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Respiratory > Bronchiolitis, asthma, virally induced wheeze and COPD > Flashcards

Bronchiolitis, asthma, virally induced wheeze and COPD Flashcards

1
Q

At what age range is the peak incidence of bronchiolitis?

A

3-6 months

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2
Q

Give 3 causes of bronchiolitis

A

RSV
Mycoplasma
Adenovirus

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3
Q

Give 6 presenting features of bronchiolitis

A 
Coryzal symptoms
Dry cough
Wheeze
Breathlessness
Fever
Fine crackles
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4
Q

What investigation can be used to show bronchiolitis caused by RSV?

A

Immunofluorescence of nasopharyngeal secretions

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5
Q

Give 5 indications for hospital referral for bronchiolitis

A 
RR>60-70
Feeding less than 50% of normal or evidence of dehydration 
Respiratory distress
spO2<92%
Central cyanosis
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6
Q

What is the management for bronchiolitis in hospital?

A 
Nasal suction
NG or IV fluids
Maintain O2 saturation>92% via head box, nasal cannula
If still deteriorating, CPAP  
In refractory cases intubation
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7
Q

What type of T cell response is seen in asthma?

A

TH2 response

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8
Q

What type of hypersensitivity reaction is responsible for allergic asthma

A

Type 1 hypersensitivity (IgE mediated; involves mast cell degranulation and histamine release)

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9
Q

Give 4 mechanisms that contribute to bronchial obstruction in asthma

A

Increased mucus production
Mucosal oedema
Bronchospasm
Smooth muscle hypertrophy

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10
Q

What time of the day are symptoms often worse in asthma?

A

During the night

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11
Q

What are the 2 first-line investigations for suspected asthma?

A

Fractional exhaled nitric oxide

Spirometry

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12
Q

What is the next step in diagnosing suspected asthma if: fractional exhaled nitric oxide >40ppb, FEV1/FVC<70%?

A

Bronchodilator reversibility test

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13
Q

In asthma, what is the result of the bronchodilator reversibility test?

A

FEV1 improved by 12% or more

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14
Q

What is the next step in diagnosing suspected asthma if: fractional exhaled nitric oxide >40ppb, FEV1/FVC>70%?

A

Peak flow rate

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15
Q

By how much should peak flow rate vary throughout the day in asthma?

A

By over 20%

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16
Q

What does an airway hyperreactivity test involve?

A

Introducing histamine or methacholine directly into the bronchioles

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17
Q

What might CXR show during an exacerbation of asthma?

A

Hyperexpanded chest

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18
Q

Give 2 features of moderate asthma

A

Worsening symptoms

Peak flow 50-75% of predicted

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19
Q

Give 4 features of acute severe asthma

A

Peak flow 33-50% of predicted
RR>25
HR>110
Cannot complete sentences in one breath

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20
Q

How does life threatening asthma affect SpO2, peak flow and PaO2?

A

SpO2<92%
Peak flow <33% of predicted
PaO2<8kPa

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21
Q

Give 2 features of near fatal asthma

A

Raised pCO2

Requirement for mechanical ventilation

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22
Q

Give 3 key steps in the management of acute asthma

A

High flow O2 if SpO2<94%
2.5-5mg nebulised salbutamol +/- ipratroprium bromide
3 days corticosteroid (oral prednisolone if alert, or IV hydrocortisone)

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23
Q

Give 3 additional therapies that may be tried in acute severe or life threatening asthma?

A

IV salbutamol
Magnesium sulfate
Aminophylline

24
Q

When should antibiotics be used in acute asthma?

A

If there is a suspected bacterial infection

25
Q

What is the first line therapy for chronic asthma?

A

Short acting beta agonist (SABA) e.g. salbutamol

26
Q

What is the most appropriate next step in the management of chronic asthma (already on SABA)?

A

Add inhaled corticosteroid (ICS) e.g. fluticasone

27
Q

What is the most appropriate next step in the management of chronic asthma (already on SABA+ICS)?

A

Add leukotriene receptor antagonist (LRTA) e.g. montelukast

28
Q

What is the most appropriate next step in the management of chronic asthma (already on SABA+ICS+LTRA)?

A

Add long acting beta agonist e.g. salmeterol

29
Q

What is the most appropriate next step in the management of chronic asthma (already on SABA+ICS+LTRA+LABA)?

