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Respiratory System > Obstructive Pulmonary Diseases + Smoking Cessation > Flashcards

Obstructive Pulmonary Diseases + Smoking Cessation Flashcards

1
Q

What is the main mechanism of asthma?

A

Hypersensitivity type 1 reaction

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2
Q

what immunoglobulin is raised in asthma?

A

IgE (allergy)

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3
Q

what are the two main physiological features which cause asthma?

A

inflammation

bronchoconstriction

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4
Q

what types of cells mediate asthma?

A

mast cells

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5
Q

what is the reaction cascade to asthma antigens?

A

antigens picked up by IgE
IgE + antigens binds to mast cells
mast cells release histamine
histamine causes inflammation/bronchospasm

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6
Q

what are the main risk factors for asthma?

A
  1. atopy/allergy
  2. occupation
  3. smoking
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7
Q

what is the concept of grandmother effect in asthma?

A

if mother/grandmother smokes during pregnancy, child/grandchild higher risk of developing asthma

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8
Q

what are some other potential risk factors for asthma?

A

obesity
diet
exposure (eg farms)

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9
Q

what are the main symptoms of asthma in adults?

A

wheeze
cough (dry or productive)
dyspnea

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10
Q

what can be other causes for obstructed airflow and asthma-like symptoms?

A

localised - tumour, foreign objects

generalised - COPD, bronchiectasis, bronchiolitis, CF

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11
Q

what should be investigated in the PMH of suspected asthma patients?

A

previous asthma
childhood bronchitis
other allergies (eczema, hayfever)

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12
Q

what should be investigated in the DH of suspected asthma patients?

A

if they are on inhalers, NSAIDS

what effects those drugs have/have had

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13
Q

what should be investigated in the FH and SH of suspected asthma patients?

A

FH: atopy
SH: occupation, pets, smoking, psychosocial factors

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14
Q

what is the MAIN investigation to be done in asthma patients?

A

spirometry

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15
Q

what should be the next step in diagnosing asthma and why, if spirometry shows an airflow obstruction?

A

lung function tests (helium and carbon monoxide)

to help rule out COPD

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16
Q

what investigation should be done after lung function tests and why, if the spirometry showed an obstructed airflow?

A

reversibility tests with salbutamol (short term) and prednisolone (long term)
to rule out COPD, which isn’t reversible

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17
Q

what is the protocol for reversibility testing in asthma with beta agonists?

A

spirometry at baseline and 15 mins after beta agonist is given
inhaled salbutamol 400microliters
nebulised salbutamol 2.5-5mg

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18
Q

what is the protocol for reversibility testing in asthma with inhaled corticosteroids?

A

spirometry at baseline and 2 weeks, along with PEF chart/meter
prednisolone for 2 weeks, 0.6mg/kg

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19
Q

what investigation should be done next in asthma diagnosis if spirometry looks normal?

A

PEFR for two weeks, twice a day

occupational asthma testing

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20
Q

how is occupational asthma tested?

A

PEFR for >5 days, every two hours

for specialist: FeNo, bronchial stimulation, colophony

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21
Q

what is the best way to assess asthma severity and the measurements which allow Jr drs to address it?

A 
HARPO
Heart rate <110
Ability to speak - yes
Resp rate <25
PEF >50%
O2 - sats >92%, PaO2 >8kPa
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22
Q

What is a sign of a near fatal asthma attack?

A

raised CO2

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23
Q

what are some of the signs of life threatening asthma?

A 
cyanosis
extreme tiredness/not conscious
inability to speak (grunting)
extreme tachycardia or bradycardia 
low RR
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24
Q

what are some other useful investigations in diagnosing asthma/ruling out other causes?

A

CXR
FBC (for eosinophils)
IgE levels (for atopy)
skin prick (for atopy)

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25
Q

how are the investigations for COPD similar to the ones for asthma?

A

COPD investigations are the same as the ones done when spirometry for asthma diagnosis shows obstructed airflow

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26
Q

how can asthma be managed non-pharmacologically?

A

exercise
stop smoking
weight loss
remove triggers

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27
Q

what is the approach of pharmacological asthma treatment?

