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Respiratory conditions Flashcards

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1
Q

What proportion of the UK population are affected by respiratory disease?

A

1 in 5

third biggest cause of death in England

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2
Q

Why are incidence and mortality rates from respiratory disease higher in disadvantaged groups and areas of social deprivation?

A

higher incidence of smoking
exposure to higher levels of air pollution
poor housing conditions
exposure to occupational hazards

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3
Q

What is the estimated cost of treating asthma and COPD in the UK?

A

asthma - £3 billion

COPD - £1.9 billion

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4
Q

What is the estimated direct cost to the NHS of all lung conditions in the UK per year?

A

£11 billion
partially due to a rise in hospital admissions in the UK over the past 7 years
most admissions are non-elective, due to exacerbation of their condition
admissions more than double in the winter period

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5
Q

List six types of respiratory disease.

A 
asthma
bronchitis
emphysema
cystic fibrosis
mesothelioma
lung cancer
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6
Q

What is the prevalence of asthma in the UK?

A

5.4 million (1.1 million children and 4.3 million adults)

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7
Q

What proportion of babies are born with cystic fibrosis in the UK?

A

1 in every 2500

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8
Q

What is the prevalence of mesothelioma in the UK?

A

1700 people

65,000 cases are expected to occur between 2020 and 2050

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9
Q

What is the prevalence of lung cancer in the UK?

A

over 46,000 diagnoses in 2015

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10
Q

What is chronic obstructive pulmonary disease (COPD)?

A 
a chronic inflammatory lung disease that causes obstructed airflow from the lungs
encompasses three respiratory conditions
(1) chronic asthma
(2) bronchitis
(3) emphysema
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11
Q

How many people have a diagnosis of COPD in the UK?

A

1.2 million

115,000 new diagnoses per year

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12
Q

What are the most common risk factors for COPD?

A

age (more common >35 years)

smoking or history of smoking

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13
Q

List some of the common signs and symptoms of COPD.

A 
exertional breathlessness
chronic cough
regular sputum production
frequent winter 'bronchitis'
wheeze
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14
Q

List some of the additional signs and symptoms of COPD.

A 
weight loss
reduced exercise tolerance
waking at night with breathlessness
ankle swelling
fatigue
occupational hazards (e.g. respiratory sensitisers)
chest pain (uncommon)
haemoptysis (uncommon)
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15
Q

What are the characteristics of asthma and COPD (ACO)?

A

persistent airflow limitation with several features usually associated with asthma and several features usually associated with COPD
the concept of asthma-COPD overlap was introduced in 2017 by the Global Initiative for Chronic Obstructive Lung Disease (GICOPD, 2017)

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16
Q

What is the prevalence of ACO in the general population?

A

0.9-11%
people with ACO have an increased burden of disease but are often misdiagnosed, so they may not receive the most appropriate therapy

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17
Q

What are the problems associated with ACO?

A 
increased symptoms
increased exacerbations
increased hospitalisations 
increased comorbidities 
increased mortality
lower quality of life
higher healthcare costs 
greater prevalence of insomnia
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18
Q

Differences between COPD and asthma

Smoker or ex-smoker?

A

COPD - nearly all

asthma - possibly

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19
Q

Differences between COPD and asthma

Symptoms under age 35?

A

COPD - rare

asthma - often

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20
Q

Differences between COPD and asthma

Chronic productive cough?

A

COPD - common

asthma - uncommon

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21
Q

Differences between COPD and asthma

Breathlessness?

A

COPD - persistent and progressive

asthma - variable

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22
Q

Differences between COPD and asthma

Night time waking with breathlessness and/or weeze?

A

COPD - uncommon

asthma - common

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23
Q

Differences between COPD and asthma

Significant diurnal or day-to-day variability of symptoms?

A

COPD - uncommon

asthma - common

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24
Q

What is the Medical Research Council (MRC) dyspnoea scale?

A

tool to grade the degree of breathlessness related to activities
used alongside the presence of smoking history and one or more signs/symptoms

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25
Q

What is the MRC grade 1?

A

not troubled by breathlessness except on strenuous exercise

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26
Q

What is the MRC grade 2?

A

short of breath when hurrying or walking up a slight hill

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27
Q

What is the MRC grade 3?

A

walks slower than contemporaries on level ground due to breathlessness, or has to stop for breath when walking at own pace

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28
Q

What is the MRC grade 4?

A

stops for breath after walking about 100 metres or after a few minutes on level ground

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29
Q

What is the MRC grade 5?

A

too breathless to leave the house, or breathless when dressing or undressing

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30
Q

What is spirometry?

A

a test that is undertaken by trained and competent practitioners (e.g. GP nurses, occupational health nurses, respiratory physiologists in hospital)
their role is to perform the test and come to a diagnosis, or complete onward referral for further investigations

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31
Q

What is the purpose of a spirometry test?

