Lungs: Obstructive Conditions - Asthma, COPD, Bronchiectasis Flashcards

1
Q

Risk factors for asthma

A
  • Atopy - asthma/eczema/hay fever
  • allergens, air pollution, smoking
  • isocyanates
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2
Q

Asthma

  • presentation of asthma
  • presentation of acute attack
A

Early onset
Cough - worse at night/in cold/exercise
Variable SOB,
Wheeze, chest tightness

Often triggered by resp infection
-worsening SOB, cough, wheeze not responding to SABA

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3
Q

Asthma

-Investigations, diagnosis

A

Expiratory wheeze
Low PEF

Clinical diagnosis 
If symptomatic
-obstructive spirometry (FER U70%)
-FeNO if also adult//unsure
-BD reversibility of 12%+
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4
Q

Management

  • maintenance and reliever therapy
  • how does each drug work, SE
A

1st line reliever - Salbutamol

  • B agonist => SM relax
  • SE => tremor

1st line maintenance - ICS (stops airways narrowing) if SABA not enough/frequent attacks
2nd line - +LRTA
3rd line- replace LRTA with LABA

ICS SE - oral thrust, children growth stunted
LABA - longer acting SABAs
LTRA PO SE - GI upset, headache
-stops airways narrowing

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5
Q

Moderate asthma attack

-management

A

PER - 50-75%
Normal speech
RR < 25
HR < 110

ADMIT - night, past near fatal, on PO CS, pregnant 
15 NRM and downtitrated to 94-98%
SABA - O2 neb/metered dose
PO prednisolone - 50mg 5 days
Add SAMA if no change
Continue with normal meds

If no change/T2RF => escalate to ITU (intubate, ventilate)

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6
Q

What are the features of a severe asthma attack

Management

A

PER - 33-50%
Incomplete sentences
RR 25+
HR 110+

ADMIT if unresponsive to normal treatment
15 NRM - downtitrated to 94-98%
SABA - O2 neb/metered dose
PO prednisolone - 50mg 5 days
Add SAMA if no change
Continue with normal meds

If no change/T2RF => escalate to ITU
-prep for intubation, ventilation

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7
Q

What are the features of a life threatening asthma attack

  • further investigations
  • management
A
ANY OF THE FOLLOWING
PER - U33%
Silent chest, cyanosis, weak breathing
HR < 110 
BP - hypotensive
pCO2 - normal
SaO2 - U92% => ABG
CXR
Exhausted, confusion
ADMIT
15 NRM - downtitrated to 94-98%
SABA - O2 neb/metered dose
PO prednisolone - 50mg 5 days
Add SAMA if no change
Continue with normal meds

If no change/T2RF => escalate to ITU
-prep for intubation, ventilation

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8
Q

Discharge criteria after asthma attack

A

Stable on discharge meds for 12-24hs without nebs or O2
Inhaler technique checked
PEF 75%+

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9
Q

COPD

-causes and triggers

A

Smoking
a1antitrypsin deficiency - COPD presentation in young with liver signs

Occupational exposures

  • cadmium
  • coal
  • cotton
  • cement
  • grain
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10
Q

COPD

-presentation

A

SOB (load capacity imbalance increases neural drive to breathe)
Wheeze
Sputum
Exercise limitation

High RR, tripod
Decreased chest expansion, barrel chested (hyperinflation)
Decreased BS
Cyanosis, asterixis
Cor pulmonale => RHF
Cachexia
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11
Q

Pathophysiology

  • emphysema
  • bronchitis
A

Emphysema
-oxidative stress => decreased recoil, capillary beds destroyed

Bronchitis
-increased goblet cells, abnormal tissue repair => mucus hypersecretion

BOTH LEAD TO AIRWAY OBSTRUCTION

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12
Q
Classify the severity of COPD
What results would indicate a 
-Mild
-Moderate
-Severe
-V severe
A

FEV1/FVC <0.7, no change in BD test (U12% change)

Mild - FEV1 >80
Moderate - FEV1 50-79
Severe - FEV1 30-49
V severe - FEV1 <30

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13
Q

COPD

-investigations, diagnosis

A

Clinical diagnosis

CONFIRMATION OF DIAGNOSIS - Post BD spirometry FER U70%

CXR
-hyperinflation, bullae, flat hemidiaphragm, RHF
-WANT TO EXCLUDE LUNG CANCER
FBC - polycythemia

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14
Q

Management for stable COPD

  • conservative
  • medical
  • prophylaxis
  • cor pulmonale
  • surgery
A

Smoking cessation
Flu and pneumococcal vaccine
Pulmonary rehab

1st line - SABA/SAMA
2nd line - switch SAMA => SABA
3rd line - if no asthma/steroid response
-add LABA + LAMA
3rd line - if asthma/steroid responsive
-add LABA + ICS
-add LAMA if needed

Azithromycin in
- non smokers, optimised inhaler management
- no bronchiectasis/TB

Cor pulmonale
- loop diuretics in edema
- O2 therapy

Surgery
-valves, coils, bullectomy

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15
Q

Presentation of acute COPD exacerbations

-most common causes

A

Increased SOB, cough, wheeze
Purulent sputum
Hypoxia

Haemophilus influenza, resp viruses

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16
Q

Management of acute exacerbations

A

Target sats

  • 94-98
  • 88-92 if CO2 retainer, T2RF risk

BD, spacer, nebulizers
-SABA, SAMA
Prednisolone 5/7

ABx if evidence of infection
-Amox/clarythromycin/doxy

If T2RF => NIV (bipap)
If 
-SaO2 U88 with max O2
-v acidotic
-unable to protect airway
-haemodynamic instability
=> ICU for invasive vent
17
Q

Bronchiectasis

  • pathophysiology, epidemiolgy
  • causes
A

More prevalent in females, older

Chronic infection/inflammation => permanent dilation of airways

  • post infection - TB, measles, pertussis, pneumonia
  • systemic AI
  • CF
  • bronchial obstruction - lung cancer, foreign body
  • Kartagner syndrome (ciliary dyskinesis)
18
Q

Bronchiectasis

-presentation

A

Persistent purulent sputum
Persistent cough
Recurrent chest infections, frequent COPD/asthma exacerbations
SOB

Coarse crackles, wheeze
Inspiratory squeak
Clubbing

19
Q

Bronchiectasis

-investigations, diagnosis

A

DEFINITIVE DIAGNOSIS - High res CT (signet rings)

AIM TO IDENTIFY UNDERLYING CAUSE

  • Obstructive spirometry
  • Sputum culture - causative organism
  • CXR (tram tracking)
  • CF testing - sweat/gene test
  • Gross AB deficiency testing
20
Q

Bronchiectasis

-management

A

MANAGE UNDERLYING CAUSE
ABx for infective exacerbations
BD
Chest physiotherapy (clear lungs in CF)

Smoking cessation
Pulmonary rehab
Flu, pneumococcal vaccine