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Intro To Respiratory Flashcards

1
Q

What is asthma

A
  • common chronic inflammatory condition of the lung airways
  • cause not completely understood
  • can occur in childhood or adulthood
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2
Q

Asthma can be divided into (2)

A
  • extrinsic = implying it has definite external cause
  • intrinsic = when no causative agent can be found

These can overlap

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3
Q

What are the symptoms of asthma

A
  • cough
  • wheezing
  • shortness of breath -> worse at night
  • chest tightness
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4
Q

What are the causes and triggers of asthma

A
  • Environmental exposure to allergen e.g. grass pollen, domestic pets
  • Occupational sensitisers
  • Atmospheric pollution
  • Drugs oral (e.g. NSAIDs) and/or topical
  • Viral infections
  • Cold air
  • Emotion
  • Excerise
  • Diet
  • Irritant dusts, vapour and fume
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5
Q

What is the NG number for asthma on NICE

A

NG80

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6
Q

Age group variation for treatment of asthma according to NG80

A
  • Under 5 years old
  • 5 to 16 years old
  • 17 years or older

Licensing varies and not all treatments licensed in children

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7
Q

Diagnosis for asthma

A
  • clinical assessment + history + signs and symptoms
  • age - objective test recommended alongside symptoms
  • lung function tests
  • probability
  • atopic status (not used alone)
  • reversibility testing
  • airway responsiveness

Investigation depends on age and specific presentation

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8
Q

PEF
NMS

A

PEP = peak expiratory flow
Indicator for monitoring deterioration + improvement in asthma. Useful tool for patients to manage their condition
NMS = new medicine service

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9
Q

Regular clinical reviews should be done at least

A

Annually

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10
Q

What should be reviewed in regular clinical review for asthma

A
  • current symptoms
  • future risk of attacks
  • management strategies
  • supported self management
  • growth (in children)
  • inhaler technique -> show me
  • written personalised asthma action plans (PAAPS)
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11
Q

What is uncontrolled asthma under NG80

A
  • 3 or more days a week with symptoms
  • 3 or more days a week with required use of SABA for symptomatic relief
  • 1 or more nights a week with awakening due to asthma
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12
Q

SABA

A

Short-acting beta agonists

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13
Q

What are the 2 main types of inhalers

A
  1. Bronchodilator
  2. Steroids
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14
Q

Bronchodilator

A

Such as salbutamol
- opens the air passages and relieve symptoms

-> short acting - relieve symptoms immediately e.g. when climbing up stairs

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15
Q

Steroids

A

Such as beclometasone
- reduce inflammation in the air passages. Improves asthma symptoms and reduces risk of severe asthma attacks and death

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16
Q

Others examples of medicines used for asthma

A
  • LTRAs
  • sodium cromoglicate nedocromil sodium (not in NICE guidelines anymore)
  • theophyllines
  • antimuscarines
  • monoclonal antibodies - started in special secondary care -> used for mere serious asthma that hasn’t worked with other inhaler
17
Q

MART

A

Maintenance and Reliver Therapy
- not first line
- maintenance therapy + relief symptoms when required
- combination of inhaled corticosteroids (ICS) and long-acting beta agonist (LABA)
- fact-acting LABA required e.g. formoterol

18
Q

Types of inhaler devices

A

Inhalers
Spacers - requires co-ordination with breathing so would be difficult to use for patient who are children or adults with less mobility

19
Q

Cleaning up inhaler

A

Need to drip dry

Don’t clean inside with cloth as drug particles might give stuck so drug dosing would differ

20
Q

COPD

A

Chronic obstructive pulmonary disease

21
Q

Characteristics of COPD

A
  • airflow obstruction that is not fully reversible
  • progressive in the long term
  • exacerbations often occurs when there are rapid + sustained worsening of symptoms beyond normal day-to-day variations
  • bronchitis + emphysema grouped under COPD
22
Q

