Resp Flashcards
Asthma
Chronic respiratory condition associated with airway inflammation and hyper-responsiveness
Asthma presentation
Dry cough Wheeze Chest tightness Shortness of breath Worse in morning and night Atopy
Precipitating factors of asthma
Exercise Allergen Irritant exposure Changes in weather Viral respiratory infections
Risk factors for asthma
Atopy FHx Exposure to smoking or smoker Premature birth and associated low birth weight Respiratory infections in infancy Obesity Social deprivation Workplace exposures including flour, dust and isocyanates from paint
Diagnosis
Hx
Peak flow
Fractional exhaled nitric oxide (FeNO) testing - 17+ yo
- 40 ppb or more
- children - 35 ppb or higher
Spirometry - Bronchodilator reversibility
- less than 0.7 gets better with salbutamol
Blood - eosinophils
Acute severe asthma signs
PEF < 50% Difficulty completing sentences PO2 reduced but above 92% RR 25+/min Pulse rate of at least 110/min Accessory muscle use
Complete control of asthma
No daytime symptoms.
No night-time waking due to asthma.
No need for rescue medication.
No asthma attacks.
No limitations on activity including exercise.
Normal lung function (FEV1 and/or PEF > 80% predicted or best). However, be aware that lung function measurements cannot be used reliably to guide asthma management in children under five years of age.
Minimal side-effects from medication.
Mx of asthma
Assess the person's baseline asthma status Vaccinated Education Action plan Medication
Stepwise medication for asthma
- SABA + ICS
- SABA + combined ICS+LABA
2b. SABA + ICS + LTRA - medium dose ICS
- High dose ICS
- Prednisolone
- Prophylactic oral macrolides (50 - 70 yo)
Types of inhaler
Pressurized metered-dose inhalers
Dry-powder inhalers
- Spacer
Asthma review
Annual: No. of attacks oral corticosteroid use time off school/nursery/work due to asthma. Nocturnal symptoms. Adherence Possession of/use of a self-management plan/written personalised asthma action plan. Exposure to tobacco smoke
Life threatening asthma
PEFR less than 33% Oxygen saturation of less than 92% Altered consciousness or exhaustion Silent chest Cyanosis Poor respiratory effort Confusion
Follow up after hospital admission
Within 2 days
COPD
Chronic bronchitis - referring to cough and sputum production for at least 3 months in each of 2 consecutive years
Emphysema - alveolar destruction
Presentation of COPD
Persistent symptoms:
- breathlessness
- Productive cough
Exacerbations of COPD
Exacerbations are acute episodes of worsening COPD symptoms beyond normal day to day variation
Risk factors for COPD
Smoking Occupation dust exposure Pollution FHx Asthma
Complications of COPD
Cor pulmonale - RHF Frequent chest infections - pneumonia Pneumothorax Lung cancer Respiratory failure
Diagnosis of COPD
35+ yo with a risk factor and 1 + more symptoms
Spirometry - FEV1/FVC < 0.7
- does not get better with bronchodilator
Chest X-ray Full blood count — to identify anaemia or polycythaemia - Serum alpha-1-antitrypsin (MRC) dyspnoea scale ECG
(MRC) dyspnoea scale
1 - Not troubled by breathlessness except during strenuous exercise
2- Short of breath when hurrying or walking up a slight hill
3 - Walks slower because of breathlessness, or has to stop for breath when walking at own pace
4 Stops for breath after walking about 100 m or after a few minutes on the level
5 Too breathless to leave the house, or breathless when dressing or undressing
Mx of stable COPD
Smoking cessation Vaccinations Pulmonary rehabilitation Personalised mx plan SABA LABA + LAMA LABA + LAMA + ICS Oral theophylline (slow release) Oral mucolytic therapy Prophylactic oral macrolides
Pulmonary rehabilitation
individually tailored, multidisciplinary care program for people with COPD which aims to optimize physical and psychological condition through exercise training, education, and nutritional, psychological, and behavioural interventions.
Follow up
FEV1/FVC < 0.7 - annually
FEV1/FVC < 0.3 - twice a year
End-stage COPD Mx
Advance care plan
Breathless
- opiates and analgesia
- oxygen
Cough
- nebulised sodium chloride
- mucolytic - Carbocisteine
