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Respiratory finals > Obstructive airway diseases > Flashcards

Obstructive airway diseases Flashcards

1
Q

Define COPD

A

Chronic, progressive lung disease characterised by irreversible airway obstruction
Formally divided into emphysema and chronic bronchitis

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2
Q

Define emphysema

A

Irreversible enlargement of the airways distal to the terminal bronchioles

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3
Q

Define chronic bronchitis

A

Persistent cough present for at least 3 months of the year, for at least 2 years

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4
Q

Describe the epidemiology of COPD

A

Common lung disease worldwide
3rd most common cause of death
Affects older adults (65+)

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5
Q

Describe the aetiology of COPD

A

RFs: smoking, indoor burning of fuel (eg fires), occupational exposure to gases/particles

  1. Chronic airway inflammation
    - > airway remodelling (increased goblet cells, SM hypertrophy, alveolar loss) -> sputum, airway resistance
  2. Cilia dysfunction
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6
Q

Describe the presentation of COPD

A

65+ ex-smoker with

  • Chronic productive cough
  • SOB, esp on exertion
  • Wheeze
  • Weight loss
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7
Q

Describe the signs of COPD on examination

A

General: tachypnoeic, flushing/cyanosis
Hands: palmar erythema, asterixis, cyanosis
Chest: barrel chest, hyper-resonance on percussion, polyphonic wheeze/inspiratory crackles

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8
Q

Describe the investigations for COPD

A

History and examination
Spirometry
Bloods for young patients eg. LFTs
CXR

Exacerbation:

  • Sputum sample
  • ECG
  • Bloods: FBC, CRP, U+Es, ABG, culture
  • CXR
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9
Q

Describe the spirometry results in COPD

A 
Reduced FEV1/FVC (<0.70)
Reduced FEV1 (used to stratify severity)
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10
Q

Describe the long term management of COPD

A

Conservative:

  • Exercise, smoking cessation
  • Vaccination
  • Pulmonary rehab

Medical:

  • Inhaler therapy:
  • 1st line: salbutamol rescue inhaler
  • 2nd line: LABA+LAMA (non-asthmatic features) or LABA+ICS (asthmatic features)
  • 3rd line: triple therapy LABA+LAMA+ICS
  • Prophylactic ABx- frequent exacerbations. Azithro.
  • Additional oral meds: Roflumilast, theophylline
  • Oxygen therapy
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11
Q

Describe the indications for home oxygen therapy

A

Assess ABG on 2 occasions, 3 weeks apart
Suitable for LTOT if: NON smoker +
-PaO2 <7.3 when stable
-PaO2 7.3-8 when stable if also: polycythaemia, pulmonary HTN, RHF

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12
Q

Describe the management of COPD exacerbations

A
  1. Bronchodilators: nebulised/inhaled (specify gas)
  2. Oral corticosteroids: 30mg for 5 days
  3. Antibiotics if indicated. 5 days Amox/doxy/clari. Send sputum culture also
  4. Oxygen therapy (specify sats goal)/ NIV/ invasive ventilation
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13
Q

Define asthma + describe pathophysiology

A

Chronic inflammatory airway disease characterised by
1) intermittent reversible airway obstruction
2) airway hyperresponsiveness
3) airway inflammation
Over time, remodelling occurs w SM hypertrophy, etc

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14
Q

Describe the epidemiology of asthma

A

Very common
Affects developed countries > developing, hygiene hypothesis
Genetic predisposition

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15
Q

Describe the presentation of asthma

A

Episodes of:
-Dry cough, worse at night. Diurnal variation
-Wheeze
-SOB
-Chest tightness
Various triggers: exertion, cold weather, allergens, viral infection
Between episodes, symptom free

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16
Q

Describe the signs of acute + chronic asthma on examination

A

General: tachypnoea, tachycardia, increased work of breathing + use of accessory muscles, cyanosis, difficulty speaking, drowsiness, etc
Chest: widespread polyphonic wheeze -> quiet chest, hyperinflated chest + Harrison’s sulci (chronic)

