Respiratory - Chronic Conditions Flashcards
what type of hypersensitivity is asthma?
Type 1 (IgE mediated)
risk factors for asthma?
FHx
atopy
allergen exposure
nasal polyps
pathology of asthma?
- inflammation due to trigger
- mast cells and basophils degranulate
- increased mucus and responsiveness
- intermittent airway obstruction, mucus and hyper-reactivity
clinical criteria for diagnosis of asthma?
atopic Hx
wheeze heard
diurnal variability
wheeze/SOB/chest tight/cough with no symptoms inbetween
other features of asthma?
kids worse at night
precipitants of cold, exercise, Bb, NSAIDs
investigations for asthma?
high probability - 6wks of Tx spirometry with bronchodilator reversibility (<80% predicted) bronchial challenge (allergic asthma)
treatment for asthma?
- SABA + ICS
- add LABA
- increase ICS or add LTRA
treatment for asthma in kids?
- SABA + ICS/LTRA if <5
- <5yrs LTRA / >5yrs LABA/LTRA
- increase ICS or add LTRA/LABA
stop LABA if no response
use spacers
e.g of SABA LTRA ICS LABA
SABA - salbutamol (blue)
LTRA - montelukast
ICS - beclamethasone (brown)
LABA - salmeterol (purple)
features of moderate acute asthma?
worsening symptoms
PEF >50-75% predicted
features of acute severe asthma?
PEF 33-50%
RR ≥25
HR ≥110
inability to complete a sentence in one breath
features of life threatening asthma?
PEF <33% SpO2 <92% altered consciousness silent chest hypotension PaCO2 can be normal, PaO2
features of acute severe asthma in kids?
SpO2 <92 PEF 33-50% inability to complete a sentence in one breath HR >140 for 1-5, >125 for >5 RR >40, >30
features of life threatening asthma in kids?
SpO2 <92 PEF <33% silent chest confused hypotension
how many puffs of a SABA can be given to children in acute asthma?
one puff every 30-60secs
up to 10 puffs
treatment of acute asthma?
Oxygen SABA Steroids Ipratropium bromide IV Mag sulphate IV Aminophylline Anaesthetics and intensive care
risk factors for COPD?
SMOKING
age
pollution
two pathological features of COPD?
emphysema - enlarged air spaces and destroyed alveoli
chronic bronchitis - sputum + cough on most days for 3 successive months for 2 years
features of COPD?
productive cough SOB hyper resonant wheeze crackles tachypnoea barrel chest
investigations for COPD and results?
spirometry with bronchodilator:
mild >80, mod <80, severe <50
reduced FEV1/FVC ratio
reduced FEV1 and FVC (not as much)
treatment for COPD?
- SABA
- SAMA
- FEV1 >50 = LABA/LAMA
FEV1 <50 = LABA + ICS/LAMA - LABA + LAMA + ICS
- oxygen
e.g of
SAMA
LAMA
LABA
SAMA = ipratropium LAMA = tiotropium LABA = salmeterol
features of obstructive sleep apnoea?
snoring
daytime sleepiness
apnoea
orthopnea
investigation and Tx of obstructive sleep apnoea?
polysomnography
weight loss
smoking cessation
CPAP
treatment of exacerbation of COPD?
amoxicillin
2nd line: doxycycline
prednisolone
SABA
SAMA
what is bronchiectasis?
permanent dilation of bronchi due to destruction of the walls
causes of bronchiectasis?
recurrent infection CF alpha 1 antitrypsin CTD tumour HIV
investigations for bronchiectasis?
CXR
high resolution CT
find the cause
features of bronchiectasis?
cough sputum SOB wheeze weight loss fever fatigue
complications of bronchiectasis?
respiratory failure
cor pulmonale
what is cor pulmonale?
high blood pressure in the pulmonary arteries
causes enlarged RHS of heart
types of respiratory failure?
type 1 - hypoxia without hypercapnia
type 2 - hypoxia with
features of hypoxia?
dyspnoea restless agitated confused cyanosis
features of hypercapnia?
headache peripheral vasodilation tachycardia tremor confused drowsy papilloedema
causes of type 1 RF?
asthma
PE
PO
pneumonia
causes of type 2 RF?
COPD
rising CO2 not matched by increased RR
treatment of type 1 and type 2 RF?
1 - treat cause and oxygen
2 - treat cause and controlled oxygen
ABG recheck
what is the haldane effect?
deoxygenated Hb binds with a greater affinity to CO2
why do COPD need controlled O2 therapy?
hypoxic vasoconstriction
oxygen just increases blood flow
does not increase ventilation
when should asthma treatment be stepped up?
using SABA >3x a week
what is FEV1?
amount expelled forcefully in one second
reduced in COPD
what is FVC?
total air exhaled in one breath
what is the spirometry pattern for restrictive lung disease? why?
FEV1/FVC normal
both equally reduced (in obstructive, FVC reduced LESS than FEV1)
