Resp - Asthma Management, COPD Management

Question 1

Asthma management - Acute management

Answer 1

O SHIT ME

Oxygen

Salbutamol
Hydrocortisone IV or Oral Prednisolone
Ipratropium Bromide
Theophylline (Aminophylline IV)

Magnesium Sulphate IV
Escalate (to PICU/HDU)

OR

Mneumonic for asthma exacerbation SIGN guidelines in order:

Oh
Shit,
I
Hate
My
Asthma

1) Oxygen
2) Salbutamol nebulisers
3) Ipratropium bromide nebulisers
4) Hydrocortisone IV or Oral Prednisolone
5) Magnesium Sulfate IV
6) Aminophylline / IV salbutamol

Question 2

Asthma management - under what criteria would you admit someone?

Answer 2

O2 sats <92%

Exhausted

Marked reduction in PEFR

No clinical response to treatment

Question 3

Asthma management - chronic management pathway

Answer 3

1. Inhaled SALBUTAMOL (SABA)
2. Add Beclometasone (ICS)
3. Add Salmeterol (LABA)
   
   • Good response = continue
   • Response, control poor = increase ICS to 800mcg
   • No response = try MONTELUKAST (LTRA)
4. Increase ICS Beclometasone to max dose 2000mcg
5. Consider oral steroid + referral to specialist services

Question 4

COPD management - stepwise stable management?

Answer 4

1. SABA or SAMA PRN basis
2. No steroid response or no asthma features = LABA + LAMA
   
   • steroid response/asthma features = LABA + ICS
3. Escalate to triple therapy (TT), LABA + LAMA + ICS:
   
   • Already on LABA + LAMA = 3 month trial on TT if clinical features impact QoL, if no improvement, revert back to LABA + LAMA
   • Already on LABA + LAMA = offer TT if 1 severe, or 2 moderate acute exacerbations within 1 year
   • Already on LABA + ICS = offer TT if clinical features impact QoL, or 1 severe or 2 moderate exacerbations within 1 year

Question 5

COPD management - management of acute exacerbations

Answer 5

1. O2 - aim for 88-92% on venturi masks to prevent T2RF
2. Bronchodilators:
   SALBUTAMOL - nebulsied 2.5mg back to back, once stable QDS +PRN
   Ipratropium - nebulised 500mcg
3. Corticosteroids:
   Oral Prednisolone 30mg once daily for 5 days
4. Antibiotics:
   Follow local guidelines
   Co-amoxiclav or Doxycycline typically used

Question 6

COPD management - drug acronym examples

Answer 6

SABA, Short-acting beta-agonist = Salbutamol

LABA, Long-acting beta-agonist = Salmeterol

SAMA, Short-acting muscarinic antagonist = Ipratropirum

LAMA, Long-acting muscarinic antagonist = Tiotropium

ICS = Inhaled Corticosteroid = Beclometasone

LABA-ICS: Seretide (salmeterol/fluticasone)

LABA-LAMA: Ultibro (indacaterol/glycopyrronium)

LABA-LAMA-ICS: Trimbow (formoterol/glycopyrronium/beclometasone)

Question 7

Pulmonary function tests - how does FEV1, FVC and FEV1/FVC look in an obstructive lung disease picture? What are some examples of conditions too?

Answer 7

FEV1 - SIGNIFICANTLY Reduced
FVC - Normal or reduced
FEV1/FVC - Reduced

Examples - Asthma, COPD, Bronchiectasis, Bronchiolitis obliterans

Question 8

Pulmonary function test - how does FEV1, FVC and FEV1/FVC look in a restrictive lung disease picture? What are some examples of conditions too?

Answer 8

FEV1 - reduced
FVC - significantly reduced
FEV1% (FEV1/FVC) - normal or increased

Examples - Pulmonary fibrosis, sarcoidosis, severe obesity, neuromuscular disorders, asbestosis