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Gen Med (Resp) > Obstructive Lung Disease > Flashcards

Obstructive Lung Disease Flashcards

1
Q

Which two conditions can be complicated by allergic bronchopulmonary Aspergillosis?

A

Asthma and CF

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2
Q

Allergic bronchopulmonary Aspergillosis is diagnosed by detected very high levels of what in the blood?

A

IgE

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3
Q

If someone aspirates a foreign body, which bronchus is it most likely to get stuck in?

A

Right inferior lobe bronchus

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4
Q

What is a clinical sign that is very specific to large airway obstruction, and should always be thoroughly investigated?

A

Stridor (inspiratory wheeze)

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5
Q

What are some investigations which may be performed in someone with a suspected large airway obstruction? Which is the most sensitive test?

A

Imaging (x-ray/CT) of the chest and neck, spirometry and bronchoscopy (the most sensitive test)

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6
Q

What medical therapy should be prescribed for a patient with newly diagnosed asthma (aged 17+) who has an infrequent, short-lived wheeze and normal lung function?

A

SABA only

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7
Q

After starting/stopping a medication for asthma, how long should the new treatment regime be followed before considering making changes?

A

4-8 weeks

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8
Q

What medical therapy should be prescribed for a patient with newly diagnosed asthma (aged 17+) who has symptoms which indicate the need for maintenance therapy at presentation?

A

SABA + low-dose ICS

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9
Q

What medical therapy should be prescribed for an adult whose asthma remains uncontrolled following 4-8 weeks of treatment with a SABA alone?

A

Low-dose ICS

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10
Q

If an adult’s asthma remains uncontrolled following 4-8 weeks of treatment with a low-dose ICS and SABA, what treatment regimen should be tried next?

A

SABA + low-dose ICS + LTRA

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11
Q

You can consider decreasing maintenance therapy for asthma when symptoms have been controlled with current maintenance therapy for how long?

A

At least 3 months

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12
Q

If an adult’s asthma remains uncontrolled following 4-8 weeks of treatment with a SABA, low-dose ICS and LTRA, what treatment regime can be tried next?

A

SABA + low-dose ICS + LABA +/- LRTA

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13
Q

In COPD, what combination of drugs is superior to any drug alone at increasing FEV1?

A

LABA + LAMA

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14
Q

Which vaccinations should be offered to all COPD patients?

A

Pneumococcal and influenza

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15
Q

If inhaled therapies are required for COPD, which medications can be offered first line to use as required?

A

SABA or SAMA

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16
Q

What medical therapy should be offered to patients with COPD who are limited by symptoms or have exacerbations despite treatment with a SABA or SAMA, and have no asthmatic features suggestive of steroid responsiveness?

A

LABA + LAMA (in addition to SABA or SAMA)

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17
Q

What medical therapy should be offered to patients with COPD who are limited by symptoms or have exacerbations despite treatment with a SABA or SAMA, and have asthmatic features, or features suggesting steroid responsiveness?

A

LABA + low-dose ICS (in addition to SABA or SAMA)

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18
Q

Give 5 examples of anti-inflammatory medications which can be used in the treatment of asthma and COPD?

A

Corticosteroids, cromones, LTRAs, methylxanthines, anti-IgE monoclonal antibodies

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19
Q

How can steroids be given in the treatment of asthma and COPD? Give an example of each type?

A

Inhaled (beclomethasone), oral (prednisolone), IV (hydrocortisone)

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20
Q

Name some side effects of inhaled corticosteroids?

A

Hoarse voice, oral candidiasis, increased risk of pneumonia (only in COPD)

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21
Q

Which medications should be given via a nebuliser in acute severe asthma?

A

Salbutamol (5mg) + ipratropium bromide (500mcg)

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22
Q

Which medications can be given IV in acute severe asthma?

A

Hydrocortisone (200mg) and magnesium sulphate (2g)

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23
Q

COPD is characterised by largely irreversible airway obstruction. This is an umbrella term for which conditions?

A

Chronic bronchitis and emphysema

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24
Q

What is the most effective way to prevent COPD?

A

Stop smoking

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25
Q

Which 3 inflammatory cells are most involved in the pathophysiology of COPD?

A

CD8+ lymphocytes, neutrophils and macrophages

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26
Q

What are the 3 main pathological features of COPD?

