lecture 11 - acute asthma and copd

Question 1

what are signs and symptoms of moderate asthma?

Answer 1

PEFR 50-75% best or predicted

no features of acute severe asthma

Question 2

what are signs and symptoms of severe asthma?

Answer 2

1 of the follwoing

PEFR 33-50% of predicted / best

unable to speak in sentences

respiratory rate > 25

pulse > 110

Question 2

what is the treatment for severe asthma?

Answer 2

referral to hospital – may not need admission
Oxygen 40 – 60% via a Venturi mask
oral corticosteroid
As prednisolone 40 – 50 mg
Nebulised SABA
Nebulised SAMA if needed

Question 3

what is the treatment for life threatening asthma ?

Answer 3

immediate hospital admission
Nebulised beta agonists & ipratropium (oxygen as the driving gas)
Oral corticosteroids – prednisolone 40 – 50 mg daily
Oxygen if SpO2 < 92%, PEFR < 60% normal/best; Target 94-98%
IV aminophylline, salbutamol or terbutaline
IV magnesium may be useful
IV fluids/electrolytes especially K

Question 4

what is monitored in patients with asthma

Answer 4

BOPR

blood gasses if indicated
oxygen saturation aim for 94-98%
pulse, PEFR
respiratory rate

Question 5

what drugs are used for mild copd treatment?

Answer 5

treat with short acting bronchodilators eg salbutamol

Question 6

what drugs is used for moderate copd treatment?

Answer 6

sabas with antibiotics and or oral corticosteroids

Question 7

what is sued for the treatment of severe copd?

Answer 7

Hospitalization required and may be associated with acute respiratory failure

Question 8

what are the symptoms of exacerbations of copd ? x5

Answer 8

Increased breathlessness
Increased cough
Increased sputum volume or purulence
Increased wheeze
Increased chest tightness
-Malaise, reduced exercise tolerance, peripheral oedema, accessory muscle use, confusion, cyanosis

Question 9

what are the causes of exacerbations?

Answer 9

viral, bacterial, environmental pollutants

bacterial - pathogenic bacteria can be grown from sputum in clinically stable patients with copd

Question 10

what is used for the treatment of copd?

Answer 10

bronchodilators
- salbutamol and terbutaline + _ tioproium
- nebulised using air not ocygen
- inhaler may be suitable

prednisolone - 30mg for 7 to 14 days

oxygen
- 24 or 28% oxygen via mask. maintain oxygen saturation between b88 and 92%. check arterial blood goes for rise in co2.
high flow oxygen may kill patients with type II respiratory failure and COPD which is why we use air

Question 11

what bacteria can cause exacerbation of copd and what is the treatment?

Answer 11

strep pneumonia, haemophilic influenzae, moraxella catarrhalis

treatment: amoxicillin 500mg every 8 hrs, doxycycline 200mg as a single dose then 100mg each day, clarithromycin 500mg every twelve hours