Respiratory Flashcards
COPD Complications
Polycythaemia (raised haematocrit)
Pulmonary function tests Restrictive lung disease
FEV1 - reduced
FEV1/ FVC - Normal or increased
Pulmonary function tests Obstructive lung disease
FEV1 - significantly reduced
FEV1 / FVC - Reduced
Clubbing - respiratory causes
Lung Ca
CF, bronchiectasis, empyema
Tb
Asbestosis, mesothelioma
COPD Mx
1st - SABA or SAMA
a) No asthmatic features
1 - LABA + LAMA + SABA
2 - LABA + LAMA + ICE (+SABA)
b) Asthmatic features
1 - LABA + ICS
2 - LAMA + LABA + ICS (+SABA)
3rd line - PO Theophylline
4th - Refer Resp - PO PDE-4 inhibitors (eg roflumilast) - if severe (eg >2 exacerbations on Triple therapy, or FEV 1 <50% after bronchodilator)
COPD Prophylaxis
Azithromycin
LFT and ECG prior to starting - to exclude QT prolongation
Can not be started if patient is still smoking (must be stopped if re-starts smoking)
COPD exacerbation Mx
Steroids - PO Prednisolone 30mg 5 days
+/- Abx if purulent sputum
Adult Asthma Mx
1st - SABA
2nd (Sx >3/ week or disturbed sleep) - SABA + ICS
3rd - SABA + ICS + LTRA (Montelukast)
4th - SABA + ICS + LABA (Continue LTRA if helpful)
5th - SABA +/- LTRA + ICS/LABA MART regime
6th - Refer resp - SABA +/- LTRA + increase dose MART
Bronchitis Mx
1st - Doxycycline (unless pregos)
2nd - Amox
Asthma Ix
Fractional exhaled Nitric Oxide (FeNO) + Spirometry/ bronchodilator reversibility test
Asthma Ix in Children (age 5-16)
1st - Spirometry with bronchodilator reversibility
2nd - FeNO if above normal
If <5yo - clinical judgement
COPD exacerbations cause (bacteria)
Haemophillus influenza
Occupational asthma Mx
Refer to resp
When to consider LTOT in COPD
FEV 1 <50%
cyanosis
polycythaemia (Hb raised)
Peripheral oedema
Raised JVP
O2 <93%
CAP Mx
1st- Amox
2nd - Doxy/ eryth/ clarith
2WW Lung Ca referral reasons
CXR shows suspicion of lung ca
>40yo + unexplained haemoptysis
Bronchiectasis Mx
Physio - inspiratory muscle training
Postural drainage
Acute asthma criteria - Life threatening
PEFR < 33%
O2 < 92%
Silent chest, cyanosis
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
Acute asthma criteria - severe
PEFR 33 - 50%
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm
Acute asthma criteria - Mod
PEFR 50-75%
Speech normal
RR < 25 / min
Pulse < 110 bpm
Churgg Strauss Fx (Eosinophilic granulomatosis with polyangiitis)
sinusitis, asthma, haematuria, eosinophilia
squamous cell ca paraneoplastic syndrome association
HyperCA secondary to PTH
clubbing
hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH
Small cell Lung ca paraneoplastic syndrome association
ADH - HypoNa
ACTH - HTN, hyperglycaemia, hypoKal, alkalosis and muscle weakness are more common than buffalo hump etc
Lambert-Eaton syndrome
Smoking cessation options
1st - Nicotine replacement therapy (CBT prior to NRT in pregnancy)
Bupropion
- a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist
- contraindicated in pregnancy and breast feeding
Varenicline
- a nicotinic receptor partial agonist
- used with caution in depression/ self harm
- contraindicated in pregnancy, breast feeding, epilepsy, eating disorder
If unsuccessful at quitting, do not repeat prescription within 6 months
MRC breathlessness scale for COPD
0 Not troubled by breathlessness except during strenuous exercise
1 Short of breath when hurrying or walking up a slight hill
2 Walks slower than contemporaries on the level because of breathlessness, or has to stop for breath when walking at own pace
3 Stops for breath after walking about 100 m or after a few minutes on the level
4 Too breathless to leave the house, or breathless when dressing or undressing
