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Respiratory > Asthma, COPD and Respiratory Failure > Flashcards

Asthma, COPD and Respiratory Failure Flashcards

1
Q

What are the three pathological factors involved in the asthma?

A

Bronchial muscle constriction - triggered by stimuli

Mucosal swelling/inflammation - mast cell and basophil degranulation resulting in release of inflammatory mediators

Increased mucus production

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2
Q

Symptoms of asthma

A

Wheeze, SOB, coughing (nocturnal) and sputum

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3
Q

Precipitants of asthma

A 
Cold air
Exercise 
Allergens (dust, fur, pollen)
Some food
Emotion 
Infection
Smoking and passive smoking 
Pollution
NSAIDs 
B-blockers
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4
Q

How do asthma symptoms vary daily?

A

Diurnal variation - usually worse in the morning - AM dip in peak flow

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5
Q

Asthma patients can also get acid reflux

A

Yup

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6
Q

Questions to ask in hx

A

How much disturbing sleep - nights per week

Exercise tolerance

Acid reflux?

Other atopic disease - eczema, hayfever, allergies

Triggers at home? Pets, soft furnishings

Job - if symptoms remit at weekends then may be job related

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7
Q

Signs of asthma

A

Tachypnoea, audible wheeze

Prolonged expiratory phase

Hyper inflated chest, hyper resonant percussion

Decreased air entry, polyphonic wheeze

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8
Q

Signs in asthma severe attack

A

Can’t speak
Tachycardic >110/min
Tachypnoea RR >25/min
PEF 33-50% of predicted

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9
Q

Signs of life threatening asthma attack

A 
Silent chest 
Bradycardia 
Hypotension
Confusion
Exhaustion
Cyanosis 
PEFR less than 33%
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10
Q

Tests in acute attack

A 
PEF to monitor
Sputum sample
ABG 
Spirometry 
CXR
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11
Q

General asthma management

A 
Stop smoking
Avoid precipitants
Check inhaler technique 
Give written emergency plan 
Relaxed breathing teaching - papworth method
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12
Q

Step 1 for treating asthma

A

Short acting b2-agonist when needed - salbutamol inhaler

If more than once daily or at night - go to step 2

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13
Q

Step 2 asthma treatment

A

Add standard dose inhaled steroid

Beclometasone 200-800ug daily

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14
Q

Step 3 asthma management

A

Long acting b2 agonist - salmeterol inhaler

Can also increase steroid dose to 800ug/day

Leukotriene receptor antagonist (montelukast or zafirlukast) may be tried

As may oral theophylline - inhibits PDE - at night - prevent morning dip

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15
Q

Step 4 asthma management

A 
Trial of beclometasone up to 2000ug/day 
or
Oral Theophylline 
or
Oral b2 agonist 
or
Oral leukotriene receptor antagonist

With previous therapy

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16
Q

Step 5 asthma management

A

Oral prednisolone - lowest possible dose and continue with inhaled

5-10mg/24hr

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17
Q

What can be added to treat acute attack

A

Oral prednisolone 40mg/24hr to treat acute attack

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18
Q

Side effects of b2 agonist

A

Tremor, tachyarrhythmia, hypokalaemia, anxiety

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19
Q

What % of the population are affected by asthma?

A

5-8%

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20
Q

What is COPD

A

Progressive disorder characterised by airway obstruction with little or no reversibility

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21
Q

3 features of COPD

A

Airway obstruction
Chronic bronchitis
Emphysema - enlarged air spaces distal to terminal bronchioles and destruction of alveolar walls

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22
Q

What is bronchitis defined as clinically

A

Coughing with sputum production on most days for 3 months per year of 2 successive years - symptoms improve if stop smoking

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23
Q

Features favouring COPD diagnosis over asthma

A 
Age of onset >35years
Smoking 
Minimal diurnal variation 
Chronic dyspnoea 
Sputum production
24
Q

Two types of COPD (not really a thing anymore?!)

A

Pink puffers, SOB but no cyanosis - alveolar ventilation - near normal PaO2 and normal or low paco2 - will get type 1 resp failure

Blue bloaters - decreased alveolar ventilation - low pao2 and high paco2 - cyanosed but not breathless - may develop cor pulmonale - rely on hypoxia drive as relatively insensitive to co2 therefore careful when give O2

25
Q

Symptoms of COPD

A

Chronic cough with sputum

Then dyspnoea and wheeze

26
Q

Signs of COPD

A 
Tachypnoea
Use of accessory muscles for breathing 
Hyperinflation
Decreased cricosternal distance 
Decreased expansion
Resonant or hyper resonant percussion 
Quiet breath sounds over bullae
Wheeze
Cyanosis 
Cor pulmonale
27
Q

CXR in COPD

A 
Hyperinflation >6 anterior ribs seen above diaphragm in midclavicular line
Flat hemidiaphragms
Large central pulmonary arteries
Decreased peripheral vascular markings 
Bullae
28
Q

