Resp (asthma, COPD, lung cancer, pneumonia, PE) Flashcards
What decreases luminal diameter in asthma? (4)
Bronchial hyper-responsiveness, inflammation, smooth muscle contraction, smooth muscle hypertrophy
2 main types of asthma
Eosinophilic and non-eosinophilic
What drives recruitment of eosinophils in asthma?
Th2 lymphocytes
3 important factors for determining outcome in asthma?
Inhaler technique and adherence, smoking cessation, severity assessment
3 fx presenting complaint in asthma?
Episodic wheeze, diurnal variation, brittle disease
RCP3 questions for assessing severity?
Recent (last 14/7) nocturnal waking, typical daily symptoms, ADL?
3 indications asthma is severe?
No. inhalers, A&E attendances, HDU/ITU stays, near-fatal episodes, recent Abx/steroids from GP, ventilation
What is Samter’s triad?
Asthma, recurrent sinus disease, NSAID sensitivity
Asthma differential - previous pneumonia
Bronchiectasis
Asthma differential - neuro/renal disease
Vasculitis
4 questions for occupational asthma
Holidays? Dust? Animals? Lab work? Paint spraying?
How does COPD differ from asthma (typical patient, symptoms)?
Age>35, hx smoking, sputum, no diurnal variation, SOB/wheeze more persistent, possible seasonal variation
5 asthma investigations?
FBC (eosinophils), IgE blood levels, skin prick test, PEFR, pulmonary function (FEV, FVC), exhaled NO (increased if eosinophilic), response to challenge agents
What is brittle disease in asthma? Why is it important?
Asthma where patients transition from well to very ill quickly. Increases risk of sudden asthma death
5 factors that increase risk of asthma death?
Brittle disease, greater than 3 classes of treatment, recent or frequent A&E/hospital admission, psychosocial factors, previous near fatal event
3 asthma differential dx?
Bronchiectasis, COPD, CF, pulmonary embolus, aspiration, bronchial obstruction (eg. tumour)
Definition of a severe asthma attack (PEFR, RR, HR)?
PEFR 33-50% predicted, RR>25, HR>110
Definition of a life-threatening asthma attack (PEFR, SaO2, PaO2, PaCO2 symptoms)?
PEFR<33% predicted, SaO2<92%, PaO2<8kPa, normal PaCO2, exhaustion, altered consciousness, hypotension, poor effort arrhythmia
6 management things in acute asthma (2 investigations, 4 treatments)?
ABG, CXR (if suspected pneumothorac, consolidation, failure to respond, severe); O2, salbutamol nebuliser (tripatropium bromide if life-threatening), IV prednisolone +/- hydrocortisone, Mg/aminophylline
Rx on discharge of acute asthma?
Min 7-14/7 prednisolone, 48hr nurse-led follow up at GP
Definition of obstructive airway disease?
FEV1/FVC<0.7
