CBM

Question 1

History in asthma

Answer 1

Symptoms:
Dyspnoea
Wheeze
Cough - nocturnal
Sputum

Differentials:
Chronic sputum, chest pain, SOB with dizziness

Precipitants
Diurnal variation (morning dipping)
Atopy 
FH
JOB

Night-waking with chest-tightness
Varying symptoms

Question 2

Explain asthma

Answer 2

Hyperresponsive airways (pipes that become swollen due to inflammation and constrict) - in response to a wide range of irritants: stress, smoke, dust mites, infection

Symptoms may improve on their own or with medication

Symptoms may stop for a while and then come back

Question 3

management of asthma

Answer 3

Lifestyle: 
Stop smoking (New leaf, e-cigs)
Avoid irritants, cold air
Lose weight?
Flu-vaccine to avoid exacerbations
Emergency Action plan 

1. Salbutamol
2. Salb + ICS
3. Salb + ICS + LABA or medium dose ICS
4. Salb + Medium ICS + LABA
5. Salb + High-dose ICS + LABA

Question 4

Side effects of asthma meds

Answer 4

Salbutamol: tremor, anxiety, tachycardia

ICS - oral candidiasis - rinse mouth. Hoarse voice

LABA - headache + anxiety, nausea, tremor, palpitations

Question 5

Explain COPD

Answer 5

Inside your lungs, these tubes divide many times — like the branches of a tree — into many smaller tubes (bronchioles) that end in clusters of tiny air sacs (alveoli). Exchange of air with the blood happens in the walls of these sacs.

Chronic lung disease where longstanding irritation by smoke causes swelling of the tubes with mucus production and destruction of the sacs leading t decreased air entry exchange and air trapping / meaning that you breath in less

Higher risk of heart disease and lung cancer.

It is not reversible.
However, most people can achieve good symptom control with medication

Question 6

Symptoms of COPD

Answer 6

Cough - sputum, blood
Later wheeze and SOB
Frequent infections
Fatigue
Exercise intolerance
CVD?
Weight loss
Depression
Anxiety
Peripheral oedema
Cor pulmonale

Question 7

Tests in COPD

Answer 7

Lung function tests (spirometry can show obstructive defect)
CXR -bullae
Hb and CRP raised?

Question 8

Management of COPD

Answer 8

Lifestyle - quit smoking/nicotine replacement therapy (patch, gum)
Support group
Varenicline - reduces cravings and reward (12 week course on prescription)
E-cigarettes (nicotine in vapour)

Flu-vaccine

Bronchodilators - relax the muscles of your airways - less cough and easier to breath

Surgery (bullectomy, lung volume reduction or transplant) - I assume in blue bloaters

Question 9

When to use long-term oxygen therapy (15h/day - 28% O2 max) in COPD

Answer 9

FEV1 <30% predicted
Cyanosis
O2 <92% on air

Use with care if acute

Question 10

Ladder of care in COPD

Answer 10

SAMA/SABA pr

FEV>50%
ADD LABA or LAMA instead of SA

FEV<50%
ADD LABA + ICS
or
Replace SAMA with LAMA

If disease progresses further:
LAMA
\+
LABA
\+
ICS