Resp conditions basics Flashcards
COPD epidemiology
Common in smokers, rarely symptomatic before middle age.
COPD signs and symptoms
Cough with production of sputum, wheeze and breathlessness.
Often lean forward, barrel chested, prolongued expiration.
May have secondary pulmonary hypertension, raised JVP and oedema.
Cachexia can occur.
COPD investigations
Spirometry
FEV1 reduced more than FVC
Diagnosis for COPD
FEV1 less than 80% predicted (unless mild)
FEV1:FVC less than 0.7 (all COPD sufferers)
Little or no reversibility.
COPD pathology
Chronic bronchitis is inflammation
Emphysema is enlargement of air spaces accompanied by destruction of their walls.
Single greatest factor is cigarette smoking.
How does cigarette smoking cause COPD
Irritant causing hypertrophy of submucosal glands and hypersecretion of mucus in large airways, and respiratory bronchiolitis in small airways.
Alters oxidant/anti-oxidant balance and protease/antiprotease balance (due to increased inflammation) leading to emphysema.
Low α1-antitrypsin leads to emphysema with/w’out smoking.
Complications of COPD
Cor pulmonale
Respiratory failure.
Treatment of COPD
Smoking cessation Bronchodilators (B2-agonists and antimuscarinic ipratropium bromide) Corticosteroids sometimes Vaccination to prevent IECOPD. Oxygen.
Treatment of IECOPD
Oxygen
Bronchodilators
Antibiotics
BiPAP (Bilevel positive airway pressure)
Bronchiectasis epidemiology
In developed countries most common cause is cystic fibrosis, but can be caused by infections.
Bronchiectasis clinical picture
Cough and sputum production; if severe, latter is green and foul-smelling.
Possible massive haemoptysis, breathlessness and wheeze
Bronchiectasis OE
clubbing and coarse inspiratory crackles.
Bronchiectasis investigations.
Chest X-ray can be normal or dilated bronchi with thickened walls, and multiple fluid containing cysts.
CT may show airway dilatation, bronchial wall thickening and cysts.
In infective exacerbration do sputum culture.
Spirometry often shows obstructive pattern.
Bronchiectasis treatment
Physiotherapy for postural drainage
Antibiotics
Bronchodilators if airway limitation
Steroids to decrease progression
Cystic fibrosis definition
An autosomal recessive condition caused by mutations in CFTR gene resulting in a defective chloride channel in epithelial cell membranes and hence an increase in viscosity and tenacity of mucus on epithelial surfaces in the pancreas, respiratory, GI and reproductive tracts.
Cystic fibrosis epidemiology
1:2000 live births.
Cystic fibrosis clinical picture.
Normal at birth, respiratory symptoms normally present.
Bronchiectasis and obstructive disease are primary causes of morbidity and mortality.
Meconium ileus in 1/5 of CF newborns: pathognomic.
Causes of infections in cystic fibrosis
Gram -ives, Staph aureus and H. influenzae in infants.
Pseudomonas in adult.
Cystic fibrosis treatment
Management of bronchiectasis and exocrine pancreatic insufficiency
Cystic fibrosis investigation
Family history
High sweat sodium and chloride (more than 60 mmol/l)
Blood DNA analysis of gene defect
Absent vas deferens and epididymis.
Asthma definition
A common chronic inflammatory condition characterised by reversible airflow limitation, airway hypersensitivity and inflammation of the bronchi.
Asthma epi
Common, especially in teenage
Asthma pathogenesis
Narrowing of airway is due to smooth muscle contraction, thickening of for airway wall and increased secretion within the lumen.
Asthma clinical features
Wheezing, cough, chest tightness and shortness of breath; intermittent, worse at night.
Asthma treatment
B-agonists Antimuscarinic bronchodilators Corticosteroids Anti-inflammatory agents such as sodium cromoglicate (in mild) leukotriene receptor antagonists.
Emergency treatment of acute severe asthma
O2
Salbutamol or terbutaline by oxygen driven nebs
Hydrocortisone 100 mg IV or 60mg oral
NO SEDATIVES
Abx
CXR to exclude pneumothorax or pneumonia.
Definition of pneumonia
An inflammation of lung tissue usually caused by infection. It is defined both anatomically and by aetiology.
Clinical features of pneumonia
How to assess severity.
Very variable: pyrexia, cough, sputum, pleurisy and dyspnoea.
Consolidation, pleural rub, pleural effusion.
Assess severity using CURB 65
Pneumonia investigations
CXR for outpatients
For inpatients: bloods (WBC, liver biochem, U&Es, serology), ABGs, CXR,
Pneumonia treatment
Mild CAP: oral amoxicillin or clarithromycin.
Severe CAP: both above
CURB-65 > 3: IV cefuroxime and clarithromycin
Fluids.
Pneumonia complications
Pleural effusion,
Respiratory failure
Lung abscess
Empyema.
Lung abscess definition
Localised suppuration of the lung associated with cavity formation.
Lung abscess clinical features
Worsening pneumonia
Copious amounts of foul smell sputum.
Lung abscess investigations
Bacteriological investigation on aspiration or bronchoscopy samples.
TB clinical features
Malaise, anorexia, weightloss, fever and cough
Mucoid, purulent or blood stained sputum
TB investigations
CXR (patchy shadows in upper zones) Ziehl-Neelsen stain for acid fast bacilli (sputum) PCR testing (not entirely reliable)
In miliary TB: lumbar puncture and CSF examination.
HIV testing.
TB management
6 months: rifampicin and isoniazid.
2 months at start: pyrazinamide and ethambutol
Sarcoidosis def
A multisystem granulomatous disorder of unknown aetiology.
Sarcoidosis epi
All ethnicities, but rare in Japanese and severe in African blacks. Peak incidence in 30s. More women than men.
