Respiratory conditions Flashcards

1
Q

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

A

1 in 5

third biggest cause of death in England

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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

A

asthma - £3 billion

COPD - £1.9 billion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List six types of respiratory disease.

A
asthma
bronchitis
emphysema
cystic fibrosis
mesothelioma
lung cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the prevalence of asthma in the UK?

A

5.4 million (1.1 million children and 4.3 million adults)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

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

A

1 in every 2500

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the prevalence of lung cancer in the UK?

A

over 46,000 diagnoses in 2015

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

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

A

1.2 million

115,000 new diagnoses per year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the most common risk factors for COPD?

A

age (more common >35 years)

smoking or history of smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

List some of the common signs and symptoms of COPD.

A
exertional breathlessness
chronic cough
regular sputum production
frequent winter 'bronchitis'
wheeze
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Differences between COPD and asthma

Smoker or ex-smoker?

A

COPD - nearly all

asthma - possibly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Differences between COPD and asthma

Symptoms under age 35?

A

COPD - rare

asthma - often

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Differences between COPD and asthma

Chronic productive cough?

A

COPD - common

asthma - uncommon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Differences between COPD and asthma

Breathlessness?

A

COPD - persistent and progressive

asthma - variable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Differences between COPD and asthma

Night time waking with breathlessness and/or weeze?

A

COPD - uncommon

asthma - common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Differences between COPD and asthma