A

stepped approach
Short acting beta agonists (salbutamol) to relieve symptoms
- inhaled ICS low dose
- low dose ICS and/or add LABA
- increase ICS +/- keep LABA
- ICS + LABA + LAMA/theophylline/leukotriene receptor antagonist
- add a fourth drug
- long term prednisolone or other specialist therapies

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28
Q

what are options of specialist therapy in asthma?

A

long term oral prednisolone
interleukin-5 antagonist
IgE antagonist
bronchial thermoplasty

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29
Q

what is the approach to mild/moderate acute asthma attacks?

A

increase inhaler they are already on
oral steroid
treat trigger
review and follow up

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30
Q

what is the approach to severe asthma attacks?

A 
nebulised salbutamol + ipratropium
oral/IV steroid
magnesium
aminophylline
treat trigger
ITU care
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31
Q

what are the different types of inhalers available?

A

pMDI - meter dose inhalers
pMDI with spacers
DPI - dry powder inhalers

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32
Q

what is the name of the most commonly used ICS for asthma in adults and children?

A

beclomethasone

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33
Q

what are the commonly used SABAs in asthma?

A

salbutamol

terbutaline

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34
Q

why should long term (>3 weeks) prednisolone not be stopped suddenly?

A

because it may cause acute adrenal insufficiency (failure of the adrenal gland to make its own glucocorticoid)

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35
Q

what is a common brand of leukotriene receptor antagonist often used?

A

montelukast

36
Q

what tests should be done for asthma in children?

A

none

37
Q

what symptoms need to be present in paediatric asthma?

A

WHEEZE!!
cough
atopy (parents have asthma)
SOB at rest

38
Q

what should be given as trial for in children with potential asthma?

A

Salbutamol (SABA) as and when.

If SABA used more than 3x per week, ICS two months

39
Q

what are other possible diseases in children which could mimic asthma?

A 
if younger than 6mts/older than 4yrs:
bronchitis
pertussis
cystic fibrosis
normal cough
congenital disease
40
Q

how should asthma be treated in children?

A

stepped approach

  1. SABA
  2. ICS very low dose/LTRA
  3. ICS + LABA/LTRA/increase ICS
41
Q

what should be done if a child doesn’t respond with dual treatment of ICS and long acting bronchodilators?

A

Specialist referral for long term corticosteroid treatment

42
Q

what is the main proven side effect of prolonged use of ICS in children?

A

growth suppression

43
Q

what are the main considerations of LABAs in children?

A

never give without ICS

give in fixed-dose inhalers

44
Q

what mechanism of inhalers should and should not be used in children?

A

pMDI with spacer, never without
DPI (if older than 8)
NO NEBULISER

45
Q

when should montelukast be given in children and why?

A

when they are under 5

tablet, easier to take so better compliance

46
Q

what non-pharmacological measures should be taken to improve asthma in children?

A

stop exposure to smoke

stop exposure to allergens (pets etc)

47
Q

how should acute treatment of asthma be treated and based on what?

A

use HARPO criteria
SABA
oral prednisolone/ipratropium
hydrocortisol/aminophylline

48
Q

what is the main difference in asthma between prescribing acute and long term oral corticosteroids?

A

acute - no need to refer

long term - refer to specialist

49
Q

what route should corticosteroids be given in acute management of asthma and why?

A

always oral

inhalers won’t help because they are PREVENTATIVE

50
Q

what is the reasoning behind prescribing ICS and SABA in asthma?

A

ICS - preventative

SABA - symptom relief

51
Q

should oral beta agonists be used in children with asthma?

A

no

52
Q

should nebulisers be used routinely in children with asthma?

A

no

53
Q

Which gender is more affected by COPD?

A

Males

54
Q

What ranking does COPD have in UK and global for leading causes of death?

A

UK - 6th

Global - 5th

55
Q

How many people in the UK have COPD and how many deaths occurs per year as a result?

A

1-2 million people

30,000 deaths

56
Q

How many acute hospitalisations in UK occur due to COPD?

A

10%

57
Q

What is the main underlying mechanisms of COPD?

A

Chronic bronchitis

Emphysema

58
Q

What are the main non-smoking causes of COPD?

A

Chronic asthma

Alpha 1 antitripsin deficiency

59
Q

How do chronic bronchitis and emphysema contribute to symptoms?