A

Hypersecretion of mucus, small airway obstruction and alveolar destruction

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27
Q

When would cromones be used?

A

Prophylaxis of allergic asthma in children

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28
Q

Give an example of a monoclonal IgE antibody?

A

Omalizumab

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29
Q

How are monoclonal IgE antibodies given?

A

As an IV injection every 2-4 weeks

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30
Q

What is the mechanism of action of methylxanthines?

A

Non-selective phosphodiesterase inhibitors

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31
Q

Give two examples of methylxanthines?

A

Theophylline and aminophylline

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32
Q

How can methylxanthines be given?

A

Oral or IV

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33
Q

Give an example of a leukotriene receptor antagonist?

A

Montelukast

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34
Q

How are leukotriene receptor antagonists given?

A

Orally

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35
Q

What kind of drug is carbocysteine?

A

Mucolytic

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36
Q

Symptoms of a COPD exacerbation are often preceded by what other symptoms?

A

Coryzal symptoms

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37
Q

If a patient with a COPD exacerbation presents with confusion and drowsiness, what should you suspect?

A

Type II respiratory failure

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38
Q

How should a COPD exacerbation be treated?

A

Prednisolone (30mg od) and amoxicillin (500mg tds) for 5 days

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39
Q

Which antibiotic should be used second line for a COPD exacerbation if the patient is penicillin allergic?

A

Doxycycline

40
Q

What are the features of alpha-1-anti-trypsin deficiency?

A

Emphysema and liver cirrhosis

41
Q

What is the most prominent feature of chronic bronchitis?

A

Chronic cough with purulent sputum production

42
Q

What is the most prominent feature of emphysema?

A

Dyspnoea

43
Q

What are some clinical signs of chronic bronchitis?

A

Cyanosis (due to hypoxaemia) and peripheral oedema (due to cor pulmonale)

44
Q

What are some potential complications of chronic bronchitis?

A

Polycythaemia, pulmonary hypertension and cor pulmonale

45
Q

What diagnosis should you suspect in someone who is a smoker, presenting with features of both COPD and asthma?

A

Asthma-COPD overlap syndrome (ACOS)

46
Q

A PEFR of what would be suggestive of severe asthma?

A

30 - 50% of predicted/previous best

47
Q

A PEFR of what would be suggestive of life-threatening asthma?

A

< 30% of predicted/previous best

48
Q

Name some features of severe asthma?

A

Unable to complete sentences, tachycardia/tachypnoea

49
Q

Name some features of life-threatening asthma?

A

Central cyanosis, silent chest, acidosis, bradycardia/hypotension

50
Q

Describe the initial management of acute severe asthma before any drugs are given?

A

Sit the patient upright and administer high flow O2 through a non-rebreather mask

51
Q

Give two examples of groups of bronchodilators (i.e. relievers) used in the treatment of asthma?

A

SABAs, LABAs

52
Q

Give two examples of groups of anti-inflammatory drugs (i.e. preventers) used in the treatment of asthma?

A

Corticosteroids and monoclonal IgE antibodies

53
Q

Give two examples of groups of drugs which act as both relievers and preventers in the treatment of asthma?

A

LTRAs and methylxanthines

54
Q

Asking what question can give an idea of how good an individual’s asthma control is? What answer would indicate poor control?

A

How often do you use your salbutamol inhaler? Using it several times a day would indicate poor control

55
Q

The mainstay of treatment of asthma is with what?

A

Regular inhaled corticosteroids

56
Q

Asthma exacerbations requiring hospitalisation are usually preceded by what?

A

A period of poor control (increased use of bronchodilator and worsening of symptoms)

57
Q

Describe the airway obstruction which occurs in asthma?

A

Variable airway obstruction (which is fully reversible in the early stages)

58
Q

Which two types of inflammatory cell are most involved in the pathogenesis of asthma?

A

Eosinophils and CD4+ lymphocytes

59
Q

What are the three ways in which inflammation narrows the small airways in asthma?

A

Smooth muscle constriction, increased mucus secretion, oedema

60
Q

The airway narrowing seen in asthma leads to a reduction in which lung volumes?

A

FEV1 and PEFR

61
Q

What are some non-pharmacological ways of preventing asthma?

A

Stop smoking, lose weight, avoid allergens

62
Q

What are the three most common symptoms of asthma?

