Respiratory Flashcards
CAP: common causes
4
Streptococcus pneumonia
Staphylococcus aureus
Haemophilus influenza
Mycoplasma pneumonia
Asthma: once diagnosed or suspected…
5
- Assess baseline level if diagnosing… eg Asthma Control Questionnaire or Asthma Control Test
- Refer is suspect occupational asthma
- Aims of Mx include…
- No day Sx
- No night waking
- No need for rescue meds
- No exercise limitation
- Normal lung numbers - Create a personalised asthma action plan for patient or relatives
- Advise and prescribe peak flow meter, cover inhaler technique
Acute Asthma: severity
% of predicted PEFR…
<33% = life-threatening
33-50% = severe
50-75% = moderate
Acute Asthma: red flags
Inability to talk, unable to complete sentences, exhaustion, silent chest, cyanosis
Acute Asthma: Mx
Community…
- O2, nebulised salbutamol, nebulised ipratropium
- Consider quadrupling ICS / prednisolone 40-50mg OD for 5 days / IM methylprednisolone 160mg (adult) / IV hydrocortisone 100mg (adult)
Hospital…
- May need Mg, ITU, ventilation, etc
COPD: criteria for Dx
5
Suspect if meets criteria:
- Age >35
- Presence of risk factor (SMOKER, occupation, pollution, alpha-1 antitrypsin deficiency)
- Classic Sx (exertional breathlessness, sputum, infective exacerbations)
- Absence of asthma features
- Post-bronchodilator spirometry (FEV1/FVC ratio <0.7)
(NB think cor pulmonale [ie RHF 2º to lung disease] if Sx worse than normal)
COPD: Ix
Consider alpha-1 antitrypsin if under 40 yo or FHx of this condition
Ix may include:
- imaging (eg CXR to exclude other causes, CT chest)
- FBC (for polycythaemia, anaemia)
- Post-bronchodilator spirometry
- sputum culture
- Cardiac Ix, eg. BNP, ECG
COPD: Spirometry
Carry out 15-20 mins after taking bronchodilator
—> Airflow obstruction: FEV1/FVC ratio <0.7
COPD: when to refer
8
- Suspected lung cancer (2WW)
- Very severe/rapidly worsening
- Frequent infections
- Suspect cor pulmonale
- FHx of alpha-1 antitrypsin deficiency
- Age <40
- Dx uncertainty
- Assessment of LTOT, NIV, long term steroids, etc
Acute COPD
If admission not needed…
Increase SABA
Prednisolone 30mg OD for 5 days (if regularly requiring then may need to think about osteoporosis prophylaxis)
Abx if purulent sputum:
Amox 500mg TDS for 5 days, or
Doxy 200mg on day 1, then 100mg OD for a total course of 5 days, or
Clarithro 500mg BD for 5 days
(In hospital may need nebs, O2, theophylline, NIV, etc)
Tension pneumothorax: Mx
As per ATLS - medical emergency, treat ASAP wherever the location…
Large bore cannula in 5th intercostal space MCL (adult) on affected side
…or 2nd intercostal space MCL (child) [some guidelines state 2nd intercostal space MCL also in adults]
Pulmonary fibrosis
Sx; Ix; Rx
Sx:
- Breathlessness, dry cough
- Inspiratory crackles, clubbing
- Usually restrictive pattern spirometry
Ix:
- May include CXR, PFTs, CT (honeycombing, reticular pattern), pleural biopsy
Rx: Multiple options depending on cause… - Oxygen, physio, meds (eg. Pirfenidone), immunosuppressants - Acute flare-ups —> e.g. steroids - Surgical, e.g. transplant
Obstructive Sleep Apnoea Syndrome (OSAS)
Qu 2; Urgent ref 5; Routine ref 2; Mx
Questionnaires:
- STOP-Bang
- Epworth sleepiness score
Urgent referral to sleep clinic (within 4 weeks) if…
- Sleepy when driving/heavy machinery/hazardous occupation
- Other condition, e.g. COPD, angina, HF
- Pregnant
- Undergoing pre-op for major surgery
- Non-arteritic anterior ischaemic optic neuropathy
Routine referral if:
- Moderate or severe OSAS
- Mild OSAS affecting QoL
Mx…
1º care: Lifestyle - diet, exercise, smoking, alcohol, weight loss AND monitor BP, CVD risk, diabetes
2º care:
- Sleep studies (e.g. polysomnography)
- CPAP - 1ST LINE for moderate or severe OSA
- Intra-oral devices - may be suitable if mild OSA and snores with normal daytime alertness
LTOT
Consider referral if…
pO2 <7.3 (8 in some cases) which is roughly equal to resting sats ≤92%
Usually life long and given 15-16 hours per day