A

to aid in the detection of a respiratory obstructive pattern which is seen in asthma
a restrictive airway pattern can be seen in many conditions (e.g. pulmonary fibrosis, cystic fibrosis)
obstructive patterns refer to difficulty exhaling
restrictive patterns refer to difficulty inhaling
shortness of breath can be seen in both cases

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32
Q

What is FEV1?

A

forced expiratory volume in one second - the volume of breath exhaled with effort in that time frame

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33
Q

What is FVC?

A

forced vital capacity - the full amount of air that can be exhaled with effort in a complete breath

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34
Q

According to NICE guideline CG12 (2004), what are the values related to a diagnosis of COPD?

A

mild - post-bronchodilator FEV1/FVC <0.7; FEV1% predicted 50-79%
moderate - post-bronchodilator FEV1/FVC <0.7; FEV1% predicted 30-49%
severe - post-bronchodilator FEV1/FVC <0.7; FEV1% predicted <30%

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35
Q

According to ATS/ERS 2004, what are the values related to the diagnosis of COPD?

A

mild - post-bronchodilator FEV1/FVC <0.7; FEV1% predicted ≥80%
moderate - post-bronchodilator FEV1/FVC <0.7; FEV1% predicted 50-79%
severe - post-bronchodilator FEV1/FVC <0.7; FEV1% predicted 30-49%
very severe - post-bronchodilator FEV1/FVC <0.7; FEV1% predicted <30%

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36
Q

According to GOLD 2008 and NICE guideline CG101 (2010), what are the values related to the diagnosis of COPD?

A 
stage 1 (mild) - post-bronchodilator FEV1/FVC <0.7; FEV1% predicted ≥80%
stage 2 (moderate) - post-bronchodilator FEV1/FVC <0.7; FEV1% predicted 50-79%
stage 3 (severe) - post-bronchodilator FEV1/FVC <0.7; FEV1% predicted 30-49%
stage 4 (very severe) - post-bronchodilator FEV1/FVC <0.7; FEV1% predicted <30%
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37
Q

What does yellow/green sputum indicate?

A

likely infection

38
Q

What does pink/red/bloody sputum indicate?

A

could be related to an infection or cancer, in some cases

39
Q

What does white sputum indicate?

A

allergies, asthma or viral infections

40
Q

What does charcoal/grey sputum indicate?

A

environmental, common in people who work in coal mines and factories or heavy smokers

41
Q

What does brown sputum indicate?

A

chronic lung disease, cystic fibrosis or bronchiectasis

42
Q

How can a chest X-ray detect hyperinflation?

A

hyperinflation occurs when air gets trapped in the lungs and causes them to overinflate
diaphragm appears flattened
enlarged retrosternal air space

43
Q

What is a limitation of chest X-rays for the diagnosis of COPD?

A

may only detect severe and progressive COPD

44
Q

What is the purpose of a sputum culture in the diagnosis of COPD?

A

to identify organisms if sputum is persistently present and purulent

45
Q

What is the purpose of serial home peak flow measurements in the diagnosis of COPD?

A

to exclude asthma if diagnostic doubt remains

46
Q

What is the purpose of an ECG and serial natriuretic peptides in the diagnosis of COPD?

A

to assess cardiac status if cardiac disease or pulmonary hypertension are suspected because of:

(1) a history of CVD, hypertension or hypoxia, or
(2) clinical signs such as tachycardia, oedema, cyanosis or features of cor pulmonale

47
Q

What is the purpose of an echocardiogram in the diagnosis of COPD?

A

to assess cardiac status if cardiac disease or pulmonary hypertension are suspected

48
Q

What is the purpose of a CT scan of the thorax in the diagnosis of COPD?

A

to investigate symptoms that seem disproportionate to the spirometric impairment
to investigate signs that may suggest another lung diagnosis (e.g. fibrosis or bronchiectasis)
to investigate abnormalities seen on a chest X-ray
to assess suitability for lung volume reduction procedures

49
Q

What is the purpose of a serum alpha-1 antitrypsin test in the diagnosis of COPD?

A

to assess for alpha-1 antitrypsin deficiency if early onset, minimal smoking history or family history

50
Q

What is the purpose of a transfer factor for carbon monoxide (TLCO) test in the diagnosis of COPD?

A

to investigate symptoms that seem disproportionate to the spirometric impairment
to assess suitability for lung volume reduction procedures

51
Q

What factors influence the treatment of respiratory diseases?

A

severity of disease
tolerance of medication
ability to adhere to treatment protocols

52
Q

What are the inhaled treatment options for asthma?

A

initial therapy - ICS
advanced therapy - ICS + LABA
uncontrolled symptoms or frequent exacerbations - referral to specialist respiratory care

53
Q

What are the inhaled treatment options for COPD?