A

Wheeze, dry cough, dyspnoea

63
Q

What treatment should be offered to someone with COPD who remains uncontrolled on either a LABA + LAMA or LABA + low-dose ICS combination?

A

LABA + LAMA + low-dose ICS

64
Q

Which medication should never be used as monotherapy in the treatment of COPD?

A

Corticosteroids

65
Q

What is the mechanism of action of bronchodilators?

A

Airway smooth muscle relaxation

66
Q

Name 5 types of bronchodilator which can be used in the management of asthma and COPD?

A

Beta 2 agonists, muscarinic antagonists, LRTAs, methylxanthines, magnesium

67
Q

In what forms can beta agonists medications be given?

A

Inhaled, oral or IV

68
Q

On which receptors do beta agonists exert their effect?

A

Beta 2 receptors

69
Q

Name some potential side effects of beta 2 agonists?

A

Tachycardia, fine tremor and hypokalaemia

70
Q

Name two examples of SABAs?

A

Salbutamol and terbutaline

71
Q

Name two examples of LABAs?

A

Salmeterol and formoterol

72
Q

How long do the effects of SABAs and LABAs last for?

A

SABAs last 3-5 hours, LABAs last 8 hours

73
Q

Which receptors do anti-cholinergic drugs used in the treatment of COPD and asthma act on?

A

M3 muscarinic receptors

74
Q

Which neurotransmitter acts on the M3 muscarinic receptors to cause bronchoconstriction?

A

Acetylcholine

75
Q

Give an example of a SAMA?

A

Ipratropium

76
Q

Give an example of a LAMA?

A

Tiotropium

77
Q

What is the most common side effect of inhaled anti-cholinergic medications?

A

An unpleasant taste

78
Q

What will PFTs of a large airway obstruction show?

A

Spirometry will show an obstructive pattern, PEFR will be reduced

79
Q

Why may biopsies be dangerous in those with severe airway obstruction?

A

Risk of bleeding/oedema which will worsen the obstruction

80
Q

Describe the management of an acute large airway obstruction?

A

High flow oxygen, high dose corticosteroids, nebulised bronchodilators and adrenaline, inubation/surgery

81
Q

What are some risk factors for the development of asthma?

A

Personal/family history of atopy, bronchiolitis in childhood, premature/low birth weight, childhood exposure to tobacco smoke

82
Q

What are some examples of drugs which are known to be triggers for asthma?

A

Beta blockers and NSAIDs

83
Q

Describe the diurnal variation which may be seen in asthma?

A

Worse through the night and on wakening

84
Q

Between episodes of asthma, there are usually no clinical signs. However, during periods of poor control, what may be audible?

A

Expiratory wheeze

85
Q

During symptomatic periods of asthma, what may spirometry show?

A

Reduced FEV1: FVC ratio, and improvement in FEV1 by > 15% after bronchodilator therapy

86
Q

What medication is required for all patients diagnosed with asthma?

A

SABA

87
Q

What happens to the residual volume and total lung capacity in COPD?

A

Increased (as a result of air trapping)

88
Q

What are some clinical signs of emphysema?

A

Accessory muscle use, cachexia, hyperinflated ‘barrel’ chest

89
Q

What is a potential complication of emphysema?

A

Pneumothorax

90
Q

Describe what the FEV1: FVC ratio should be to diagnose COPD?

A

Decreased, < 75%

91
Q

Name three bacteria which may colonise individuals with COPD?

A

Haemophilus influenzae, Strep pneumoniae, Moraxella catarrhalis

92
Q

If an infection is suspected in somebody with COPD, what microbiology investigations may be required?

A

Sputum +/- blood cultures

93
Q

What investigation is used to diagnose COPD?

A

Spirometry

94
Q

Patients with severe COPD may show what on an ECG?

A

Signs of right heart strain

95
Q

What investigation should be performed in all acute cases of COPD, and in those chronic cases showing hypoxia?

A

ABG

96
Q

Name the non-pharmacological treatment options for COPD?

A

Smoking cessation, pulmonary rehab, non-invasive ventilation, palliative care input

97
Q

Which COPD patients are offered ambulatory oxygen therapy?

A

Those with a PaO2 < 7.3kPa on two blood gas samples, two weeks apart

Gen Med (Resp) (4 decks)

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