Asthma, COPD (a1antitrypsin), Bronchiectasis Flashcards
Risk factors for asthma
- Atopy - asthma/eczema/hay fever
- allergens, air pollution, smoking
- isocyanates
- exercise
- cold weather
Asthma
- presentation of asthma
- presentation of acute attack
Early onset
Cough - worse at night/in cold/exercise
Variable SOB,
Wheeze, chest tightness
Often triggered by resp infection
-worsening SOB, cough, wheeze not responding to SABA
Asthma
-diagnosis and investigations
17+
-refer to specialist if symptoms better away from work
-spirometry (FER U70%) + BDR (12%) + FeNO
FeNO +ve = 40ppb+
(will be inaccurate in smokers)
5-16
-spirometry + BDR
-FeNO if normal/obstructive spirometry with -ve BDR
FeNO +ve = 35ppb+
Asthma
-Management (maintenance, reliever therapy)
-How does each drug work, SE
-aim of treatment
-when to step up and down
1st line reliever - Salbutamol
- B agonist => SM relax
- SE => tremor
1st line maintenance - ICS (stops airways narrowing) if SABA not enough/frequent attacks
2nd line - +LRTA
3rd line- replace LRTA with LABA
ICS SE - oral thrust, children growth stunted
LABA - longer acting SABAs
LTRA PO SE - GI upset, headache
-stops airways narrowing
Aim of treatment
-no daytime symptoms
-no exacerbations
Any need to use SABA 3x a week
Night symptoms
Moderate asthma attack
-classification
-management
PER - 50-75%
Normal speech
RR < 25
HR < 110
ADMIT - night, past near fatal, on PO CS, pregnant
15 NRM and downtitrated to 94-98%
-PRIORITISE OXYGEN!
SABA - O2 neb/metered dose
PO prednisolone - 50mg 5 days
Add SAMA if no change
Continue with normal meds
If no change/T2RF => escalate to ITU (intubate, ventilate)
Severe asthma attack
-classification
-management
PER - 33-50%
Incomplete sentences
RR 25+
HR 110+
ADMIT if unresponsive to normal treatment
15 NRM - downtitrated to 94-98%
SABA - O2 neb/metered dose
PO prednisolone - 50mg 5 days
If no change - add SAMA, then IV MgSO34
Continue with normal meds
If no change/T2RF => escalate to ITU
-prep for intubation, ventilation
Life threatening asthma attack
-classification
-management
ANY OF THE FOLLOWING
PER - U33%
Silent chest, cyanosis, weak breathing
HR U110
BP - hypotensive
pCO2 - normal
SaO2 - U92% => ABG
Exhausted, confusion
ADMIT
15 NRM - downtitrated to 94-98%
SABA - O2 neb/metered dose
PO prednisolone - 50mg 5 days
If no change - add SAMA, them IV MgSO4
Continue with normal meds
If no change/T2RF => escalate to ITU
-prep for intubation, ventilation
Discharge criteria after asthma attack
Stable on discharge meds for 12-24hs without nebs or O2
Inhaler technique checked
PEF 75%+
Review at GP
-inhaler technique
-smoking cessation
-annual flu vaccine
-do they have an asthma emergency plan?
-peak flows when they’re well
COPD
-risk factors
Smoking
a1antitrypsin deficiency - COPD presentation in young with liver signs
Occupational exposures
- cadmium
- coal
- cotton
- cement
- grain
COPD
-presentation, signs, symptoms
SOB (load capacity imbalance increases neural drive to breathe)
Wheeze
Sputum
Exercise limitation
High RR, tripod
Decreased chest expansion, barrel chested (hyperinflation)
Decreased BS
Cyanosis, asterixis
Cor pulmonale => RHF
Cachexia
Pathophysiology of COPD
Emphysema
-oxidative stress => decreased recoil, capillary beds destroyed
Bronchitis
-increased goblet cells, abnormal tissue repair => mucus hypersecretion
BOTH LEAD TO AIRWAY OBSTRUCTION
Severity of COPD
-mild
-moderate
-severe
-V severe
FEV1/FVC <0.7, no change in BD test (U12% change)
Mild - FEV1 >80
Moderate - FEV1 50-79
Severe - FEV1 30-49
V severe - FEV1 <30
COPD
-diagnosis, investigations
Clinical diagnosis
CONFIRMATION OF DIAGNOSIS - Post BD spirometry FER U70%
CXR
-hyperinflation, bullae, flat hemidiaphragm, RHF
-WANT TO EXCLUDE LUNG CANCER
FBC - polycythemia
COPD
-management (conservative, medical, prophylaxis, cor pulmonale, surgery)
Smoking cessation
Flu and pneumococcal vaccine
Pulmonary rehab - refer if MRC 3 (having to stop because of SOB, or walks slower than other people)
1st line - SABA/SAMA as required
2nd line - switch SAMA <=> SABA as required
3rd line - if no asthma/steroid response
-add LABA + LAMA to SABA as required
3rd line - if asthma/steroid responsive
-add LABA + ICS to SABA as required
-add LAMA if needed
Prophylactic azithromycin if
-3+ exacerbations needing CS
-1 exacerbation => admission
Cor pulmonale
- loop diuretics in edema
- O2 therapy
Surgery
-valves, coils, bullectomy
LTOT if
PO2 U7.3 OR
PO2 7.3-8 and
-2ndary polycythemia
-pHTN
-peripheral edema
Acute COPD exacerbation presentation
-common causative organisms
Increased SOB, cough, wheeze
Purulent sputum
Hypoxia
Haemophilus influenza, resp viruses