NICE number for COPD

23
Q

Causes of COPD

A
  • smoking
  • long term exposure to toxic particles and gases
  • developing countries: inhalation of smoke for biomass fuels used in heating, cooking in poorly ventilated areas
  • pollution + climate
  • deficiency in Alpha 1 Antitrypsin
24
Q

Symptoms of COPD

A
  • chronic productive cough
  • smoker’s cough
  • wheeze (not always present)
  • breathlessness
  • infective exacerbation with purulent sputum
  • cardiovascular functions affected e.g. hypertension,osteoporosis + metabolites problems
25
Symptoms can be worsened by for COPD
- cold - foggy weather - atmospheric pollution - in advanced disease - mild exercise
26
In severe cases of COPD symptoms are:
- tachypnoea - rapid shallow breathing - prolonged expiration - intercostal in drawing on inspiration - pursing of lips on expiration - poor chest expansion - hyperinflated lungs - loss of normal cardiac + hepatic dullness - carbon dioxide - responsive/insensitive - heart failure + oedema - rare features + in terminal cases
27
Diagnosis for COPD
- based on several factors - age > 35 years (smoking) and who present with one or more symptoms - exertional breathlessness - chronic cough - regular sputum production - frequent winter bronchitis - wheeze
28
What are the further investigations that needs to be carried for COPD
- post-bronchodilator spirometry - chest x-ray - FBC - calculate patient’s BMI
29
Stage 1 of COPD
Mild - 80% normal lung function - mild limitation of airflow, chronic cough, muscus(not always)
30
Stage 2 of COPD
Moderate - 50-80% normal lung function - increased airflow limitation, SOB - especially on excretion, chronic cough, mucus - usually when present
31
Stage 3 of COPD
Severe - 30-50% normal lung function - greater airflow limitation, worsening of other symptoms, daily activities limited, exacerbations, impact on quality of life
32
Stage 4 of COPD
very severe - less than 30% normal lung function - very severe symptoms leading to impact on heart + circulatory symptoms, noticeable negative impact on quality of life, potentially life threatening exacerbation, hospitalisation, o2
33
Levels of exacerbation in COPD
Mild: increased need for medication, which they can manage in their own normal environment Moderate: sustained worsening of respiratory status that requires treatment with systemic corticosteroids/ antibiotics Severe: rapid deterioration in respiratory status that requires hospitalisation
34
Management of COPD
- Smoking cessation - beta 2 agonists - antimuscarinics - corticosteroids (more effective in asthmatic symptoms) - combined with inhaler preparation - oral therapy - oxygen therapy - rescue packs - flu + pneumococcal vaccines - non-pharmacological e.g. physiology - mental health review - holistic approach
35
Follow up + monitoring disease progression of COPD
- spirometry - post bronchodilator spirometers should be carried out to confirm diagnosis of COPD - severity of airflow obstruction can be graded according to reduction in patient’s FEV1 - parameters measured when spirometry is carried out include: FEV1, FVC , FEV1/FVC ratio - COPD review
36
Allergies
Reaction to something that is normally harmless e.g. pollen Usually mild but can be life threatening I.e. anaphylaxis
37
Symptoms of allergies
- runny noise/sneezing - pain or tenderness around cheeks, eyes or forehead - coughing, wheezing or breathlessness - itchy skin or raised rash (hives) - diarrhoea - feeling or being sick - swollen eyes, lips, mouth or throat - respiratory + cardiac arrest in severe anaphylaxis Last 2 can be life-threatening Vaccination can lead to anaphylaxis
38
Management of allergies
- symptomatic relief - OTC products such as oral antihistamines, steriod nasal sprays, nasal irrigation, eye drops - avoidance of triggers - 999 for anaphylaxis - adrenaline injections e.g. epipen, jext
39
Redflags
- shortness of breath - unintentional weight loss - can suggest cancer - night sweats - unable to complete full sentence when talking - coughing up blood - chest pain - anaphylaxis

Therapeutics (7 decks)

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