PBL 3 - managing respiratory disease Flashcards
what are 5 symptoms of respiratory disease?
- dyspnoea
- cough
- chest pain
- wheeze/stridor
- haemoptysis
how is dyspnoea diagnosed?
- speed of onset
- timing of breathlessness
- PND (paroxysmal nocturnal dyspnoea) - positional breathless
- orthopnoea (lying flat), platypnoea (sitting forward) - severity
- MRC dyspnoea scale - personal and family history
- occupational and environment
- travel
- medication (illicit drugs)
- smoking
causes of instantaneous dyspnoea
- pneumothorax
- pulmonary embolism
- asthma
causes of gradual (days) dyspnoea
- pleural effusion (fluid around lung in pleural space)
- lobar collapse
- SVC obstruction
causes of acute (mins —> hours) dyspnoea
- pulmonary embolism
- pneumonia
- LVF (heart failure)
causes of chronic (months —> years) dyspnoea
- COPD
- bronchiectasis
- pulmonary fibrosis
describe cough assessment
- onset and duration — acute and chronic (>8 weeks)
- sputum production — volume
- sputum character — colour, smell, consistency
- cough character — bovine, barking, whoop
- associated features — eg. impaired cough effort
pleuritic vs visceral pain
- pleuritic pain is in relation to breathing pattern
- visceral pain is a more consistent gnawing pain
what is haemoptysis?
coughing up blood — non specific feature of respiratory disease
- 60-80% infective (TB, pneumonia, bronciectasis), pulmonary embolus
- 10-20% malignant
- no cause identified in up to 30%
what is a wheeze?
a noisy musical sounds from turbulent flow through the airways
what can a silent chest indicate?
severe acute asthma
what is stridor?
coarse inspiratory wheeze caused by laryngeal or large airway obstruction
what is the cardinal test to diagnose COPD?
FEV1
is COPD non-progressive or progressive?
progressive condition
what is important to note when taking a history for COPD?
- exertional breathlessness
- chronic productive cough
- wheeze
what is noticeable on examination of COPD?
- chest hyperinflation
- quiet breath sounds
- wheeze
- purse lip breathing
- accessory muscle use
- cyanosis
- cachexia
describe the MRC dyspnoea scale?
- only troubled on strenuous exercise
- SOB walking up a hill
- walks slower than contemporaries on flat or stops when walking at own pace
- stops for breath after walking 100m or after a few minutes on the flat
- too breathless to leave the house, or breathless with ADLs
FEV1/FVC in obstructive disease vs restrictive disease
obstructive: less than 75%
restrictive: more than 75%
obstructive: lower because it is taking a lot longer to actually blow the air out and less is being blown out in 1 second due to the obstruction
restrictive: lungs are stiff due to parenchymal lung damage and most of the air is being blown out within the 1st second, with little more being able to be blown out at 6 seconds
what is the dutch hypothesis for the link between smoking and annual decline in FEV1?
recurrent airway inflammation leads to airflow obstruction
what is the British hypothesis for the link between smoking and annual decline in FEV1?
frequent infections caused by mucus hypersecretion caused decline in lung function, but the two are separate
what are 4 parts of non-pharmacological COPD management?
- smoking cessation = most important
- pulmonary rehabilitation
- nutrition
- patient support
what is the leading cause of preventable disease and death in the world?
smoking
what does the stages if change model applied to smoking emphasise?
that repeated cycling through the stages occurs before permanent cessation is achieved
at what level of oxygen is oxygen therapy required?
PaO2 < 7.3kPa OR < 8.0 kPa but in presence of a secondary complication
what secondary complications can oxygen therapy be used to prevent in people with severe COPD?
- pulmonary hypertension
- polycythaemia
what is the median duration of stay for people with COPD?
1 week
what is required before discharging a patient with COPD?
spirometry (FEV1/FVC)
