Diagnosis and therapeutics of Respiratory disorders

Question 1

Use of the Peak Flow Meter

Answer 1

identify respiratory diseases

monitor treatment efficacy

Question 2

what values are considered when measuring peak flow

Answer 2

sex
age
height
ethnicity

Question 3

what value men max peak flow

Answer 3

up to 100 L/min

Question 4

what value woman max peak flow

Answer 4

up to 85 L/min

Question 5

describe the difference between healthy stable and unstable asthmatics Peak expiratory flow

Answer 5

Health subjects have a stable high PEF

stable asthmatics have a reduced PEF

unstable would show variable PEF readings at different times of the day

Question 6

what type of drug is tiotropium bromide

Answer 6

long acting muscarinic antagonist bronchodilator that blocks M3 muscarinic receptors

Question 7

what effect does tiotropium bromide have

Answer 7

reducing bronchoconstrictions and mucus secretion

Question 8

what type of drug is fluticasone

Answer 8

corticosteroid that alters gene expression for pro and anti inflammatory proteins

Question 9

what effect does fluticasone have

Answer 9

inflammation and promoting bronchodilation

Question 10

what type of drug is salmeterol

Answer 10

long acting beta 2 adrenoceptor agonist

Question 11

what effect does salmeterol have

Answer 11

relaxes bronchiole smooth muscle to dilate the airways. It promotes a long lasting bronchodilatation

Question 12

what do we need to ensure when managing COPD

Answer 12

Ensure efficacy of treatment e.g. only offer ICS to those patients that are likely to respond to corticosteroid, those with asthmatic features.

Reduce use of ICS as risk of side effects including pneumonia on those tacking ICS

Question 13

what is exarcerbation

Answer 13

a sustained acute onset worsening of the person symptoms from their usual stable state which goes beyond their normal day to day variations.

worsening, breathlessness, cough, increased sputum productions and change in sputum colour

Question 14

what inhaled therapy exist for managing COPD exarcerbation

Answer 14

Increased dose of short acting bronchodilators

delivery systems nebulisers and hand held inhalers

Question 15

what oral therapy exist for managing COPD exarcerbation

Answer 15

systemic corticosteroids
- offer 30mg oral prednisolone for 5 days

antibiotics

• empirical treatment
• exarcerbation of COPD associated with purulent sputum
• Prophlactic use of antibiotic azithromycin

Question 16

what intravenous therapy exists for managing COPD exarcerbation

Answer 16

bronchodilators e.g. theophylline and other methylxanthines

respiratory stimulatans
doxopram

Question 17

what does doxopram do

Answer 17

targets potassium channels in the carotid artery whose chemoreceptors sense and respond to the partial pressure of oxygen. Co2 pH and temperature of arterial to cause respiratory stimulation

Question 18

what non pharmacological therapies exist for COPD management of Exarcebation

Answer 18

Oxygen therapy
Ventilation
Respiratory physiotherapy

Question 19

how can we help with adherance

Answer 19

number of tablets
adverse effects
symptoms improvement
treatment frequency 
unclear instructions

combination preparation
pil
directly observered therapy 
once a day
counselling points