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Primary care > Asthma/COPD > Flashcards

Asthma/COPD Flashcards

1
Q

Symptoms of asthma

A

More than one of:

Cough

Wheeze

SOB

Chest tightness

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2
Q

Factors increasing likelihood of asthma

A

Timing: Worse at night/early morning

Triggers: Allergens, cold, exercise

DHx: Worse with beta blockers, asthma

PMHx: Personal or family Hx of atopy

Ix: Unexplained eosinophilia

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3
Q

Factors reducing likelihood of asthma

A

Cardiac Hx

significant smoking Hx

Voice disturbance

Dizziness, tingling, light-head

Chronic cough w/o wheeze/breathlessness

Only with colds, no interval symptoms

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4
Q

Paediatric differential for asthma

A

CF

Structural tracheal abnormality

Bronchiectasis/TB

GORD (esp w/ vomiting)

Postnasal drip

Foreign body inhalation

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5
Q

Adult differential for asthma

A

Heart: IHD, HF

Airways: COPD, ILD, PF, bronchiectasis

Other: TB, malignancy, GORD

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6
Q

Factors making COPD more likely than asthma

A

Onset >40y

Significant smoking Hx

Progressive worsening, constant symptoms

Chronic cough/bronchitis preceded dyspnoea

Post-bronchodilator FEV1/FVC <0.7

Poor response to inhaled therapy (short-lived)

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7
Q

Stepwise management of asthma

A

PRN SABA inhaled

Regular inhaled CS, check inhaled technique

ICS + LABA

Increase ICS dose + LABA +/- consider other therapies (e.g. theophylline, LTRA (montelukast), LAMA)

Combination inhalers used to raise compliance

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8
Q

Screening for long-term oral steroid therapy

A

BP

glucose and lipids

Bone density

Growth (in children)

Cataracts (esp children)

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9
Q

Reversible reasons for inadequate control of asthma

A

Poor inhaler technique

Reduced compliance/concern w/ SEs

Alternative Dx

Trigger factors

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10
Q

Asthma annual review components

A

Symptoms - level of control (sleeping, daytime, ADLs)

Exacerbations/acute attacks - number, frequency, severity

Medication - compliance, technique, rescue prescriptions

Screening for SEs (Esp steroids)

Smoking - status and cessation

Vaccinations - pneumococcus, flu

Personal action plan - further goals

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11
Q

Non pharma therapy of asthma

A

Breathing exercises

Breastfeeding in babies

Avoidance of tobacco smoke

Weight loss in obese patients

Others (e.g. dust mite removal) not evidence based

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12
Q

Common co-morbidities adolescent asthma

A

Anxiety/depression

GORD

Obesity

Smoking

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13
Q

Features of acute severe asthma

A

PEF 33-50% of predicted

Cannot complete sentences

RR >25

HR >110

Sats >92%

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14
Q

Features of life-threatening asthma

A

PEF <33% of predicted/best

Cyanosis, silent chest, poor resp effort

Exhaustion, altered consciousness

Sats <92%

Normal PaCO2

Arrhythmia, hypotension

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15
Q

Management of acute asthma

A

Salbutamol nebuliser

Hydrocortisone/prednisolone

Fluids

If infx suspected, abx

If severe, ipratropium bromide

Reassess every 15min, incl. ECG/ABG

If unresponsive to therapy, magnesium sulfate (senior consultation)

If remains unresponsive, consider aminophylline (ICU)

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16
Q

Salbutamol dose acute asthma

A

5mg nebulisedrepeated every 15-30min or 10mg/h continuously

17
Q

TTO for asthma

A

5-7d of 40-50mg oral prednisolone

GP f/u

Respiratory clinic f/u

18
Q

Management of acute exacerbation of COPD

A

Salbutamol + ipratropium bromide

O2 > titrate to sats of 88-92%

Prednisolone

Antibioticsif infective

If unresponsive, consider aminophylline/NIV (not intubation unless haemodynamically unstable/unable to protect airway)

19
Q

Management of moderate asthma in GP

A

Bronchodilator - 4 puffs then 2 puffs ever 2 mins up to 10 puffs

PO prednisolone 40-50mg - 5 days

Nebuliser (O2 driven) - 5mg salbutamol or 10mg terbutaline

20
Q

Investigations for suspected COPD in 1ry care

A

CXR - rule out other pathology

FBC - esp eosinophilia

BMI - provide baseline, monitor disease progression

Spirometry - confirm airway obstruction

21
Q

MRC dyspnoea scale

A

>3 –> pulmonary rehab referral

1: Strenuous exercise

2: Slight hill

3: Mild on level

4: Mild on level <100m

5: Unable to dress/leave house

22
Q

Interventions modifying disease progression for COPD

A

Smoking cessation

Pulmonary rehab (physio for the lungs)

23
Q

COPD subtypes and effect on management

A

Asthma-like: steroid responsive

Non-asthma: LABA + LAMA

24
Q

Examples of LABAs

A

Salmeterol

Formoterol

25
Q

Exapmle of LAMA

A

tiotropium

26
Q

Asthma-like features of COPD

A

Hx of asthma/atopy

Variation in FEV1/PEFR

Eosinophilia

27
Q

Management of COPD exacerbations

A

Oral steroids to reduce inflammation

Abx (less essential, can be guided by POC CRP)

28
Q

Indication for moving up asthma management ladder

A

>2-3x p/w of salbutamol use

Aim should be to never need reliever inhalers

29
Q

MART vs fixed-dose regimens

A

MART –> use formoterol

Allow increased use if feeling more wheezy than normal (e.g. in hayfever season)

Immediate relief + increased preventer action

Primary care (8 decks)

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