Obstructive Diseases Flashcards
risk factors of COPD
tobacco smoking
occupational exposure to noxious particles
alpha-1-antitrypsin deficiency
MH of asthma/recurrent infection in childhood
symptoms of COPD
chronic productive cough
dyspnoea
wheeze
reduced exercise tolerance
signs of COPD
cyanosis
hyperinflation of chest - Barrel appearance
use of accessory muscles
purse lips during breathing
differentials of COPD
asthma
bronchitis
cor pulmonale
congestive heart failure
definition of COPD
an irreversible obstruction of airways that comprises of both chronic bronchitis and emphysema
gold standard investigation of COPD
spirometry
- shows FEV1:FVC <0.7
- no improvement with SABA
additional investigations of COPD
bloods - FBC, U+E, CRP and serum alpha-1 antitrypsin
sputum cultures
CXR and CT thorax
ECG
conservative management of COPD
smoking cessation
annual influenza vaccinations
pulmonary rehabilitation
long-term medical management of COPD
step 1: SABA or SAMA
step 2: if no asthma or steroid responsiveness = LABA/LAMA or if have asthmatic/steroid response, LABA and ICS
step 3: LAMA, LABA and ICS
step 4: refer to specialist
additional medical management of COPD
nebulisers
long-term oxygen therapy
oral theophylline
management of COPD exacerbations (if can remain home)
ICS with prednisolone
if have signs of infection, antibiotics
management of acute COPD exacerbations
carry out CXR and ECG bloods - FBC, U+E, ABG sputum cultures maintain O2 sats (88-92%) provide nebulised bronchodilators oral and IV steroids
management if not responding to 1st line hospital treatment
IV aminophylline
non-invasive ventilation
referral to HDU/ICU
define asthma
a paroxysmal and reversible obstruction of the trachea and bronchi that occurs due to increased responsiveness of airways to induce narrowing
describe asthma pathophysiology
disease of the lung airways mediated by immune system, triggering inflammation, bronchospasms and excessive mucous secretion
risk factors of asthma
familial history of asthma maternal smoking in pregnancy occupational hazards poor diet obesity
symptoms of asthma
wheeze dyspnoea nocturnal cough chest tightness symptoms worse in morning/night FH or MH of atopy
signs of asthma
tachypnoea hyperinflated chest hyper-resonance on chest percussion decreased air entry wheeze on auscultation
signs of severe asthma attack
inability to speak in complete sentences
respiratory rate >25
peak flow 33-50%
sings of life threatening asthma attack
silent chest confusion bradycardia cyanosis exhaustion
investigations in chronic asthma
peak flow
spirometry - FEV1/FVC < 0.7 that improves with use of SABA
investigations in acute asthma
ABG - check for respiratory failure
routine bloods - FBC and CRP to check for infection
CXR
management of acute asthma attack
ensure patent airway ensure O2 sats 94-98% salbutamol and ipratropium nebulisers oral prednisolone or IV hydrocortisone if severe IV MgSO4 (if severe)
if no response to nebulisers in acute asthma attack, what are next steps?
