Asthma, COPD & bronchiectasis

Question 1

Outline the function of a spacer

Answer 1

To enhance drug delivery and reduce need for good coordination.

Question 2

Describe the main principles of the stepwise ladder for asthma treatment

Answer 2

• Start at the most appropriate step for the severity of the symptoms.
• Review at regular intervals based on severity.
• Step up and down the ladder based on symptoms.
• Aim to achieve no symptoms or exacerbations on the lowest dose and number of treatments.
• Always check inhaler technique and adherence at review.

Question 3

Differentials for COPD

Answer 3

Lung cancer, lung fibrosis, heart failure.

Question 4

Blue bloater vs pink puffer

Answer 4

• Blue bloater (chronic bronchitis): chronic productive cough, overweight, cyanotic, peripheral oedema, wheezing.
• Pink puffer (emphysema): older, thin, severe SOB, pursed lip breathing, accessory muscles, silent chest, hyperinflation.

Question 5

Describe the features of a life-threatening asthma attack

Answer 5

• PEFR < 33% best or predicted.
• Oxygen sats < 92%.
• ‘Normal’ pC02 (4.6-6.0 kPa).
• Silent chest, cyanosis or feeble respiratory effort.
• Bradycardia, dysrhythmia or hypotension.
• Exhaustion, confusion or coma.

Question 6

What is the most common organism in bronchiectasis?

Answer 6

Haemophilus influenzae

Question 7

Criteria for discharge of an acute asthma exacerbation

Answer 7

• Been stable on their discharge medication (i.e. no nebulisers or oxygen) for 12-24 hours
• Inhaler technique checked and recorded
• PEF >75% of best or predicted