/FVC, >80% FEV1 % predicted

Stage 2 = <0.7 FEV1/FVC, 50-79% FEV1 % predicted

Stage 3 = <0.7 FEV1/FVC, 30-49% FEV1 % predicted

Stage 4 = <0.7 FEV1/FVC, <30% FEV1 % predicted

22
Q

What is pulmonary rehab?

A

Program of exercise, education + support

23
Q

SIRS criteria

A

RR >20

Temp high or low

HR >90

WCC <4 or >12

24
Q

COPD x ray appearance

A

Hyperinflated Flat diaphragms Bullae

25
Q

Management of COPD exacerbation

A

Controlled O2 - check ABG

Salbutamol nebs

Ipratropium bromide nebs - crossout LAMA

Corticosteroids - IV hydrocortisone

Antibiotics

Aminophylline

Resp support (BiPAP if rising CO2)

26
Q

Ongoing management of COPD post exacerbation

A

Prednisolone 30mg OD for 7 days

Continue antibiotics

27
Q

What medications precipitate asthma?

A

Beta blockers + aspirin

28
Q

Management of mild + moderate COPD

A

All COPD pts: SABA or SAMA (ipratropium)

If mild (>50%): LABA (salmetrol) or LAMA (tiotropium) + ICS if not working

If moderate (<50%) = LABA (salmetrol) or LAMA (tiotropium)

AND ICS

If starting LAMA, stop SAMA - causes heart block

Remember flu vaccine + pneumococcal jab annually

29
Q

Obstructive vs restrictive FEV1/ FVC ratio

A

Obstructive <75% (due to decreased FEV1, slightly decreased FVC)

Normal 75-80%

Restrictive >80% (due to slightly decreased FEV1, decreased FVC)

30
Q

SE of steroid use

A

Immunosuppression

Mood + behaviour changes

Adrenal suppression after stopping

Steroids increase INR

Mineralcorticosteroids increase BP

Increases blood glucose - caution in diabetics

31
Q

What happens when stopping steroids?

A

Adrenal insufficiency if stopped suddenly after prolonged period - use 6 week reduction course

32
Q

SE of salbutamol

A

Palpitations Tremor Hypokalaemia

33
Q

What is trelegy?

A

Inhaler with 3 drugs ICS + LABA + LAMA

34
Q

What are blue, purple, green + brown inhalers?

A

Blue - SABA

Green - LAMA

Brown - ICS

Purple - contain ICS + LABA - used in COPD + asthma

35
Q

What is the centor + fever pain criteria?

A

Fever

Purulence

Attend rapidly

severely Inflamed tonsils

No cough

Centor: tonsillar exudate, fever, tender lymphadenopathy, absence of cough

Primary Care HG (23 decks)

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