A

initial therapy - SABA

advanced therapy - LABA + LAMA → ICS + LABA + LAMA

54
Q

What are the inhaled treatment options for ACO?

A

initial therapy - ICS
advanced therapy - ICS + LABA → ICS + LABA + LAMA
uncontrolled symptoms or frequent exacerbations - referral to specialist respiratory care

55
Q

List some examples of long acting beta antagonists (LABAs).

A

formoterol

indacaterol

56
Q

List some examples of long acting muscarinic antagonists (LAMAs).

A

glycopyrronium

tiotropium

57
Q

List some examples of LABAs and LAMAs combined.

A

Anoro

Ultibro

58
Q

What is the first-line treatment with steroids for respiratory exacerbations?

A

prednisolone 30mg PD for 5 days

this can be stored in the patient’s home and commenced when symptoms appear

59
Q

What are the most common infections in patients with respiratory diseases.

A

Hemophilus influenza
Moraxella catharralis
Streptococcus pneumonia
Pseudomonas

60
Q

When is the use of antibiotics most beneficial in patients with respiratory diseases?

A

during a severe acute exacerbation

61
Q

What are the first-choice oral antibiotics for respiratory diseases?

A

amoxicillin
doxycycline
clarithromycin

62
Q

What is the dosage and course length of amoxicillin?

A

500mg TD for 5 days

63
Q

What is the dosage and course length of doxycycline?

A

200mg on first day, then 100mg OD for 5-day course in total

64
Q

What is the dosage and course length of clarithromycin?

A

500mg BD for 5 days

65
Q

BETA-LACTAM ANTIBIOTICS

Penicillins: amoxicillin - actions

A

bactericidal

interfere with cell wall synthesis in dividing bacteria

66
Q

BETA-LACTAM ANTIBIOTICS

Penicillins: amoxicillin - MOA

A

bind to and inhibit the enzyme that cross-links the peptide chain of the newly formed ‘building block’ to the peptidoglycan cell wall backbone

67
Q

BETA-LACTAM ANTIBIOTICS

Penicillins: amoxicillin - abs/distrib/elim

A

rapid oral absorption
can also be given IM or IV
pass into all body fluids
cross the placenta but not the blood-brain barrier unless the meninges are inflamed
half-life 61.3 mins
excreted in the urine (blocked by probenecid)

68
Q

BETA-LACTAM ANTIBIOTICS

Penicillins: amoxicillin - clinical use

A

otitis media
bronchitis
pneumonia

69
Q

BETA-LACTAM ANTIBIOTICS

Penicillins: amoxicillin - adverse effects

A

hypersensitivity reactions (rashes, urticaria, angioedema, fever, arthralgia, anaphylaxis)

70
Q

What is the difference between oral and IV amoxicillin in terms of dosage and frequency of administration (acute exacerbation of COPD)?

A

oral - 500 mg 3 times a day for 5 days, increased if necessary to 1 g 3 times a day, increased dose used in severe infections
IV - 500 mg every 8 hours, increased to 1 g every 6 hours, increased dose used in severe infections

71
Q

BACTERIAL PROTEIN SYNTHESIS BLOCKERS

Tetracyclines: doxycycline, tetracycline, oxytetracycline - actions & MOA

A

interfere with bacterial protein synthesis by competing with tRNA for the A site of the ribosome and reversibly inhibiting its binding to the mRNA codons in the 30s subunit

72
Q

BACTERIAL PROTEIN SYNTHESIS BLOCKERS

Tetracyclines: doxycycline, tetracycline, oxytetracycline - abs/distrib/elim

A

given orally, absorption impaired by milk and by calcium, magnesium and iron preparations

73
Q

BACTERIAL PROTEIN SYNTHESIS BLOCKERS

Tetracyclines: doxycycline, tetracycline, oxytetracycline - clinical use

A

doxycycline is drug of choice for chlamydial, rickettsial and brucella infections
effective in most chest infections, including mycoplasma and Haemophilus influenzae
used in acne, sinusitis, prostatitis, syphilis, Lyme disease and in treatment/prevention of malaria
demeclocycline used in inappropriate secretion of antidiuretic hormone causing hyponatraemia (different action from its antibacterial effect)

74
Q

BACTERIAL PROTEIN SYNTHESIS BLOCKERS

Tetracyclines: doxycycline, tetracycline, oxytetracycline - adverse effects

A

staining of the teeth, GIT disturbances, anorexia, flushing, tinnitus
eare: hepatotoxicity pancreatitis, hypersensitivity reactions

75
Q

BACTERIAL PROTEIN SYNTHESIS BLOCKERS

Tetracyclines: doxycycline, tetracycline, oxytetracycline - special points

A

tetracyclines should not be given to children or pregnant or breastfeeding women

76
Q

What is the difference between oral and IV doxycycline in terms of dosage and frequency of administration (acute exacerbation of COPD)?

