Respiratory Flashcards

Question

what is asthma

Answer 1

chronic inflammatory disease of the airways --- characterised by reversible airflow obstruction

Answer 2

symptoms: wheeze + chest tightness --- diurnal variation cough +/- sputum --- worse at night dyspnoea ---- exacerbated by triggers atopic triad: hay fever + eczema + rhinitis signs vitals -- increased HR, RR widespread polyphonic wheeze harrison's sulci/hyperinflated chest reduced air entry signs of steroid use to assess asthma control: no. exacerbations in the last year ---- of which how many required hospital admission, vs ICU admission no. steroid & Abx courses per year

Answer 3

acc to GINA 2022 guidelines typical Hx of asthma >1 type of respi symptom variable over time & intensity worse at night or on waking triggered by exercise, laughter, allergens, cold air worse w viral infections confirmed variable expiratory airflow limitation before vs after bronchodilator admin --- >12% FEV1 or >200ml volume

Answer 4

(for acute exacerbation = see VIVA section) conservative Tx awareness/avoidance of triggers smoking education inhaler technique --- hold breath for 10s + wait 30s before 2nd puff adherence GINA 2022 guidelines 2 separate tracks preferred track: reliever = PRN low dose ICS-formoterol step 1-2: PRN low dose ICS-formoterol step 3: maintenance low dose ICS-formoterol step 4: maintenance medium dose ICS-formoterol step 5: add on LAMA refer for assessment of phenotype consider high dose ICS-formoterol +/- immunologics alternative track: reliever = SABA PRN step 1: take ICS whenever SABA taken step 2: low dose maintenance ICS step 3-5 same as above regularly reassess --- step down if possible, step up where necessary

Answer 5

asthma symptom control + risk factors for poor asthma outcomes asthma symptom control criteria --- in the last 4 wks, how many times day time asthma symptoms night waking due to asthma SABA reliever for symptoms activity limitation due to asthma interpretation well controlled = none partly controlled = 1-2 poorly controlled = 3-4 risk factors for poor asthma outcomes meds: high SABA use, inadequate ICS, poor adeherence, incorrect inhaler technique other co-morbidities: obesity, chronic rhinosinusitis, GERD exposures context: major psychological or socioeconomic problems lung function: low FEV1 (<60% predicted), high BD responsiveness type 2 inflammatory markers other independent risk factors: ever intubated or in ICU for asthma, 1 or more severe exacerbation in last 12 months

Answer 6

post-bronchodilator airflow obstruction (FEV1/FVC <0.7) + not fully reversible

Answer 7

chronic bronchitis --- typical blue bloaters productive cough on most days inflammation --> increased mucus production --> constricted + obstructed airway emphysema --- typical pink puffers permanently enlarged air spaces distal to terminal bronchioles + destruction of alveolar walls w/o obv fibrosis

Answer 8

symptoms: cough SOB wheeze +/- sputum (chronic bronchitis) +/- weight loss (emphysema) reduced exercise tolerance signs: general inspection inhalers O2 supply nicotine, cigarettes sputum pot respi exam increased RR prolonged expiration hyperinflation -- reduced cricosternal distance, hoover's sign wheeze +/- early inspiratory crackles cor pulmonale --- increased JVP, oedema, loud P2 peripheral exam cyanosis -- bronchitis tar staining tripod position anaemia cushingoid features palmar erythema high vol pulse tremor

Answer 9

bedside BMI ECG --- ? RA or RV hypertrophy ABG bloods FBC --- polycythaemia, anaemia U&E CRP alpha 1 antitrypsin imaging CXR --- findings hyperinflation --- >6 anterior ribs prominent pulmonary A peripheral oligaemia bullae ECHO --- pulmonary HTN

Answer 10

conservative Tx smoking cessation pulmonary rehab --- grp B & E only education + physio + behavioural intent for 6-8 wks physio vaccinations: influenza, pneumococcal, covid-19, pertussis, shingles acute Tx (see that section) initial pharmco Tx acc to the GOLD 2023 guidelines --- ABE assessment split into 3 groups according to mMRC & CAT scpre + no. exacerbations in the last year grp A = bronchodilator grp B = LABA + LAMA grp E = LABA + LAMA if blood eosinophils >300 = consider + ICS if response to Tx not appropriate check adherence + inhaler technique + possible interfering comorbidities consider predominant treatable trait to target --- dyspnoea or exacerbations dyspnoea: LABA or LAMA <--> LABA + LAMA <--> (a few possibilities) consider switching inhaler device or molecules implement or escalate non-pharmco Tx Ix & Tx other causes of dyspnoea exacerbations LABA or LAMA <--> LABA + LAMA <--> LABA + LAMA + ICS <--> (either or) roflumilast --- FEV1 <50% + chronic bronchitis azithromycin --- preferentially in former smokers supplementary O2 at home surgical Tx VATS video assisted thoracoscopic surgery lung vol reduction in bronchoscopy

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Respiratory Flashcards

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