COPD + Asthma Flashcards
How is asthma in adults diagnosed?
Spirometry
- FEV1/FVC ratio of < 70% (reduced) to diagnose obstructive airway disease
- Bronchodilator reversibility of >12%
Offer FENO testing to adults:
- FENO (fractional exhaled nitric oxide) >=40ppb
○ Increased production of nitric oxide synthase can be caused by a rise in inflammatory cells, particularly eosinophils
Peak flow (needed for dianosis if normal spirometry + FENO)
* Peak flow variability of >20%
What is the first and 2nd line step in management of Asthma?
- Salbutamol (SABA) PRN
If Asthma symptoms >3x/ week or nightime sx:
- Low-dose ICS inhaled
What is the next step up in management of Asthma in a person who is on a SABA + Low-dose ICS?
Add Leukotriene recetptor antagonist (Montelukast) for 4-8 Weeks
What is the next step up in management of Asthma in a person who is on a SABA + Low-dose ICS and Leukotriene Receptor antagonst?
Discuss if response to LTRA present
If yes: add LABA (long-acting Beta 2 agonist)
If not: stop LTRA and start LABA
What is the next step in management of uncontrolled Asthma of a person with ICS and LABA (and SABA) ?
offer to change the person’s ICS and LABA maintenance therapy to a MART regimen with a low maintenance ICS dose
What is the next step in managmenet if ASthma is uncontrolled with a MART regime + low-dose ICS maintenance?
Increase the ICS dose
- first to moderate dose
- Then to high-dose inhaled steroids
If still no control: Refere to specialist
What are the features of a moderate asthma exacerbation?
- Increasing symptoms
- PEF 50-75% best or predicted
- No features of severe asthma
What are features of a severe asthma exacerbation?
- PEF 33-50% best or predicted
- RR > 25
- HR > 110
- Inability to complete sentences in one breath
What are signs of life-treatening Asthma exacerbation?
- PEF < 33% best or predicted
- Normal pCO2 or high PCO2 (4.6-6.0)
- Tiering
- Silent chest
- Hypoxia (SPo2 < 92% or paO2 < 8 kPa), Cyanosis
- Bradycardia, arrhythmia, hypotension
What is the initial management of an acute asthma attack?
- Nebulised Salbutamol (5mg Nebulised - every 20-30min or continous) with O2
For severe or life-threatening or poor initial respnose to treatment:
- Add nebulised Ipratroprium bromide (500 micrograms every 4h for adults)
- Add oral prednisolole 40-50mg adults (and keep on short course for 5 days)
Monitor response with Peak flow and O2 saturations
A patient with life-threatening features of asthma has already been given salbutamol, ipraproprium bromide and oral prednisolone. What other management options should be considered?
- ITU involvement for ventilatory support + Administration of
- Consider IV magnesium sulphate 1.2–2 g infusion over 20 minutes (unless already
given) - Give nebulised β2
bronchodilator more frequently eg salbutamol 5 mg up to every
15-30 minutes or 10 mg per hour via continuous nebulisation (requires special nebuliser)
( Theophylline/ aminophylline infusion 1g in 1L 0.5ml/kg/h (usually for ICU) and more commonly used in children)
When can a patient with asthma exacerbation be discharged home?
How is COPD diagnosed?
Spirometry
- reduced FEV and FEV1 with decreased FEV1/FEC ratio
- Post-bronchodilator FEV1/FV Ratio < 0.7
Stages of obstruction FEV1:
□ >80 mild obstruction (Stage 1)
□ 50-79% moderate obstruction (Stage 2)
□ 30-49% severe obstruction (Stage 3)
□ <30% Very severe (Stage 4)
(also consider COPD If ratio >0.7 but young, also consider something else if >0.7 and old)
Which factors are considered durinch choosing which COPD management is appropriate?
Management is guided by Symptom + Exacerbation, not Spirometry
What is the first-step in management in COPD?
SABA PRN
