Asthma & Coughs Flashcards
Other than B symptoms, what are the 6 red flag features of a cough?
Haemoptysis. Hoarseness. Peripheral oedema with weight gain. Prominent dyspnoea, especially at rest or at night. Trouble swallowing. Vomiting
7 co-morbidities that could cause a cough?
Asthma COPD Heart Failure Allergies Sleep Apnoea GORD Bronchiectasis
What medication can cause a cough?
ACE inhibitors
What pack history is significant in smokers?
30
What is the time limit on acute cough?
3 weeks
If someone had an acute cough with sudden onset pleuritic pain what 2 conditions would you suspect?
Pneumothorax
PE
Common causes of a chronic cough?
Asthma
Smokers
GORD
ACE inhibitor associated
If a cough is worse on weekdays but better at weekends what would you suspect?
Environmental or occupational causes
In someone had a cough what 4 other symptoms would suggest heart failure?
significant breathlessness,
orthopnoea
paroxysmal nocturnal dyspnoea.
peripheral oedema
A cough with sputum, breathlessness, haemoptysis, weight loss, fever, night sweats, anorexia, general malaise, and finger clubbing. What do you suspect?
TB
When would you refer someone for admission with an acute cough?
Pneumothorax
PE
Foreign body
Systemically Unwell
In a URTI how long does a cough usually last for?
3 or 4 weeks
Safety net for acute cough
seek medical advice if symptoms worsen rapidly or significantly,
do not improve in 3–4 weeks,
or they become systemically very unwell.
For people with acute cough who are systemically unwell what would you offer?
doxycycline
If you suspect pneumonia what tool would you use to help guide management?
CRB-65
What are the criteria of the CRB-65
Confusion (new disorientation in person, place, or time; or abbreviated mental test score 8 or less).
Raised respiratory rate (30 breaths per minute or more).
Low blood pressure (diastolic 60 mmHg or less, or systolic less than 90 mmHg).
Age 65 years or more.
When would you order a CXR for someone with a CAP?
If there was the possibility of underlying pathology
What do you do if the person with sub-acute cough does not need emergency admission and has clinical features of post-infectious cough?
explain that the cough is often self-limiting and usually lasts for no longer than 8 weeks (advise the person to re-attend for assessment if the cough does not improve after 2 months
How do the CRB scores relate to management?
Score of 3 or more, arrange urgent admission to hospital.
Score of 1 or 2, hospital assessment should be considered (particularly for people with a score of 2).
Score of 0, treatment at home should be considered, depending on clinical judgement and the person’s social circumstances
Safety net for pneumonia when antibiotics prescribed?
Symptoms worsen rapidly or significantly.
Symptoms do not start to improve with 3 days, or they are not improving as expected.
They become systemically very unwell
What investigation would you organise for a pt following a CAP?
CXR 6 weeks later
How would you differentiate between bronchitis and CAP?
Sputum production and pain - possible
Systemically unwell
Exam - pneumonia= focal signs
What is the difference in terms of management between bronchitis and pneumonia?
Bronchitis - self limiting so self care
Pneumonia - antibiotic
Why wouldn’t you usually prescribe antibiotics for bronchitis?
Acute bronchitis is usually a self-limiting illness and the cough usually lasts about three to four weeks.
Antibiotics do not make a large difference to the duration of symptoms, only shortening cough duration by about half a day on average.
Adverse effects, including diarrhoea and nausea are possible with antibiotic treatment.
When would you write up an antibiotic prescription for pt with bronchitis?
Systemically unwell
When would you write a back up prescription for someone with bronchitis?
A pre-existing comorbid condition Hospital admission in the previous year. Type 1 or type 2 diabetes mellitus. History of congestive heart failure. Current use of oral corticosteroids.
What is the time limit and cause of a sub acute cough?
4-8 weeks
post infective
What is the management of a subacute cough?
Usually self resolving, come back if not improved in 2 months
Pattern of asthma symptoms
episodic,
diurnal (worse at night or in the early morning), and/or triggered or exacerbated by exercise,
viral infection,
and exposure to cold air or allergens
What classes of drug can trigger asthma?
non-steroidal anti-inflammatory drugs
beta-blockers.
What aspects of asthma do you typically monitor on follow up?
Number of asthma attacks, oral corticosteroid use, time off school/nursery/work due to asthma.
Nocturnal symptoms.
Adherence (which can be assessed by reviewing prescription refill frequency).
Possession of/use of a self-management plan/written personalised asthma action plan.
Exposure to tobacco smoke.
What 3 questions do you ask to determine assthma ccontol?
Have you had difficulty sleeping because of your asthma symptoms (including cough)?
Have you had your usual asthma symptoms during the day (e.g. cough, wheeze, chest tightness, or breathlessness)?
Has your asthma interfered with your usual activities (e.g. housework, work, school)?
What do these finding suggest?
PEFR less than 33% best or predicted, or oxygen saturation of less than 92%, or altered consciousness, or exhaustion, or cardiac arrhythmia, or hypotension, or cyanosis, or poor respiratory effort, or silent chest, or confusion.
Life threatening acute exacerbation of asthma
Management of Acute exacerbations of asthma treatment whilst waiting for ambulance
Oxygen
SABA - salbutamol via nebuliser
ipratropium bromide as well
Corticosteroids
Draw step wise management for asthma?
1 - SABA/SAMA PRN 2 - SABA + ICS (low dose) 3 - LABA + ICS (low dose) 4 - LABA + ramp up ICS OR trial LAMA 5 - More ICS and refer
Define complete control of asthma (6)
No daytime symptoms. No night-time waking due to asthma. No need for rescue medication. No asthma attacks. No limitations on activity including exercise. Normal lung function
Example of a SABA
Salbutamol
Example of a SAMA
Ipratropium Bromide
Example of a LABA
Salmeterol
Example of a LAMA
tiotropium
Example of a LRTA and who usually gets this
Montelukast
Children
Example of ICS
beclomethasone/prednisolone
