Respiratory

Question 1

What are some causes of bronchiectasis?

Answer 1

CF 
Non CF
- Hypogammaglobulinaemia / CVID 
- severe / recurrent lung infection 
- COPD
- CTD
- ILD

Question 2

What is the definition of chronic bronchitis?

Answer 2

Chronic cough for >3 months for 2 years

Question 3

Asthma management Spiel?

Answer 3

Goals:

• symptom control to maintain function
• minimise future risk of flares or permanent airway damage

Management:
- Education about self-management and therapeutic partnership
- Asthma Action Plan
- address modifiable RFs (smoking / triggers)
Pharm:
- Stepwise approach based on symptoms
- Sx <2x/month -> PRN SABA
- Sx >2x / month, or nocturnal sx -> reg low-dose ICS + PRN SABA
- poorly controlled sx -> reg medium- to high-dose ICS. Combination ICS+LABA and/or addition of a short course of oral corticosteroids may be considered

Regular monitoring and follow up

Question 4

COPD management spiel?

Answer 4

Non-pharm:

• Education on self-management
• Smoking cessation is key
• Pulmonary rehab
• Vaccinations
• Nutritional optimisation
• Consider O2 / Pall Care at end stage

Pharm: (stepwise approach)

• SABA / SAMA
• LAMA
• > can go to LABA + LAMA
• > ICS can be added on if FEV1<50% + >2 exac in last year

Question 5

What are predictors of mortality in COPD? (BODE)

Answer 5

BODE index 
Body-mass index <21 (low = bad)
Obstruction (FEV1)
Dyspnoea score (by mMRC)
Exercise tolerance (6MWT)

Question 6

IPF management spiel?

Answer 6

Confirm diagnosis and severity

• HRCT with UIP pattern
• PFTs
• Check for hypoxia

Management:

• > pulmonary rehabilitation
• > vaccinations
• > treat co-morbidities (GORD)
• > Anti-fibrotics = pirfenidone / nintedanib to slow progression if fulfill criteria
• > LTOT if hypoxic
• > Early lung transplant assessment

Question 7

Management of CF Bronchiectasis?

Answer 7

Non-pharm:

• strict infection control and resp viral avoidance
• vaccination
• chest physio
• optimise nutrition
• Mucolytics

Pharm:

• Long term Azithromycin in pseudomonas
• Bronchodilators if co-existent asthma
• Targeted therapy if fulfils criteria

Advanced:

• LTOT
• NIV
• Lung Tx

Question 8

OSA Management spiel?

Answer 8

Goal = to improve sleep quality and daytime function

Non-pharm:
- Weight loss if overweight
- Sleep position (non-supine) / hygiene 
- Avoidance of ETOH and benzos

Device:

• CPAP
• Oral appliances (expensive, can be considered if not tolerating CPAP)

Surgical:
- only if severe, surgically correctable lesion of upper airway

Question 9

Targeted management options for PAH?

Answer 9

CCBs: nifedipine, diltiazem

• have benefit in small proportion of patients that show response to vasodilator on RHC
• can cause severe hypotension / oedema

Endothelin receptor antagonists:

• Bosentan, ambrisentan and macitentan
• AEs: liver, oedema

PDE5 inhibitors:

• Sildenafil / tadalafil
• Do not combine with nitrates

Riociguat (soluble guanylate cyclase inhibitor)
- well tolerated

Prostanoid analogues:

• Epoprostenol infusion / iloprost inhalation
• can precipitate severe rebound if interrupted