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

A

COPD - uncommon

asthma - common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the MRC grade 1?
not troubled by breathlessness except on strenuous exercise
26
What is the MRC grade 2?
short of breath when hurrying or walking up a slight hill
27
What is the MRC grade 3?
walks slower than contemporaries on level ground due to breathlessness, or has to stop for breath when walking at own pace
28
What is the MRC grade 4?
stops for breath after walking about 100 metres or after a few minutes on level ground
29
What is the MRC grade 5?
too breathless to leave the house, or breathless when dressing or undressing
30
What is spirometry?
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
31
What is the purpose of a spirometry test?
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
32
What is FEV1?
forced expiratory volume in one second - the volume of breath exhaled with effort in that time frame
33
What is FVC?
forced vital capacity - the full amount of air that can be exhaled with effort in a complete breath
34
According to NICE guideline CG12 (2004), what are the values related to a diagnosis of COPD?
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%
35
According to ATS/ERS 2004, what are the values related to the diagnosis of COPD?
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%
36
According to GOLD 2008 and NICE guideline CG101 (2010), what are the values related to the diagnosis of COPD?
``` 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% ```
37
What does yellow/green sputum indicate?
likely infection
38
What does pink/red/bloody sputum indicate?
could be related to an infection or cancer, in some cases
39
What does white sputum indicate?
allergies, asthma or viral infections
40
What does charcoal/grey sputum indicate?
environmental, common in people who work in coal mines and factories or heavy smokers
41
What does brown sputum indicate?
chronic lung disease, cystic fibrosis or bronchiectasis
42
How can a chest X-ray detect hyperinflation?
hyperinflation occurs when air gets trapped in the lungs and causes them to overinflate diaphragm appears flattened enlarged retrosternal air space
43
What is a limitation of chest X-rays for the diagnosis of COPD?
may only detect severe and progressive COPD
44
What is the purpose of a sputum culture in the diagnosis of COPD?
to identify organisms if sputum is persistently present and purulent
45
What is the purpose of serial home peak flow measurements in the diagnosis of COPD?
to exclude asthma if diagnostic doubt remains
46
What is the purpose of an ECG and serial natriuretic peptides in the diagnosis of COPD?
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
What is the purpose of an echocardiogram in the diagnosis of COPD?
to assess cardiac status if cardiac disease or pulmonary hypertension are suspected
48
What is the purpose of a CT scan of the thorax in the diagnosis of COPD?
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
What is the purpose of a serum alpha-1 antitrypsin test in the diagnosis of COPD?
to assess for alpha-1 antitrypsin deficiency if early onset, minimal smoking history or family history
50
What is the purpose of a transfer factor for carbon monoxide (TLCO) test in the diagnosis of COPD?
to investigate symptoms that seem disproportionate to the spirometric impairment to assess suitability for lung volume reduction procedures
51
What factors influence the treatment of respiratory diseases?
severity of disease tolerance of medication ability to adhere to treatment protocols
52
What are the inhaled treatment options for asthma?
initial therapy - ICS advanced therapy - ICS + LABA uncontrolled symptoms or frequent exacerbations - referral to specialist respiratory care
53
What are the inhaled treatment options for COPD?
initial therapy - SABA | advanced therapy - LABA + LAMA → ICS + LABA + LAMA
54
What are the inhaled treatment options for ACO?
initial therapy - ICS advanced therapy - ICS + LABA → ICS + LABA + LAMA uncontrolled symptoms or frequent exacerbations - referral to specialist respiratory care
55
List some examples of long acting beta antagonists (LABAs).
formoterol | indacaterol
56
List some examples of long acting muscarinic antagonists (LAMAs).
glycopyrronium | tiotropium
57
List some examples of LABAs and LAMAs combined.
Anoro | Ultibro
58
What is the first-line treatment with steroids for respiratory exacerbations?
prednisolone 30mg PD for 5 days | this can be stored in the patient's home and commenced when symptoms appear
59
What are the most common infections in patients with respiratory diseases.
Hemophilus influenza Moraxella catharralis Streptococcus pneumonia Pseudomonas
60
When is the use of antibiotics most beneficial in patients with respiratory diseases?
during a severe acute exacerbation
61
What are the first-choice oral antibiotics for respiratory diseases?
amoxicillin doxycycline clarithromycin
62
What is the dosage and course length of amoxicillin?
500mg TD for 5 days
63
What is the dosage and course length of doxycycline?
200mg on first day, then 100mg OD for 5-day course in total
64
What is the dosage and course length of clarithromycin?
500mg BD for 5 days
65
BETA-LACTAM ANTIBIOTICS Penicillins: amoxicillin - actions
bactericidal | interfere with cell wall synthesis in dividing bacteria
66
BETA-LACTAM ANTIBIOTICS Penicillins: amoxicillin - MOA
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
BETA-LACTAM ANTIBIOTICS Penicillins: amoxicillin - abs/distrib/elim
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
BETA-LACTAM ANTIBIOTICS Penicillins: amoxicillin - clinical use
otitis media bronchitis pneumonia
69
BETA-LACTAM ANTIBIOTICS Penicillins: amoxicillin - adverse effects
hypersensitivity reactions (rashes, urticaria, angioedema, fever, arthralgia, anaphylaxis)
70
What is the difference between oral and IV amoxicillin in terms of dosage and frequency of administration (acute exacerbation of COPD)?
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
BACTERIAL PROTEIN SYNTHESIS BLOCKERS Tetracyclines: doxycycline, tetracycline, oxytetracycline - actions & MOA
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
BACTERIAL PROTEIN SYNTHESIS BLOCKERS | Tetracyclines: doxycycline, tetracycline, oxytetracycline - abs/distrib/elim
given orally, absorption impaired by milk and by calcium, magnesium and iron preparations
73
BACTERIAL PROTEIN SYNTHESIS BLOCKERS Tetracyclines: doxycycline, tetracycline, oxytetracycline - clinical use
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
BACTERIAL PROTEIN SYNTHESIS BLOCKERS Tetracyclines: doxycycline, tetracycline, oxytetracycline - adverse effects
staining of the teeth, GIT disturbances, anorexia, flushing, tinnitus eare: hepatotoxicity pancreatitis, hypersensitivity reactions
75
BACTERIAL PROTEIN SYNTHESIS BLOCKERS Tetracyclines: doxycycline, tetracycline, oxytetracycline - special points
tetracyclines should not be given to children or pregnant or breastfeeding women
76
What is the difference between oral and IV doxycycline in terms of dosage and frequency of administration (acute exacerbation of COPD)?
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
BACTERIAL PROTEIN SYNTHESIS BLOCKERS Macrolides: erythromycin, clarithromycin, azithromycin - actions
inhibit bacterial protein synthesis
78
BACTERIAL PROTEIN SYNTHESIS BLOCKERS Macrolides: erythromycin, clarithromycin, azithromycin - MOA
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
BACTERIAL PROTEIN SYNTHESIS BLOCKERS Macrolides: erythromycin, clarithromycin, azithromycin - abs/distrib/elim
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
BACTERIAL PROTEIN SYNTHESIS BLOCKERS Macrolides: erythromycin, clarithromycin, azithromycin - clinical use
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
BACTERIAL PROTEIN SYNTHESIS BLOCKERS Macrolides: erythromycin, clarithromycin, azithromycin - adverse effects
GIT disturbances | less frequent: allergic reactions, cholestatic jaundice
82
BACTERIAL PROTEIN SYNTHESIS BLOCKERS Macrolides: erythromycin, clarithromycin, azithromycin - special notes
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
What is the difference between oral and IV clarithromycin in terms of dosage and frequency of administration (acute exacerbation of COPD)?
oral - 500 mg twice daily for 5 days | IV - 500 mg every 12 hours, to be administered into a large proximal vein
84
Which patient groups are more likely to use an inhaler or nebuliser incorrectly?
children and the elderly
85
What is pulmonary rehabilitation?
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
What is involved in the treatment of depression and/or anxiety in patients with COPD?
appropriate identification and discussion with patients | consideration of the guidelines that relate to this area as provided by NICE (2009)
87
What is the 'expert patient programme' (EPP) initiative?
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
What did Law et al. (2019) conclude about the parental administration of asthma inhalers to their young children?
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
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?
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
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?
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