Chapter 3 - Respiratory System

Question 1

What is acute bronchitis and how is it categorised?

Answer 1

Infection of the bronchi

Symptoms:

• nagging cough that can last up to a few weeks
• Coughing up mucus that is clear, yellow, or green

! NOT usually associated with fever !

Viral induced - not generally treated with ABx

Question 2

What is pneumonia and what are the presenting symptoms for it?

Answer 2

Infection of pulmonary parenchyma

Symptoms:

●Cough
●Fever
●Trouble breathing
●Pain when you take a deep breath
●Increase heart rate 
●Shaking chills

Question 3

What is croup and what are the presenting symptoms?

Answer 3

Croup = laryngotracheitis

Infection of trachea

Symptoms:

●Get a cough that sounds like a seal barking or a frog croaking
●Become hoarse (lose their voice or get a scratchy voice)
●Get a fever (temperature greater than 100.4ºF or 38ºC)
●Start having noisy, high-pitched breathing (called “stridor”), especially when they are active or upset

Most common in children aged 6months - 3 years

Viral induced

Severity differs, mild can be treated in community. Moderate - severe needs referral

Question 4

Which inhaler out of the following has a dose indicator which changes colour from red to green to show a dose has been inhaled correctly?

Breezehaler
Ellipta
Genuair
Nexthaler
Respimat

Answer 4

Genuair

Question 5

What is the new BTS guidance (Sept 2016) for the management of asthma in children?

Answer 5

Baseline at all levels - SABA

Diagnosis + Assessment: SABA + very low dose ICS

Confirmed asthma - regular maintenance therapy
(Step 1):
SABA +
Children > 5yo: titrate down to lowest effective dose of ICS (some patients may not even require this)
Children < 5yo: can keep them on lowest effective ICS dose OR can remove very low dose ICS and replace with LTRA (chewable tablets or granules)

Step 2: Initial add on therapy:
SABA + very low dose ICS +
Children > 5yo: LABA
Children < 5yo: LTRA (or add in very low dose ICS if started on LRTA previously)

Step 3: Additional add-on
SABA +
Children > 5yo: No response to LABA then withdraw and increase ICS dose to low dose
OR if there is benefit from LABA but asthma still uncontrolled, maintain LABA and increase ICS dose to low dose
OR benefit from LABA, then keep + very low dose ICS + consider trial of LTRA
Children < 5yo: LTRA + increase ICS dose to low dose ICS

Step 4: High-dose Therapy
Consider trials of:
- medium dose ICS
OR addition of a fourth drug;
- slow release theophylline 

Step 5: Continuous or frequent use of oral steroids

• use daily steroid at lowest effective dose
• maintain inhaled medium dose ICS
• consider other treatments to reduce use of steroid tablets

Question 6

What is the new BTS guidance (Sept 2016) for the management of asthma in adults?

Answer 6

Baseline at all levels - SABA

Diagnosis + Assessment: SABA + low dose ICS

Confirmed asthma - regular maintenance therapy
(Step 1):
SABA + low dose ICS (if needed - may also be titrated down to lowest effective dose)

Step 2: Initial add on therapy:
SABA + low dose ICS + LABA

Step 3: Additional add on therapy
SABA +
- if no benefit from LABA, then withdraw and increase ICS dose
- if benefit with LABA, but still inadequate, maintain LABA + medium dose ICS
- if benefit with LABA, maintain LABA + ICS + consider trial of either LTRA, SR Theophylline or LAMA

Step 4: High dose therapy
SABA + consider trials of:
- increase ICS to high dose
- adding a fourth drug - LTRA, SR Theophylline, LAMA, beta agonist tablet

Step 5: Continuous or frequent use of oral steroids

• use daily steroid at lowest effective dose
• maintain inhaled high dose ICS
• consider other treatments to reduce use of steroid tablets