breathlessness Flashcards
what can be classed as acute breathlessness?
less than 4 weeks
what can be pulmonary causes of acute breathlessness?
– pneumonia, pneumothorax, PE, asthma, acute exacerbation of COPD, acute resp distress syndrome (COVID, SARS), large airway obstruction eg anaphylaxis, foreign body obstruction, epiglottis (cover that covers trachea swells)
what can be cardiac causes of acute breathlessness?
severe PE, acute MI, cardiac arrythmia, pericarditis, pericardial effusion
what can be non cardiac/ pulmonary causes of acute breathlessness?
- pain, diabetic ketoacidosis, drugs (aspirin overdose, opiates, benzyl benzonate, trauma, hyperventilation, panic attack, thyrotoxicosis, altitude sickness
what are pulmonary causes of chronic breathlessness?
COPD, emphysema, fibrosis, pleural effusion, lung cancer, asthma, hereditary lung disorder (Cystic fibrosis), pulmonary Tb
what are cardiac causes of chronic breathlessness?
left ventricular, heart valve disease (mitral and aortic stenosis), arrhythmias, pericardial causes
what are non cardiac/ pulmonary causes of chronic breathlessness?
severe anaemia, psychogenic eg anxiety, thromboembolic disease, thyroid (hyper/ hypo), obesity, neuromuscular eg Guillian- barre syndrome
what should be included within the history taking for breathlessness?
- Onset and duration
- Timing
- Severity – MRC scale (medical research council scale to measure breathlessness
- Course
- Exacerbating and relieving factors
- Previous episodes – why see now?
- associated features
what is the MRC scale?
quantifying breathlessness
1. Not troubled by breathlessness on strenuous exercise
2. Short of breath when hurrying on a level or when walking up a slight hill
3. Walks slower than most people on the level, stops after a mile or so or 15 mins walking at own pace
4. Stops for breath after walking 100yrds or after a few mins on level ground
5. Too breathlessness to leave house, breathless when dressing/ undressing – ADL
why are associated features important within breathlessness?
rare to be SoB alone
what are common associated features of breathlessness?
- Cough – productive, colour, volume
- Wheeze – times
- Haemoptysis
- Chest pain – SOCRATES
- Red flags/ systemic – fever/ night sweats/ weight loss. Concerns – red frothy sputum, red blood clots, severe and prolonged
what is important within past med history/ drug history?
- Resp conditions/ cardiac conditions/ allergies
- Other co-morbidities – anxiety – check physical first so you do not miss anything
- Hospital admissions/ ITU admissions/ surgical
- Drug history: helps with naming conditions
what needs to be included within a social history?
- Smoking – calculate pack years
- Recreational drugs
- Baseline: activities of daily living – eg dressing
- Travel history: TB, exotic
- Occupation: previous/ current – exposures?
what is interstitial lung disease?
group of disorders affecting lung interstitum - alveolar and capillary epithelium, basement membranes
cause fibrosis - scarring, loss of elasticity
what are classic ILD symptoms?
SoB, dry cough
name some causes of ILD
> 200 causes
idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, sarcoidosis (group of inflame cells called granuloma), asbestosis, drug side effects eg methotrexate
what is idiopathic pulmonary fibrosis?
IPF is reserved when no other underlying cause exists
when is the onset of idiopathic PF?
50-70yrs
what are classic symptoms of idiopathic PF?
: progressive exertional dyspnoea, bi-basal crackles on auscultation, dry cough, clubbing, low sats, cyanosis
what investigations should be done for idiopathic PF?
spirometry, reduced TLCO (total capacity for lung capacity of carbon monoxide), CXR, high resolution CT (ground glass/ frosted glass, honeycomb appearance)
what is the management of idiopathic PF?
: no cure – can only manage symptoms, pulmonary rehab, pirfenidone (antifibrotic agent may be useful), supplementary O2, lung transplant
what is the prognosis of idiopathic PF?
3-4 yrs
progressive nature
what is sarcoidosis?
multi system chronic inflammation
non caseating granuloma across body with predilection for lungs
when is the onset for sarcoidosis?
mid 20s to mid 40s
do black patients have worse outcomes with sarcoidosis
yes
what are common symptoms of sarcoidosis
rashes, nodules, skin lesions, dry eyes, blurry vision, enlarged lymph nodes, cough (with/ out blood), heart complications, enlarged spleen and liver, joint pain, arthritis, swelling of knees
what investigations are needed for sarcoidosis?
FBC (eosinophils, lymphopenia, Ca can be high), serum ACE, blood films (lymphocytes raised
what management is required for sarcoidosis?
test eyes, steroids, most resolve spontaneously (20% can result in pulmonary fibrosis), osteoporosis protection, flu vaccine, stop smoking
what is bronchiectasis?
chronic air way inflammation with dilation of bronchi/ branches
what causes bronchictasis?
- Extra mucus made in abnormal airways which is not cleared due to loss cilia
- Collection of thick viscous mucus results in patients becoming more prone to chest infections
- Causes: in ½ of cases cannot be found, history of serios lung infection is most common cause eg TB, whooping cough, pneumonia/ measles – childhood infections. Immunosuppression’s eg AIDs, transplant patients, hypogammaglobinaemia. Immune hyperactivity: colitis, crohns disease and RA. Inherited – CF. airway obstruction, aspiration – GORD, chronic alcoholics
what are common symptoms of bronchiectasis?
cough with lots of phlegm , recurrent chest infections (mucus in the airway forms a broth for bacteria to grow, sputum turns green/ yellow when infected. Bad breath can indicate active infection. Tiredness/ poor concentration, wheeze, SoB, occasional cough up small amounts of blood from inflamed airway
what would help to diagnose bronchiectasis?
CT - widened bronchi - signet rings
MRI - bronchiectasis of cystic fibrosis
what is involved in the management of bronchiectasis?
antibiotics (amoxicillin – severe cases/ continuous infections) , resp physio (help cough up and clear airways – 20-30m ins BD), inhaler (SABAs and SAMAs for wheezing in acute attack. Steroid inhalers should not be used unless underlying asthma). Other meds – other bronchodilators
