Extras Flashcards
best investigation and treatment for vocal cord dysfuntion
ix direct visualisation and provoke with forced exp movement
treat with speech therapy
smoking graph- what age stop to prevent all premature mortality
30
what is hypoxic pulmonary vasoconstriction
where there is hypoxia but not hypercapnoea, the pulmonary artery will constrict to direct blood flow to better oxygenated lung
happens in COPD, high altitude pulmonary oedema
why does hypercapnoea happen in COPD
reduced ventilatory drive
alpha trypsin def upper or lower
lower emphysema
compare smoking upper emphysema
Why is COPD harder work
need larger volumes to optimise expiratory air flow, but harder work as stiffer chest wall and lung at larger inflation
air trapping happens because no time to expire the whole of this large volume, so builds up
monitor disease activity in ABPA?
IgE total
treat ABPA?
steroids and itraconazole
omalizumab may be used
what is OMALIZUMAB?
monoclonal Ab against IgE- may reduce glucocorticoid requirements
OSA does what to your health
indep RF for hypertension
indep all cause mortality if AHA over 30
assoc with HF, arrhythmia, DM- but shard risk factors MVA 2-3 X IMPAIRED daily function depression x 2 pulmonayr hypertension, stroke, CAD Increase triglycerides Increased periop complications
How is the bernoulli effect involved in OSA
airflow velocity increase at site of narrowing–>pressure on lateral walls decreases–>collapse (BERNOULLI)
why are you apnoeic in CSA?
hyperventilate which drives the CO2 down, expecially in NON REM SLEEP, but throughout sleep cycle (compare OSA)
always NON sustained HYPERCAPNOEIC
if high CO2, it is sleep related hypoventilation syndrome
what do you do if CPAP causes CSA (can happen)
adaptive servoventilation
NM disease what do you use for sleep?
Bipap not cpap
Continuous oxygen therapy who gets it
PaO2 55 or under awake at rest 1 months post smoking
PaO2 59 or under if polycythemia, RHF or pulm hypertension on echo
15 hours per day for max benefit
can use intermittent for QOL if desat 88 or below on walk test
MMRC dyspnoea scale 0-4
0- nil except strenuous 1- hurrying or hill 2-shorter of breath than others same age 3- after 100m or a few mins 4- cannot leave house, cannot get dressed
COPDX severity based on FEV1
MILD- FEV1 60-80% PREDICTED- few sx and ADLs ok
MODERATE- FEV1 40-60%- breathless on the flat
SEVERE- FEV1 UNDER 40% PREDICTED- minimal exertions, complications of disease like pulm hypertension
COPD diagnosis bronchodilator
ratio under 0.7 POST bronchodilator not fully reversible
earliest thing to go is actually lung volumes, before FEV1
what proportion of smokers develop clinical disease CODP
10-20%
systemic corticosteroids in COPD exac effect
improve FEV1, PaO2, reduce treatmetn failure, relapse, length stay
5 dys enough
MOA of indacaterol
very long acting beta agonist
effect of adding anticholinergic or LABA in COPD moderate
mortality
QOL
reduce exacerbations
pneumovax does what
reduce invasive disease
flu vax does what
reduce number and severity of exacerbations
COPD mortality causes
probably resp over VCS and cancer
beta blockers in COPD
even if severe disease or reversible component that is fine
Survival improvement in COPD?
pharm therapy reduces symptoms, improves QOL, and reduces exac but NO improved survival or decline in FEV1