Lung function tests

A

Obstructive
FEV1 decreased and therefore decreased Fev1 :fvc ratio

Increased total lung capacity

29
Q

Non medical treatment

A

Stop smoking
Nutrition
Mucolytics
O2 long term keep pao2 >8 for 15 hours a day

30
Q

General medical treatment for COPD

A

Short-acting b2 agonist or short-acting anti-muscarinic (ipratropium) PRN

31
Q

Mild to moderate COPD medical treatment

A

FEV1 >50%

32
Q

Severe COPD treatment

A

FEV1 30-49% of predicted
Combination long acting B2 agonist + corticosteroids
Symbicort = budenoside and formoterol

Or tiotropium

33
Q

If COPD on treatment for severe remains symptomatic

A

Tiotropium + inhaled steroid + long acting B2 agonist

34
Q

Causes of type 1 respiratory failure

A

Primarily ventilation/perfusion mismatch

Pneumonia
Pulmonary Oedema
PE
Asthma
Emphysema 
Pulmonary fibrosis
ARDS
35
Q

Causes of type 2 respiratory failure

A

Alveolar hypoventilation leading to raised PaCO2

Pulmonary disease: asthma, COPD, pneumonia, end-stage fibrosis, OSA

Reduced respiratory drive: sedative drugs, CNS tumour or trauma

Neuromuscular disease: cervical cord lesion, diaphragmatic paralysis, poliomyelitis, MG, GBS

Thoracic wall disease: flail chest, kyphoscoliosis

36
Q

Features of hypoxia in respiratory failure

A

Dyspnoea, restlessness, agitation, confusion, central cyanosis.

Long standing can lead to pulmonary hypertension, cor pulmonale and polycythaemia

37
Q

Features of hypercapnia in respiratory failure

A

Headache, peripheral vasodilation
Tachycardia, bounding pulse
Tremor/flap, papilloedema
Confusion, drowsiness, coma

38
Q

Management of type 1 respiratory failure

A

Treat underlying cause
Give O2 (35-60%) by facemask
Assisted ventilation if PaO2

39
Q

Management of type 2 respiratory failure

A

Treat underlying cause
Give O2 controlled therapy - start at 24%
Recheck at 20mins (ABG) and if PaCO2 is steady or lower then you can increase to 28%
If PaCO2 has risen >1.5kpa and patient is still hypoxic then consider assisted ventilation

40
Q

Max flow rate with nasal cannulae

A

24-40% - relatively imprecise (1-4L/min relatively correlates with % given)

41
Q

When use simple face mask

A

Flow rate faster but don’t use in hypercapnia or type 2 respiratory failure because less precise than Venturi masks

42
Q

Colours of venturi masks

A 
Blue - 24% 
White - 28% 
Yellow - 35% 
Red - 40% 
Green - 60%
43
Q

When use non-rebreathing mask

A

Deliver high concentration 60-90% therefore in emergency

Imprecise therefore not good for controlled O2 therapy

44
Q

Presentation of acute asthma attack

A

Acute wheeze and SOB

45
Q

Features of severe asthma attack

A

Unable to complete sentences
RR > 25
Pulse >110
PEF 33-50% of predicted/best

46
Q

Treatment of asthma attack

A

Salbutamol (or terbutaline) neb
Hydrocortisone IV or prednisolone PO
or both if very ill

47
Q

If severe asthma attack carries on

A

Salbutamol Nebs every 15mins or 10mg continuously per hour
Add ipratropium
Single dose of magnesium sulphate IV

48
Q

Maintenance after asthma attack

A 
Prednisolone 5-7 days 
Need to have been stable on discharge meds for 24 hours
Check inhaler technique 
PEF >75% of predicted
Gp appointment within 1 week
Resp clinic appointment within 4 weeks
49
Q

Presentation of acute COPD exacerbation

A

Increasing cough, breathlessness or wheeze

Decreased exercise capacity

50
Q

Treatment of acute COPD

A

Salbutamol and ipratropium nebuliser
Controlled O2 therapy
Steroids - IV hydrocortisone and oral prednisolone
Antibiotics

51
Q

If no response to initial acute COPD management

A 
IV aminophylline 
Then
NIPPV 
Then
Intubation and ventilation 
Or
respiratory stimulant drug eg. Doxazo ran short term
52
Q

What is the MRC dyspnoea scale grade 1

A

Not troubled by breathlessness except on strenuous exercise

53
Q

What is the MRC dyspnoea scale grade 2

A

Short of breath when hurrying or walking up a slight hill

54
Q

What is the MRC dyspnoea scale grade 3

A

Walks slower than contemporaries on flat because of breathlessness or has to stop for breath if walking at normal pace

55
Q

What is the MRC dyspnoea scale grade 4

A

Stops for breath after walking 100m on level ground or after a few minutes

56
Q

What is the MRC dyspnoea scale grade 5

A

Too breathless to leave the house. Or breathless when dressing/undressing

Respiratory (7 decks)

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