Respiratory Flashcards
Smoking cessation treatment licensed for use in pregnancy
Nicotine replacement therapy
COPD treatment - 1st line
SABA (salbutamol) prn
or
SAMA (ipratropium) prn
COPD on SABA or SAMA prn - still breathless - no asthmatic features
Offer LABA + LAMA
COPD - on SABA or SAMA prn - still breathless - with asthmatic features/steroid responsiveness
Consider LABA + ICS
What is Fostair
LABA + ICS
(formoterol + beclometasone)
COPD - on LABA + LAMA - symptoms still affecting QOL
Consider 3 month trial of LABA + LAMA + ICS
What is Trimbow
LABA + LAMA + ICS
(formoterol + glycopyrronium + beclometasone)
What is Ellipta
LABA + LAMA + ICS
(vilanterol + umeclidinium + fluticasone)
COPD - on LABA + LAMA - with 1 severe/2 moderate exacerbations in a year
Consider LABA + LAMA + ICS
COPD - with no asthmatic features - no improvement after 3 month trial of LABA + LAMA + ICS
Revert to LABA + LAMA
COPD with asthmatic features - on LABA + ICS - with symptoms affecting QOL
Offer LABA + LAMA + ICS
COPD with asthmatic features - on LABA + ICS - with 1 severe/2 moderate exacerbations in a year
Offer LABA + LAMA + ICS
Refer for LTOT assessment in COPD if:
FEV1 <30% predicted
Cyanosis
Polycythaemia
Peripheral oedema
Raised JVP
Sats <92% on air
Moderate asthma attack - PEFR
50-75% best or predicted
Severe asthma attack - PEFR
33-50% best or predicted
Life-threatening asthma attack - PEFR
<33% best or predicted
Moderate asthma attack - RR
RR < 25/min
Moderate asthma attack - HR
HR < 110 bpm
Severe asthma attack - RR
RR > 25/min
Severe asthma attack - HR
HR > 110 bpm
Speech in moderate asthma attack
Speech normal
Speech in severe asthma attack
Can’t complete sentences
Features of life-threatening asthma attack - vitals
Bradycardia
Dysrhythmia
Hypotension
Features of life-threatening asthma attack - examinaion
Silent chest
Cyanosis
Exhaustion
Features of life-threatening asthma attack - behaviour
Feeble respiratory effort
Confusion
Coma
Normal pCO2 (4.6-6.0) is a feature of what degree of asthma attack
Life-threatening
Respiratory causes of clubbing
Lung cancer
CF
Bronchiectasis
Abscess/empyema
TB
Asbestosis, mesothelioma
Fibrosing alveolitis
Cardiac causes of clubbing
Cyanotic congenital heart disease (Fallot’s, TGA)
Bacterial endocarditis
Atrial myxoma
Non cardiac/resp causes of clubbing
Crohn’s, UC
Cirrhosis, PBC
Graves’
Whipple’s disease
Life expectancy at diagnosis of idiopathic pulmonary fibrosis
3-4 years
Asthmatic/steroid responsiveness features in COPD
History of asthma/atopy
Eosinophilia
FEV1 variation >400ml
> 20% diurnal variation PEFR
Mechanism of action of varenicline
Nicotinic receptor partial agonist
B in CURB-65
Systolic <=90 /
Diastolic <=60
Point-of-care CRP in pneumonia - when to offer antibiotics
> 100 mg/L
Point-of-care CRP in pneumonia - when to consider delayed prescription
20 - 100 mg/L
U in CURB-65
Urea > 7 mmol/L
Causes of obstructive lung disease
Asthma
COPD
Bronchiectasis
Bronchiolitis obliterans
Adverse effects of nicotine replacement therapy
Flu-like symptoms
Headache
Nausea & vomiting
Options for smoking cessation therapy
Nicotine replacement therapy
Varenicline
Bupropion
Varenicline should be started when
1 week before target stop date
Varenicline side effects
Nausea
Headache
Insomnia/abnormal dreams
Varenicline recommended course
12 weeks
Varenicline in pregnancy
Contraindicated
Varenicline in breastfeeding
Contraindicated
Buproprion should be started when
1 - 2 weeks before target stop date
Bupropion adverse effects
Low risk of seizure
Bupropion is contraindicated in
Epilepsy
Pregnancy, breastfeeding
(relative: eating disorder)
All patients >=17y with suspected asthma should have
Spirometry with BDR test
+
FeNO test
Positive result in FeNO test in adult
> = 40 parts per billion
Positive result in FeNO test in child
> = 35 parts per billion
In primary-care management of moderate acute asthma, when should prednisolone be started
If PEFR between 50-75%
Adult low dose ICS - as budesonide
<= 400 mcg / day
Adult moderate dose ICS - as budesonide
400 - 800 mcg /day
Adult high dose ICS - as budesonide
> 800 mcg / day
Consider referral for LTOT assessment in COPD if
FEV1 <50% predicted
Adult Low Dose ICS example: Beclometasone diproprionate
(Non-proprietary / Clenil Modulite)
Non-proprietary / Clenil Modulite 100mcg/dose x two puffs x twice a day
[=200mcg BD]
Adult Medium Dose ICS example: Beclometasone diproprionate
(Non-proprietary / Clenil Modulite)
Non-proprietary / Clenil Modulite 200mcg/dose x two puffs x twice a day
[=400mcg BD]
Adult High Dose ICS example: Beclometasone diproprionate
(Non-proprietary)
Non-proprietary 200mcg/dose x four puffs x twice a day
[=800mcg BD]
Adult High Dose ICS example: Beclometasone diproprionate
(Clenil Modulite)
Clenil Modulite 250mcg/dose x 2 puffs x twice a day
/
Clenil Modulite 250mcg/dose x 4 puffs x twice a day
[=500mcg-1g BD]