17
Q

Describe the different severity of asthma attacks (criteria)

A

Mod:

  • Normal sats
  • PEFR >50% expected

Severe:

  • PEFR 33-50% expected
  • RR >25, HR >110
  • Unable to complete full sentences

Life-threatening:

  • PEFR <33% expected
  • Silent chest
  • Drowsy/exhausted
  • Cyanotic
  • Sats <92%
  • Rising PaCO2
18
Q

Describe the investigations for chronic asthma

A

History + examination suggestive ->

  • Offer FeNO test (>40 is positive)
  • Offer spirometry (<0.70 is Dx of obstructive disease) + reversibility test (^ of 12% is significant)
    1. Dx uncertainty: monitor PEF variability for 2-4 weeks (>20% is positive)
    2. Dx clear: start treatment
19
Q

Describe the management of chronic asthma

A

Conservative:

  • Education, avoid triggers
  • Smoking cessation
  • Vaccinations

Medical:
All patients: SABA- salbutamol PRN
-1st step: SABA + low dose ICS BD
-2nd step: SABA + ICS + LABA (BTS) or LTRA (NICE)
-3rd step: increase dose of ICS to medium. Stop LABA if not effective. Add LTRA/LABA
-4th step: refer.

20
Q

Describe the management of acute asthma

A

History + exam / A to E approach

  • Measure sats + give high flow O2 if required
  • Gain IV access, take bloods and ABG if needed

Mx:

  • Mod attack: inhaled SABA
  • Sev/life-threatening:
    1. Nebulised SABA (5mg every 20-30mins)
    2. Nebulised ipratropium (0.5mg 4-6hourly)
    3. Oral steroids (PO pred 40-50mg)
    4. IV Mg sulphate (1.2-2g infusion over 20mins)
    5. IV SABA
    6. IV aminophylline

Monitoring:

  • Cont sats monitoring
  • PEFR after 15-30 mins, repeat as needed
21
Q

When should inhaled steroids be considered?

A

In anyone who has:

  • Had an asthma attack
  • Using SABA >3x/week
  • Symptomatic 3x/week or more
  • Waking during the night (1+/week)
22
Q

Describe the important parts of an asthma review

A

-Current medication
-Symptom control: frequency per week, asthma control score etc
-Bronchodilator use frequency
-Asthma attacks/ED visits/hospitalisations
-ICE
If poor control: medication adherence, inhaler technique

23
Q

Describe the side effects of beta 2 agonists

A 
Tachycardia, palpitations
Sweating
Tremor
Anxiety
**Increased risk of death with LABA alone (without ICS)
Caution in CVD
24
Q

What is the typical dose of salbutamol?

A

100-200mcg, up to 4x daily

25
Q

Describe the epidemiology of OSA

A

Relatively common. M > F

Associated w overweight/obesity

26
Q

Describe the pathophysiology of OSA

A

During sleep, reduced NM tone -> collapse of pharynx on expiration -> breath-holding episodes -> rise in CO2 and drop in O2 -> waking and SNS arousal -> breathing

27
Q

Describe the presentation of OSA

A

Snoring and gasping/apnoiec episodes
Unrefreshing sleep, waking from sleep
Morning headaches
Daytime sleepiness

28
Q

Describe the investigations for OSA

A
  • History and exam (collateral)
  • Scoring: Epworth Sleepiness Scale
  • Fibreoptic endoscopy in clinic to assess tonsils etc
  • Polysomnography is diagnostic/ home sleep study

+ consider testing RFs eg. lipids, HbA1c, BP, ECG, etc

29
Q

Describe the management of OSA

A

Conservative:

  • Weight loss
  • Oral appliances

Medical:

  • RF management
  • CPAP

Surgical:

  • Upper airway surgery if physical problem or unresponsive patients
  • Hypoglossal nerve stimulation
30
Q

Describe the complications of OSA

A

Increased risk of:

  • T2DM
  • CVD
  • Depression
  • Motor vehicle accidents

Respiratory finals (5 decks)

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