A

Increase ICS dose

30
Q

What is the most appropriate next step in the management of chronic asthma (already on SABA+ICS (maximum dose) +LTRA+LABA)?

A

Oral prednisolone

31
Q

Give 3 risk factors for COPD

A

Smoking
Air pollution
Alpha-1 antitrypsin deficiency

32
Q

When should you investigate for suspected COPD in over 35s?

A 
A risk factor AND one of:
Dyspnoea on exertion
Chronic cough
Regular sputum production
Winter "bronchitis"
Wheeze
33
Q

What investigation results confirm COPD?

A

FEV1/FVC<70% AND lack of bronchodilator-induced reversibility

34
Q

What is the target SpO2 range for acute exacerbations of COPD (hypercapnic on ABG)?

A

88-92%

35
Q

What is the target SpO2 range for acute exacerbations of COPD (not hypercapnic on ABG)?

A

94-98%

36
Q

Give 4 key therapies in the management of acute exacerbations of COPD

A

Oxygen
Nebulised salbutamol and ipratroprium
5 day course of IV hydrocortisone and oral prednisolone
IV doxycycline or co-amoxiclav

37
Q

What should be added in the management of acute exacerbations of COPD if there is an inadequate response to nebulisers?

A

Aminophylline/theophylline

38
Q

What is the indication for BiPAP ventilation in acute exacerbations of COPD?

A

Worsening respiratory acidosis

39
Q

What are the criteria for GOLD group A in COPD?

A

1 or less exacerbations per year, not requiring admission

Mild symptoms between exacerbations

40
Q

What are the criteria for GOLD group B in COPD?

A

1 or less exacerbations per year, not requiring admission

Severe symptoms between exacerbations

41
Q

What are the criteria for GOLD group C in COPD?

A

2 or more exacerbations per year, or 1 requiring admission

Mild symptoms between exacerbations

42
Q

What are the criteria for GOLD group D in COPD?

A

2 or more exacerbations per year, or 1 requiring admission

Severe symptoms between exacerbations

43
Q

What is the appropriate management for chronic COPD (GOLD group A)?

A

Any bronchodilator (short or long acting)

44
Q

What is the appropriate management for chronic COPD (GOLD group B)?

A

LABA or LAMA

45
Q

What is the appropriate management for chronic COPD (GOLD group C)?

A

LAMA

46
Q

What is the appropriate management for chronic COPD (GOLD group D)?

A

LAMA or LAMA+LABA or LABA+ICS

47
Q

What requirements must be met to receive long term oxygen therapy?

A

Non-smoker
AND
PaO2<7.3kPa OR PaO2 of 7.3-8.0kPa with one of: secondary polycythaemia, peripheral oedema, pulmonary hypertension

48
Q

Which vaccinations should be given to COPD patient?

A

Annual influenza and one-off pneumococcal vaccine

49
Q

Which GOLD groups should be offered pulmonary rehabilitation for COPD?

A

Groups B, C and D

50
Q

What is the first line management of chronic COPD according to NICE?

A

SABA or SAMA to relieve breathlessness

51
Q

What is the second line management of chronic COPD according to NICE?

A

LABA + LAMA if no asthmatic features or features of steroid responsiveness
LABA + ICS if asthmatic features or features of steroid responsiveness
If there is no benefit from ICS after 3 months switch to LABA/LAMA

52
Q

What are “steroid responsive features” in COPD?

A

Previous diagnosis of asthma/atopy
Raised eosinophil count
>400ml variation in FEV1 over time
>20% diurnal variation in peak flow

53
Q

What are the most common causes of virally induced wheeze?

A

RSV
Rhinovirus
Influenza

54
Q

What distinguishes virally induced wheeze from asthma?

A

There are no respiratory symptoms in between episodes, and only viral illness triggers wheeze

55
Q

What is multiple trigger wheeze?

A

Patients are well between episodes, but episodes are triggered by other factors as well as viral infection

56
Q

What is the management of virally induced wheeze?

A

Give oxygen if SpO2<92%
Salbutamol (nebulised with oxygen if SpO2<92%, otherwise inhaled)
Ipratropium if salbutamol insufficient
In refractory cases, ventilation

Respiratory (6 decks)

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