COPD & CROUP & Cystic Fibrosis Flashcards
What does COPD stand for?
Chronic obstructive pulmonary disease
Give examples of COPD?
- Emphysema: air sacs in lungs are damaged, leading to shortness of breath
- Chronic bronchitis: long term inflammation in lungs
Is COPD progressive or irreversible?
It is progressive (worse over time)
And irreversible - have to manage the symptoms.
How is COPD diagnosed?
- Give high dose of ICS, if it gets better then it is COPD.
- If symptoms get worse after stopping ICS, then most likely COPD.
What is used to treat COPD?
Inhalers:
- Short acting anti-muscarinic antagonist = Ipratropium
- Long acting anti-muscarinic = Aclidinium bromide, glycopyrronium bromide and umeclidimium
- Mucolytic drugs = Carbociestine
- Long term oxygen = given for severe COPD & hypoxaemia
Antibiotics = for infection, if phlegm becomes purulent than usual
- Steroids (either inhaled like ICS or oral like Prednisolone)
What non-pharmacological treatment can treat COPD?
Stopping smoking as it reduces effectiveness of ICS and high doses of ICS will be needed.
It can also cause potential steroid resistance to develop.
When are oral corticosteroids given?
Given for severe infection, when COPD meds cannot get to lungs due to mucus
What dose of oral corticosteroid is given to treat COPD?
Short course and high dose
40mg as a single dose for a week in the morning.
What are the rules of stopping oral corticosteroid?
- If taking for a week as a one off, can be stopped abruptly.
- If several courses, need to reduce slowly.
Which patients need to carry oxygen alert cards?
- Patients who have had episode of hypercapnic respiratory failure (too much carbon dioxide in the blood)
What are Mucolytics drugs used for and give an example?
Used to help coughing and reduce sputum thickness
Example - Carbocisteine
When should Mucolytics drugs be stopped?
If not effective after 4 weeks.
What is a caution of Mucolytic drugs?
History of peptic ulceration - can cause potential upset stomach
What are the cautions and side effects of SAMA & LAMA?
Caution: Prostatic hyperplasia (enlarged prostate)
Side effect: Dry mouth, cough, headache
What are asthmatic features?
Asthma symptoms
What are asthmatic features?
Symptoms:
- Cough
- Wheeze
- Chest tightness
- Breathlessness
COPD is more consistent symptoms
What is the initial treatment of COPD?
A SABA or a SAMA
Used for quick relief.
Whether they have asthmatic features or not.
What needs to be done for patients starting LAMA?
Stop SAMA.
They can either have SAMA or LAMA
What is the step up treatment without asthmatic features?
- SABA or SAMA
If doesn’t work then add LABA and LAMA (own 3 inhalers in total)
SAMA - stopped
SABA - continued
Add ICS if:
- severe exacerbation within a year and needed to go hospital or TWO exacerbations needing Prednisolone/antibiotics.
So patient would now own 4 inhalers
What is the step up treatment with asthmatic features?
- SABA or SAMA
If doesn’t work then add LABA and ICS (own 3 inhalers in total - SABA, LABA n ICS)
SAMA - stopped
SABA - continued
Add LABA if:
- severe exacerbation within a year and needed to go hospital or TWO exacerbations needing Prednisolone/antibiotics.
So patient would now own 4 inhalers (SABA, LABA, ICS, LAMA)
What is Trixeo Aerosphere used for and what does it contain?
Used in exacerbations of COPD, with asthmatic features.
Contains:
- Formoterol (LABA)
- Glycopyrronium (LAMA)
- Budesonide (ICS)
What is CROUP?
A, usually, self-limiting infection of the upper airways that causes breathing difficulty and a BARKING cough.
Common in babies and young children. Worse at night.
What are symptoms of cgroup?
- Barking cough
- Hoarse voice
- Difficulty breathing
- Rasping sound when breathing in
What is the treatment of CROUP?
- Give fluids.
and NOT cough medicine as it prevents cough and you want them to cough out the infection to get it out.
For mild croup, use single dose steroid (dexamethasone).
If severe, give single dose steroid.
What should be given if single dose steroid doesn’t work?
Give nebulised adrenaline (reduces airway swelling)
And monitor child carefully to see if croup returns.
What are Antihistamines for?
Nasal allergies and seasonal allergic rhinitis (inflammation of inside of nose caused by an allergen)
- To treat urticaria (itchy rashes/hives)
- rashes
- pruritis (itching)
- Insect bites and stings
- Drug allergies
What are the different types of Antihistamines?
Sedating and non-sedating ones
What are the sedating antihistamines?
- Alimemazine
- Promethazine
What are the non-sedating antihistamines?
- Cetirizine
- Acrivastine
- Bilastine
- Loratadine
- Desloratadine
- Fexofenadine
- Mizolasatine
- Rupatadine
What are the cautions of anti-histamines?
For sedating anti-histamine, there is a caution in:
- prostatic hypertrophy (prostate enlargement)
- Urinary retention
- Epilepsy
AND AVOID IN LIVER DISEASE - risk of coma
Which patients are more susceptible to side effects of antihistamines?
Children and Elderly
What are side effects of Antihistamines?
- Drowsiness - may stop after few days
- Headache
What is Cystic fibrosis?
- Lungs
- Pancreas
- Liver
- Intestines
- Productive organs
What are the symptoms of Cystic Fibrosis?
- Pulmonary disease (lung disease)
- Reccurent infections (repeated infections)
- Production of thick sputum
- Hard to digest and absorb food and nutrients due to lack of pancreas function
Other complications include:
- Liver disease
- Osteoporosis
- CF related diabetes (pancreas scarring leads to less insulin produced)
What is the treatment Cystic Fibrosis?
1st line: Dornase alfa (via nebulisers)
Mannitol dry powder, if Dornase alfa is unsuitable
Antibiotics for lung infections
What is a non-pharmacological treatment for cough and congestion?
- Eucalyptus oil
- Menthol crystals in warm water
- Breathe in towel over your head
NOT BOILING WATER - because it can scald skin
Examples of Cough supressants?
- Codeine = evidence to suggest not effective
- Dextromethorphan and pholcodine - less SE
- Expectorants - no evidence to suggest they work. Not for sale under 6.
- Simple linctus paediatric for under 12 year olds
Who can cough suppressants be given to? And how long for?
6-12 year olds.
And they must have already tried non-drug and not helped.
Used max for 5 days.
What can be given for palliative care cough?
- Diamorphine and methadone can used.
- Morphine - THIS IS PREFERRED
