Respiratory Flashcards
Key aspects of COPD management
Active Rx
- Pharmacotherapy
- Pulmonary rehab
- Action plan
- Self-management
Prevention
- Vaccination
- Smoking cessation
- Nutrition
- Co-morbidities
Diagnosis of COPD
Hx, then needs to be confirmed on SPIROMETRY
Persistent airflow limitation (without complete reversibility)
= Post bronchodilator FEV1/FVC <0.7
How to assess COPD severity
3/2/1
Testing
- oximetry <92% when stable
- ABG with peristent hypercapnia
- lung function
Through History
- effect of Sx of daily living
- level of breathlesssness
presence of complications/commorbidities
Complications and comorbidities with COPD (5)
Infections +- hospitalisations
Hypoxaemia
Pulmonary HTN
Heart failure
Polycythaemia
5-As smoking cessation
Ask, Assess, Advise, Assist, Arrange
Ask and identify
Asses nictotine dependence + motivation to quite
Advise about risks of smoking + benefits of quitting
Assist cessation - counselling + pharamcotherapy
Arrange follow-up within 1 wk and 1 month
LAMAs (4)
- ium
Umeclidnium (Incruse Elipta)
Tiotropium (Spiriva)
Glycopyrronium (Seebri Breezhaler)
Aclidinium (Bretaris Genuair)
LABAs (3)
- erol
indacaterol (Onbrez)
Formeterol
Salmeterol
ICS
- asone + -onide
Fluticasone
Beclometasone
Ciclesonide
Budesonide
LAMA/LABA (4)
Indacaterol/glycopyrronium (Ultibro)
Tiotroprium/olodaterol (Spiolto)
Umeclidinium/vilanterol (Anoro)
Aclidinium/formeterol (Brimica Genuair)
Testing and treatment for dry cough in bouts
Nasopharyngeal swab for pertussis PCR within 3wks, otherwise serology
Treatment - if within 3wks needs treatment with oral azithromycin for 5/7
Treat contacts if will expose at risk pt (<6mo, pregnant)
Features on XR + Diagnosis
60 smoker, presents with acute history of worsening SOB
Large RUZ opacity with collapse, assoc with hilar mass. Note hyperlucency of the hyper expanded RM and RL lobes
-> Small Cell Lung Cancer (SCLC)
Key differences between 3 stages of asthma
- mild/mod
- severe
- life threatening
6+ child with asthma. Other than interval Sx, what are indications for preventer (3)
- Asthma symptoms limiting normal activity (school, sports)
- Asthma requiring hospitalization (mod flare) OR req ICU (severe flare)
- 2x exacerbations requiring oral steroids
Non pharma Mx of Paed asthma (5)
- Prepare up to date AAP
- Educate on avoidance of triggers
- Avoid passive smoke exposure
- Advise carrying salbutamol at all times
- Advise annual flu vacc
Management steps for pertussis (4)
- Notify Deparment of Health
- Commence patient on oral azithromyxin for 5/7
- Reccomend treatment of other risk contacts
- pregnancy
- <6mo
- whole house if <6mo or pregnant individual
- any contacts who have exposure to high risk pts - Advise patient to isolate when they have completed 5/7 of antibiotics
4yo boy with symptoms of rhinosinusitis, Mx options (3)
- Oral loratidine OD
- Intranasal nasonex both nostrils BD
- Oral montelukast (singulair) OD
Definition of severe acute asthma (3)
Speaking short sentences
Sats 90-94%
Mod-severe WOB
11 yo with severe asthma, Mx in ED (5)
- 12puffs inhaled salbutamol with spacer
- 8 puffs inhaled ipratropium with spacer
- Prednislone 1mg/kg (??immediate)
- Supplemental oxygen to maintain sats >95%
- Gain peripheral IV access
Adult asthma - when is PRN SABA appropiate?
Only if symptoms < twice a month + no risk factors for flare ups
Patient with history consistent with asthma, has symptoms 1x per week. No previous management. Pharmacological management?
Regular low dose ICS OD + PRN SABA
or/
Budesonide/formeterol (low dose) PRN
Adult asthma patient on PRN symbicort, having frequent exacerbations. Next step in management
Change symbicort (ICS/formeterol) to regular dose + use PRN
or/
Change to regular + PRN SABA
Adult asthma patient on low dose ICS/formeterol daily. In last 3 months, has been using 2-4 extra puffs most days
?Rx
Poor control despite low dose regular ICS/formeterol
Increase to medium-high dose
NB: if doesnt work, refer to specialist
WHen to consider step down of adult asthma management + features of good asthma control (4)
If stable for 2-3 months
Good control
- Day time symptoms <2days/wk
- Need for SABA <2days/wk
- No limitation on activities
- No symptoms during night or on waking
Adult asthma, poorly controlled, before stepping up treatment - what should you double check (3)
- Symptoms are due to asthma
- Inhaler technique is correct
- Adherence is adequate
Medium dose of budesonide?
500-800 microg PER DAY
ie, lower is low dose, higher is high dose
When to step down children asthma treatment?
If stable for 6 months, different to adults who are only 2-3mo
Spirometry - what defines positive bronchodilator response (2)
Increase FEV1 or FVC atleast 12% and 200ml
Spirometry but it doesnt give LLN, only gives % predicted, how to intepret.
Older style
LLN for FVC + FEV1/FVC is <70% predicted
(FEV1 <80% predicted)
35yo recent dx chest infection, hasnt responded to 3/7 augmentin. ?keep going or change treatment
Bilateral ill defined opacities
-> suggestive of mycoplasma pneumonia
-> Change to oral doxycycline BD
40yo presents with 10/7 muscle aches, intermittent fever, dry cough. Tried amox with GP 5/7 ago, no improvement. Works in a pet store with birds.
DDx (6)
- Psittacosis
- Hypersensitivity pneumonitis
- Pertussis
- Post nasal drip from allergic rhinosinusitis
- Viral URTI
- Atypical pnuemonia (mycoplasma)
KFP: Pt with COPD, exam findings that would warrant admission (6)
- Hypotension SBP <90
- Tachycardia HR >100
- Tachypnoea RR>30
- Hypoxia Sp02 <92% on RA
- Increased WOB
- New onset confusion
KFP: Features on hx the support provisional dx of OSA - note need diversity (5)
- Waking with gasping/witnessed apnoeas
- Excessive daytime sleepiness
(grouped with unrefreshing sleep etc) - Poor concentration
- Low mood
- Nocturia
