Respiratory Flashcards
symptoms of asthma
intermittent dyspnoea, wheeze, cough (often nocturnal), sputum
signs of asthma
tachypnoea, audible (widespread, polyphonic) wheeze, hyper inflated chest, hyper-resonant percussion more, decrease air entry,
def dyspnoea
shortness of breath
def tachypnoea
rapid breathing
tests run for acute attack of asthma
PEF
sputum culture
FBC, UE, CRP, blood cultures
tests run for chronic asthma
PEF
spirometry
CXR
identifying allergens: skin prick tes, histamine challenge, Aspergillus serology
asthma differential diagnosis
pulmonary oedema ('cardiac asthma') COPD large airway obstruction (foreign body, tumour etc) SVC obstruction, pneumothorax, PE, bronchiectasis, obliterative bronchiolitis
which vaccines to get with asthma
influenza and pneumococcal
def peak expiratory flow rate
maximal rate that a person can exhale during short maximal expiratory effort after a full inspiration
what are the pathological changes in asthma
- smooth muscle and submucosal glands hypertrophy and hyperplasia
- infiltration of eosinophils, mast cells and neutrophils
- globlet cell metaplasia + loss of epithelium (–> mucus plug)
factors contributing to airway narrowing in asthma
- bronchial muscle contraction
- mucosal swelling/inflammation (mast cells and oesinophil degranulation –> release of inflammatory mediators)
- increase mucus production
precipitants in asthma
-cold air and exercise
-emotion
-allergens
-pollution and irritant dusts, vapours and fumes
-drugs (NSAIDs, beta-blockers)
-diet
infection, smoking exacerbate it
What range should body pH be kept
7.35-7.45
how to interpret blood gas results
- look at pH
- look at metabolic component (HCO3)
- look at respiratory component (pCO2)
- combine all of the above info
- check compensation is appropriate
- look at pO2 level
FEV1, FVC, FEV1/FVC ratio, RV and RV/TLC in obstructive lung disease
FEV1: (normal or) decreased FVC: normal od decreased FEV1/FVC ratio; decreased (<70%) \+ coving of the curve (in the flow volume loop) RV increased RV/TLC increased
FEV1, FVC, FEV1/FVC ratio, RV and RV/TLC in restrictive lung disease
FEV1: normal or decreased FVC: decreased FEV1/FVC ratio: normal or increased (>70%) RV decreased RV/TLC decreased
GOLD staging based on FEV1 for COPD
GOLD Stage I: FEV1 > 80%
GOLD Stage II: 50% < FEV1 < 80%
GOLD Stage III: 30 < FEV1 < 50
GOLD Stage IV: FEV1 < 30%
causes of clubbing
lung cancer congenital heart defects bronchiectasis CF lung abscess infective endocarditis interstitial lung disease coeliac disease cirrhosis dysentry grave's disease cancers (liver, GI, hodgkin lymphoma)
questions to ask at an annual asthma review?
- difficulty sleeping due to asthma (in the last month)?
- usual asthma symptoms during the day?
- has asthma interfered with usual daily activities?
in which conditions do you hear bronchial breathing?
- Consolidation
- Lobar Collapse with patent bronchus
- lung Cavity
how do you record serial readings of PEFR and for how long?
for diagnosis: 2-4 weeks (twice daily)
for occupational asthma: 2-4 hourly readings over several weeks
complete asthma control definition
- no daytime symptoms
- no night time waking due to asthma
- no need for rescue meds
- no asthma attacks
- no limitation on activity
- normal lung function (FEV1/PEF)
- minimal side effects from meds
asthma treatment
- SABA (for symptoms relief)
- inhaled corticosteroid as preventer therapy if
- use of inhaled SABA 3x/week and/or
- have asthma symptoms 3x/week+ and/or
- woken at night bt asthma symptoms 1x/week+
- -> use twice daily at first and then adjust dose (1 dose/day good for maintenance)
if symptoms not well controlled:
- recheck adherance, tehnique and trigger factors
- leukotriene receptor antagonist (LTRA) + ICS
- LABA + ICS
- MART (single inhalor with ICS and fast acting LABA)
Check this for adults/children
features of acute exacerbation of asthma
- agitation/connsciousness: signs of hypoxia
- signs of exhaustion, cyanosis and use of acessory muscles while at rest