A

oral - initially 200 mg daily for 1 dose, then maintenance 100 mg once daily for 5 days in total, increased if necessary to 200 mg once daily, increased dose used in severe infections
IV - 200 mg first day in one or two infusions, subsequent daily dosage 100-200 mg based on severity of infection (IV not recommended)

77
Q

BACTERIAL PROTEIN SYNTHESIS BLOCKERS

Macrolides: erythromycin, clarithromycin, azithromycin - actions

A

inhibit bacterial protein synthesis

78
Q

BACTERIAL PROTEIN SYNTHESIS BLOCKERS

Macrolides: erythromycin, clarithromycin, azithromycin - MOA

A

macrolides inhibit bacterial protein synthesis by an effect on ribosomal translocation
they bind to same 50s subunit of bacterial ribosome as chloramphenicol and clindamycin and any of these drugs may compete if given concurrently

79
Q

BACTERIAL PROTEIN SYNTHESIS BLOCKERS

Macrolides: erythromycin, clarithromycin, azithromycin - abs/distrib/elim

A

given orally or by IV infusion (IV injection can cause thrombophlebitis)
erythromycin half-life 1.5h
distributed widely but does not enter brain or CSF

80
Q

BACTERIAL PROTEIN SYNTHESIS BLOCKERS

Macrolides: erythromycin, clarithromycin, azithromycin - clinical use

A

for pneumococcal and streptococcal infections in patients allergic to penicillin
for chlamydial and mycoplasma infections
for infections of the skin and the respiratory tract (for syphilis, diphtheria, prostatitis, whooping cough, campylobacter enteritis)
azithromycin more effective against Haemophilus influenzae and may be more active against Legionella
clarithromycin effective against H. influenzae and Mycobacterium avium-intracellulare and may also be useful in leprosy and against Helicobacter pylori

81
Q

BACTERIAL PROTEIN SYNTHESIS BLOCKERS

Macrolides: erythromycin, clarithromycin, azithromycin - adverse effects

A

GIT disturbances

less frequent: allergic reactions, cholestatic jaundice

82
Q

BACTERIAL PROTEIN SYNTHESIS BLOCKERS

Macrolides: erythromycin, clarithromycin, azithromycin - special notes

A

concomitant use of statins with clarithromycin is contraindicated
statins are extensively metabolized by CYP3A4 and concomitant treatment with clarithromycin increases their plasma concentration, which increases the risk of myopathy, including rhabdomyolysis

83
Q

What is the difference between oral and IV clarithromycin in terms of dosage and frequency of administration (acute exacerbation of COPD)?

A

oral - 500 mg twice daily for 5 days

IV - 500 mg every 12 hours, to be administered into a large proximal vein

84
Q

Which patient groups are more likely to use an inhaler or nebuliser incorrectly?

A

children and the elderly

85
Q

What is pulmonary rehabilitation?

A

this is considered appropriate patients with COPD who have an exacerbation that led to hospitalisation, or who have a MRC grade 3 or above
limited benefit for patients unable to walk
the program is determined on the patient’s ability to engage and continue within the home environment

86
Q

What is involved in the treatment of depression and/or anxiety in patients with COPD?

A

appropriate identification and discussion with patients

consideration of the guidelines that relate to this area as provided by NICE (2009)

87
Q

What is the ‘expert patient programme’ (EPP) initiative?

A

began in 1999 following the development of National Service Frameworks
the aim was to empower patients through peer-led and supportive groups to offer patient education via a different platform

88
Q

What did Law et al. (2019) conclude about the parental administration of asthma inhalers to their young children?

A

online discussions show parents’ distress, lack of preparedness, and understanding of administering inhalers to their children
health professionals must review their own knowledge and skills in administration of inhalers to younger patients, and their provision of patient- and family-centred care

89
Q

What did Granados-Santiago et al. (2019) conclude about the effectiveness of a shared decision-making and patient engagement (SDM-PE) program following acute exacerbation of COPD?

A

SDM-PE program significantly improved perceived health status, COPD knowledge, medicines adherence, general functionality, and healthy lifestyle measures at discharge and 3-month follow-up
COPD patients and professionals must work together to select the best care and treatment model for patients, taking into account individual values and preferences

90
Q

What did Peckham et al. (2019) conclude about the effectiveness of a bespoke smoking cessation service compared with treatment as usual for people with severe mental ill health?

A

people with SMI are more ready to engage with a bespoke intervention that results in increased 6-month quit rates
health professionals should ask all patients about their smoking status and offer referrals to effective smoking cessation services
health professionals can be confident that smoking cessation is likely to either be beneficial to mental health or not harm mental health

Therapeutic Nursing (16 decks)

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