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Respiratory > 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

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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?

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18
Q

S+S COPD

A

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

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19
Q

RF for COPD

A

Smoking

Pollutants in work place

Alpha-1 antitrypsin deficiency

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20
Q

Investigations for COPD

A

CXR - hyperinflation, flat diaphragms, bullae

Spirometry

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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 light blue, teal, orange, red+white, purple, green, brown, white+turquoise inhalers?

A

Blue - salbutamol

Teal - salmeterol

Orange - fluticasone (ICS)

Red+white - Symbicort (budesonide + formoterol)

Green - ipratropium

Brown - budesonide

Purple - fluticasone + salmeterol

White+turquoise - tiotropium

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

36
Q

Causative organisms for COPD exacerbations

A

Haemophilus influenza

Strep pneu

Moraxella catarrhalis

Rhinovirus

37
Q

Investigations for acute COPD

A

ABG (bicarb for acute on chronic)

CXR (hyperinflation, flat diaphragms, bullae)

FBC + U+Es, CRP

ECG

Peak flow

Culture sputum +- blood

Measure theophylline baseline

38
Q

Management of acute exacerbation of COPD

A

COSI CAA

Controlled Oxygen (88-92) through venturi - repeat ABG 30 mins after changing O2

Salbutamol 5mg

Ipratropium bromide 500mcg neb

Corticosteroids: Hydrocortisone IV/ Pred oral 30mg 7-14 days

Amoxicillin + clarithromycin/ doxycycline

Aminophylline if no response to steroids

NIV if indicated

39
Q

Indications for NIV + 2 types

A

COPD with respiratory acidosis (BiPAP)

Type 2 failure

Pulmonary oedema (CPAP)

40
Q

Severity of asthma (moderate, severe + life threatening)

A

Mod = 50-75% PEFR sats >92%

Severe = RR>25 HR >110 33-50% PEFR sats >92%, unable to complete sentences

Life threatening = silent chest, cyanosed, bradycardic, hypotensive, confusion, sats <92%

41
Q

What is the GOLD criteria?

A

Uses MRC + CAT score with number of exacerbations = produces a group (A-D)

Group dictates what inhaler to use

42
Q

What is the MRC scale?

A

For COPD pts

Grade 1-5: not troubled by SOB to too breathless to leave house

43
Q

When should MDI + spacers be used?

A

Reduce SE

Improve amount inhaled

Increase efficiency of use

44
Q

What is the Anthisonian criteria?

A

For acute exacerbation of COPD. 2 of: increased SOB, increased sputum volume or presence of purulent sputum)

45
Q

What is brittle asthma (+ the types)?

A

Difficult to control form of asthma

Type 1 = prolonged wide PEF variability

Type 2 = sudden severe attacks on stable background

46
Q

When do steroids need to be tapered?

A

If the pt has been on them for >3 weels

47
Q

When is NIV + invasive ventilation used in asthma?

A

NIV = never, unless on ICU

Invasive = if pt has worsening hypoxia or increasing CO2, decreasing pH or they’re becoming exhausted/ confused, respiratory arrest

48
Q

What abx are given to COPD pts + what needs to be checked?

A

Azithromycin

LFTs + QT length on ECG

49
Q

Criteria for LTOT

A

Non-smoker

Sats <88%

pO2 <7.2

Evidence of HF or polycythaemia = pO2 <8

Check pCO2 doesn’t rise with oxygen therapy = NIV may be needed

50
Q

What is the BODE index?

A

Scoring system for COPD survival

Respiratory (8 decks)

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