IV aminophylline
ICU admission
invasive ventilation
conservative management in chronic asthma
smoking cessation
avoid precipitating factors
review inhaler technique
pharmacological management of chronic asthma
step 1: SABA
step 2: SABA and ICS
step 3: either LABA or increased ICS dose
step 4: oral leukotriene receptor antagonists, high-dose ICS and SABA/LABA
differentials of asthma
GORD ABPA bronchiectasis heart failure malignancy
risk factors of paediatric asthma
premature birth low birth weight FH of asthma/atopic disease exposure to tobacco smoking maternal smoking respiratory infection
clinical features of asthma in children
wheeze
shortness of breath (dyspnoea)
cough (dry and brought on by exercise)
differential diagnosis of paediatric asthma
cystic fibrosis TB foreign body aspiration pertussis bronchitis
investigations in paediatric asthma
peak expiratory flow
spirometry
- FEV1 must improve >14% with use of ICS to indicate asthma
conservative management of paediatric asthma
recommend adults in living environment cease smoking
identify and reduce exposure to environmental triggers
promote and advise healthy and active lifestyle
when are medical interventions considered in paediatric asthma
when symptoms causing significant impact on QoL
medical management of paediatric asthma
step 1: SABA
step 2: SABA + low dose ICS
step 3: SABA, ICS and LABA/LTRA
step 4: addition of theophylline
when do you utilise LABA vs. LTRA in paediatric asthma
inhaled LABA in >5 year old
LTRA in < 5 years
define obstructive sleep apnoea
occurs when there is intermittent closure and collapse of the upper airway, causing apnoeic episodes during sleep that cease with partial waking
name the two categories of sleep obstructive apnoea
apnoea if intermittent collapse >10s
hypnoea if intermittent collapse <10s
risk factors in obstructive sleep apnoea
male sex smoking obesity sedative drugs FH of obstructive sleep apnoea
clinical features of obstructive sleep apnoea
excessive sleepiness in the daytime lack of concentration morning headaches decreased libido restless/poor quality sleep loud snoring
differentials of obstructive sleep apnoea
depression
narcolepsy
excessive alcohol consumption
hyperthyroidism
investigations of obstructive sleep apnoea
polysomnography (sleep study)
blood pressure
bloods - ABG and TFTs (exclude hyperthyroidism)
pulse oximetry during sleep
Epworth Questionnaire (if score >11 = abnormal)
what are the requirements of diagnosis for obstructive sleep apnoea
> 5 episodes of waking respiratory events per hour of sleep
conservative management of obstructive sleep apnoea
weight loss
education of patient and family on OSA
good sleep hygiene and lying on side
avoidance of stressful situations and triggers
medical management of obstructive sleep apnoea
modafinil to aid excessive daytime sleepiness
continuous positive airway pressure (CPAP)
requirements for surgery in obstructive sleep apnoea
failure of CPAP and oral appliances can indicate consideration of tonsillectomy or polypectomy
common complications of obstructive sleep apnoea
risk of accidents due to ⬇️ concentration and ⬆️ sleepiness
hypertension
psychological consequences
define cystic fibrosis
an autosomal recessive disorder that causes mutations within the CFTR gene on chromosome 7
result of the CFTR gene mutation in cystic fibrosis
mutation causes dysfunction of the CFTR gene that reduces chlorine ion absorption, causing sweat to contain high sodium levels and increase viscosity of other secretions
risk factors of cystic fibrosis
known carrier status of parents
FH of cystic fibrosis
caucasian descent
clinical features of CF in neonates
failure to thrive
malabsorption
recurrent/persistent chest infections
rectal prolapse
clinical features of CF in children
cough, wheeze and haemoptysis bronchiectasis recurrent lower resp tract infections pancreatic insufficiency distal intestinal obstruction male infertility clubbing osteoporosis
differential diagnosis of CF
malignancy
investigations of CF in neonates
heel prick (day 5-9)
sweat test - Na and CL >60mmol/L
faecal elastase
genetic screening
investigations of CF in children
sputum culture/throat swab if have presentation of resp tract infection
spirometry
faecal fat and elastase test
common blood tests carried out in CF
FBC, U+Es, LFTs, clotting, vitamin A,D+E and glucose tolerance
imaging modalities used in CF
abdominal US - signs of liver cirrhosis, chornic pancreatitis or distal intestinal obstruction
CXR - hyperinflation and bronchiectasis
conservative management of CF
education on condition and support groups
psychosocial, fertility and genetic counselling
dietician
chest physiotherapy
screening for complications
medical management of CF
GI insufficiency: insulin replacement oral pancreatic enzyme (creon) fat-soluble vitamin supplements ursodeoxycholic acid
respiratory infections:
antibiotics
nebulised mucolytics
bronchodilators
management of advanced lung disease in CF
home oxygenation and CPAP
lung transplant
diuretics (signs of cor pulmonale)
postural drainage
common complications of CF
diabetes development
liver disease
infections