A

Chronic bronchitis - long term inflammation

Emphysema - destruction and collapse of alveolar spaces, difficult breathing

60
Q

How can COPD lead to cor pulmonale and RVF?

A

Hypoxaemia —> pulmonary vasoconstriction/polycythaemia —> increased resistance —> pulmonary hypertension —> RV enlargement and failure

61
Q

What are the possible types of emphysema?

A

Centriacinar
Panacinar
Periacinar (bullae)

62
Q

What are some signs of COPD?

A 
Finger clubbing 
Cor pulmonale/RVF
Peripheral oedema
Reduced breath sounds
Hyperinflated chest
Pursed lip breathing 
Cyanosis
CO2 flap/SABA tremor
63
Q

What are some symptoms of COPD?

A 
Cough
Sputum
Wheeze
Recurrent RTI’s
SoB on exertion/rest
Weight loss
Peripheral oedema
64
Q

What are the main investigations?

A

Spirometry —> LFT —> reversibility tests (SABA and ICS)

65
Q

What are other useful investigations in diagnosing COPD?

A 
CXR
ECG
FBC/U&amp;E
Alpha1antitrypsin tests
ABG
66
Q

What is the main non-pharmacological management of COPD?

A

Stop smoking
Nutritional support
Respiratory physio
Vaccinations

67
Q

What are the main pharmacological treatments for chronic COPD?

A

Stepped approach:

  • SABA
  • LAMA/LABA
  • LAMA + LABA
  • ICS + the above (triple therapy)

Other:
Long term O2 therapy

68
Q

What are the main differences in symptoms between asthma and COPD?

A

COPD not reversible and normally comes with sputum

Asthma reversible with treatment and doesn’t normally present with sputum

69
Q

What is the management for acute exacerbation of COPD?

A 
Nebulised SABA + SAMA
oral prednisolone (or IV hydrocortisone)
Antibiotics (if infection caused exacerbation)
Aminophylline
O2/NIV
70
Q

What are some of the investigations to do in acute exacerbations of COPD?

A 
FBC/U&amp;E
Blood/sputum cultures 
CXR
Theophylline concentration (if pt takes it)
ECG
ABG
71
Q

What are some possible symptoms of acute exacerbation of COPD?

A 
Increased cough 
Lots of (purulent) sputum
Severe SoB
Cyanosis
Altered consciousness
Pyrexia (infection)
72
Q

Why should you be careful when prescribing oxygen to patients with acute exacerbation of COPD?

A

Because they rely on hypoxic drive for breathing, giving too much oxygen can reduce RR

73
Q

What are some of the risk factors for COPD?

A 
SMOKING
Alpha 1 antitrypsin deficiency
Occupation 
Maternal/passive smoking
Environmental exposure (pollution)
Chronic asthma
74
Q

What is nicotine responsible for in cigarettes?

A

Addiction

75
Q

Is nicotine responsible for the damage caused by smoking?

A

No, other added chemicals are

76
Q

How many people in scotland smoke as a percentage, and who are they likely to be?

A

20% of the population

Deprived areas, unskilled/unemployed, not well educated

77
Q

What proportion of women smoke during pregnancy?

A

1 in 3

78
Q

How many women are likely to start smoking again after pregnancy?

A

2 in 3

79
Q

What are the risks of smoking during pregnancy?

A

Increased risk of miscarriage/neonatal death

80
Q

what is an important law that was passed in scotland with regards to smoking?

A

Smoking, Health and Social Care Act (2005)

81
Q

What are some of the strategies adopted to reduce smoking in the UK?

A
  • Smoking, health and social care act 2005
  • child protection
  • tobacco regulation
  • ban smoking in public places
82
Q

By what percentage does stopping smoking reduce the chance of MI after 1 year and 15 years?

A

50% reduction

83
Q

What is the benefit of smoking cessation in terms of heart and lung disease after 15 years?

A

MI and lung cancer chance same as a non-smoker

84
Q

What percentage of a cigarette pack price is paid as tax?

A

77%

85
Q

What are some of the diseases for which smoking is a risk factor?

A 
Lung/RT cancer
COPD
Diabetes 
Osteoporosis 
Crohn’s disease 
Macular degeneration
Psoriasis

Respiratory System (7 decks)

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