respiratory 1 2 and 3 Flashcards
FEV1
forced expiratory vol in 1 sec
FVC
forced vital capacity over 6-12 secs
diagnose COPD
FEV1/FVC less than 70%
chronic bronchitis
3/12 productive cough for more than 2 consecutive yrs
symptoms of chronic COPD
SOBOE
Wheeze
Cough
Weight loss
symptoms of acute/exacerbation COPD
Acute sob/wheeze
Worsening sputum production
Fever
Drowsiness/CO2 narcosis
signs of COPD
Cachexia Use of accessory muscles Pursed lips Cyanosis CO2 flap Drowsiness in CO2 narcosis Hyper-expanded chest – barrel shaped Hyperesonant – percuss on the chest, sounds echo like Reduced breath sounds Wheeze Elevated JVP & peripheral oedema in late disease
if you have COPD likely to have other issues
what can be used to measure SOB
MRC breathlessness scale
treatment once diagnosis of COPD
prevention i.e. stop smoking
SABA/SAMA
then LABA (If asthma then also inhaled steroid) LAMA ifnot
asthmatic and not working, triple therapy LAMA/LABA and ICS
theophylline can be symptomatic relief
inhaled steroid not for use on its own
what increases risk of pneumonia
inhaled steroids
management of stable COPD
address muscle deconditioning improve QoL non pharmacological intervention smoking cessation oral theophylline
prevention of COPD exacerbations
seasonal influenza vaccination inhaled steoids anticholinergics mucolytics pulmonary rehabilitation
hypoxic drive
body is used to CO2
usually the more CO2 , you breath more to reduce the CO2 but not a driver with some
types and causes of respiratory failure
I - pneumonia, asthma, fibrosing lung disease
2 - overdose trauma ,COPD, neuromuscular
asthma
tightening of smooth muscle
what to look for when diagnosing asthma
recurrent episode of symptms symtom varaibiloty wheeze personal history of atophy historical record of variable FEV1
- see if there is a response to tx
symptoms of asthma
Wheeze Cough Chest tightness Dyspnea Nocturnal duration
triggers for asthma
Exertion Dust Change in temperature Emotional situations Occupation
signs of asthma
Eczema
Nasal polyps
Cushingoid
Wheeze
asthma treatment pyramid
regular preventer SABA - low dose ICS (B2 agonists)
add on - inhaled LABA and low dose ICS
additional- LABA not working increase ICS dose and try LAMA etc (or leukocyte receptor agonist)
high dose
- increase ICS, addition of 4th drug
oral steroids (monoclonal Ab) - maintain high ICS
method of delivery of inhaled drugs
metered dose inhaler (SABA/LABA/ICS)
spacer (10 puff salbutamol equiveland to nebuliser, 4 initials, 2 puff every 2 min max 10)
types of lung cancer
non small vs small
non small cell lung cancer subtypes
squamous cell
adenocarcinoma
adenocarcinoma in situ
can metasize
lung cancer chest conditions
Sob – lobar collapse, effusion, lymphangitis
Chest pain – rib involvelement, chest wall invasion
Cough
Haemoptysis – usually due to endobronchial involvement
paraneoplastic syndromes of lung cancer
High calcium (PTH release or bone involvement) – nausea, confusion, abdo pain & constipation
SIADH – confusion, fits, lethargy
Hypertrophic pulmonary osteoarthropathy
Lambert Eaton Syndrome - neuromuscular weakness
signs of lung cancer
Finger nail clubbing Cachexia Horner’s syndrome (wasting of muscles between thumb and finger) Neck nodes Chest signs Palpable liver SVCO (superior vena cava obstruction)
diagnosis of lung cancer
tissue biopsy
bronchoscopy
throacoscopy
surgical
treatment of lung cancer
RT or surgery for limited disease
chemo
immunotheray
treatment of small cell lung cancer
cisplatin based chemotherapy
tend to present late however due to wide spread disease
if localised RT
types of interstitial lung disease
- interstitial lung disease
diffuse parenchymal lung disease
lung fibrosis
how to classify interstitial lung disease
Idiopathic
Drug reaction
Extrinsic Allergic Alveolitis/Hypersensitivity Pneumonitis
Associated with rheumatological disease
symptoms of intersistial lung disease
Dyspnea Cough Constitutional symptoms Onset of symptoms may identify aetiology EAA – post exposure IdiopathicPF – chronic AIP – rapid onset
signs associated with intersistial lung disease
Signs associated with CTD/RA
Nail clubbing
Sclerodactyly
Signs of steroid use
Chest – audible crackles; distribution may influence diagnosis
Chest - squeaks - suggest small airways disease
idiopathic pulmonary fibrosis
Associated with clubbing
Mainly lower zone preponderance
Classically restrictive spirometry and reduced transfer factor
Diagnosis can be made from CT
hypersensitivity pneumonitis
causes lots of cysts
triggered
tx - allergen avoidance
trial of corticoid steroid therapy
sleep apnea
excessive daytime sleepiness with disordered nocturnal irregular breathing
apnea
when you stop breathing for 10 secs
hypopnea
reduction in nasal flow in 10 secs
types of sleep apnea
obstructive (high BMI and wide neck collar)
central (CV disease)
mixed
risk factors for obstructive SleepApnonea
Obesity >17inch collar Men x2-3 likely Age Cranio-facial & upper airway abnormalities e.g short mandible, tonsillar/adenoid hypertrophy, wide craniofacial base
sleep apnea symptoms
excessive daytime sleepiness impair conc snoring choking episodes during sleep restless sleep irritability
diagnosis of SApnea
polysomnography and pulse oximetry
Central apnea
Cessation of nasal flow
Ceccessation of lung movement
Obstructive (movement of lung will try to happen, cessation of nasal flow as there is upper blockage)
tx for SApnea
Weight loss/lifestyle change
Continuous Positive Airway Pressure (CPAP)
Mandibular Advancement Device (MAD)
Pharmocotherapy & surgery?
short acting bronchodilators
relief of symptoms
used inCOPD and asthma
immediate bronchodialtion
increase in cAMP with reduction in cell Ca2+ leading to relaxation of smooth muslce
side effects of SABA
Increased HR & palpitations Tremor Hypokalaemia Headache Nervousness
LABA
alternative to increase steroid dose
selectivity for B2 adenoceptor in pulmonary tissue
not used in monotherapy in asthma
anticholinergic agents and side effects
relief of symptoms
usually for COPD
block of muscarinic receptors M1-3
Possible effect on urinary retention
Dry mouth
Possible adverse cardiovascular effects
inhaled steroids
prevents symptoms
reduces risk of exacerbations
reduces cytokines, bronchoconstriction and airwa inflammation
Side effect
- ORAL CANDIDA
oral steroids w side effects
acute or chronic severe asthma
side effects Weight gain Hyperglycaemia Skin change Hypertension Eye change Mood change Reduce bone mineral density
theophyllines w side effects
acute/chronic asthma
tablets and IV
side effects Nausea Vomiting Palpitations Headaches Dyspepsia Arrhythmias Confusion
antileukotrines
chronic asthma tx
but only limited pt benefit
