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Respiratory disorders and their management Flashcards

Gain knowledge about the symptoms, signs and management of COPD Asthma Lung Cancer Fibrotic Lung Disease Obstructive Sleep Apnea Appreciate the action of different drugs used to manage patients with Asthma or COPD

1
Q

Estimated prevalence of COPD UK

A

3M
Majority in 50s
Will rise by 30% over 10 next years

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2
Q

Prevalence of diagnosed/ undiagnosed COPD

A

0.9M diagnosed

2M undiagnosed

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3
Q

Survival rates of COPD

A

5 year survival in individuals with O2 or neb utilisation <30%
2005: 5% of all deaths globally

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4
Q

Diagnosis of COPD

A

Traditionally defined as emphysema (pathological diagnosis) or chronic bronchitis (clinical diagnosis with 3/12 of productive cough for >2 consecutive years)

  • bronchial wall thickening
  • airflow obstruction due to combination of airway and parenchymal damage
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5
Q

Diagnosis of COPD - spirometry CHART

A

FEV1/ FVC less than 70%

Suboptimal predictor of disability and QOL

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6
Q

Symptoms of chronic COPD

A

Shortness of breath on exertion
Wheeze
Cough
Weight loss

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7
Q

Symptoms of acute/ exacerbation of COPD

A 
*worsening of the following*
Acute sob/ wheeze
Worsening sputum production
Fever
Drowsiness/ CO2 narcosis
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8
Q

Signs of COPD - general inspection

A 
Cachexia - low body weight (severe disease)
Use of accessory muscles
Pursed lips
Cyanosis (late disease)
CO2 flap (severe disease)
Drowsiness in CO2 narcosis
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9
Q

Signs of COPD - chest

A 
Hyper-expanded chest (gross disease)
Hyperesonant
Reduced breath sounds
Wheeze (acute disease)
Elevated jugular venous pressure and peripheral oedema in late disease
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10
Q

Disease severity COPD - different clinical parameters

TABLE and CAT SCORE

A

Lung function
Symptoms (e.g. COPD assessment test)
Exacerbation frequency
BODE index

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11
Q

The MCR breathlessness scale

A

1 - not troubled by breathlessness except on strenuous exercise
2 - short of breath when hurrying on level or walking up slight hill
3 - walks slower than most people on level, stops after a mile or so, or stops after 15 minutes walking at own pace
4 - stops for breath after walking about 100 yds or after a few mins on level ground
5 - too breathless to leave the house, or breathless when undressing
less subjective than CAT scale

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12
Q

Disease severity comparisons COPD

- bringing all scores together

A 
A - low risk, less symptoms (you want to be here)
-risk 1-2
-mMRC 0-1
CAT< 10
B - low risk, more symptoms
-risk 0-1
-mMRC >/2
-CAT>/10
C - high risk, less symptoms
-risk 3-4
-mMRC 0-1
-CAT <10
D - high risk, more symptoms
-risk >/2
-mMRC >/2
-CAT >/10
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13
Q

Inhaled treatment of COPD (FLOW CHART)

A

Aims are directed as trials to improve symptoms and < exacerbations
-not stepwise algorithm in contrast to asthma

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14
Q

S/LABA

A

Short/ long acting beta agonist

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15
Q

S/ LAMA

A

Short/ long acting muscarinic agonist

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16
Q

ICS

A

Inhaled corticosteroid

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17
Q

Management of stable COPD

A 
Smoking cessation
Oral Theophylline
Oral mucolytic therapy
Vaccination therapy
Pulmonary rehabilitation
Nutritional support
Surgery
Oxygen therapy
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18
Q

Management of stable COPD - smoking cessation

A

NRT
Bupropion
Varenicline

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19
Q

Management of stable COPD - Oral theophylline

A

Trial of therapy

Risk of side effects

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20
Q

Management of stable COPD - oral mucolytic therapy

A

Carbocisteine

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21
Q

Management of stable COPD - vaccination therapy

A

Annual influenza and 5 yearly pneumococcal vaccination

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22
Q

Management of stable COPD - pulomary rehabilitation

A

Addresses muscle deconditioning
Improves QoL, exercise tolerance
May have some impact on exacerbation
Non-pharmacological intervention

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23
Q

Management of stable COPD - nutritional support

A

BMI of 20-25

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24
Q

Management of stable COPD - surgery (very severe disease)

A 
Transplant
Lung volume reduction surgery
Bullectomy
-surgical removal of a bulla, which is a dilated air space in the lung parenchyma measuring more than 1 cm
Placement of endobronchial valves
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25
Management of stable COPD - oxygen therapy
Long term oxygen therapy Ambulatory Short burst oxygen therapy (SBOT)
26
Management of stable COPD - LTOT
``` Pts with persistant respiratory failure Min 14 hours per day of continuous O2 therapy delivered by concentrator -has prognostic benefit PO2 <7.3kPa persistently PO2 7.3-8kPa and secondary polycythaemia -+ nocte sPO2 <90% for >30% of night -+ peripheral oedema -+ pulmonary hypertension Not for symptomatic relief ```
27
Management of stable COPD - ambulatory oxygen
Desaturation on exercise > in exercise with supplemental O2 Delivered by cylinder
28
Management of stable COPD - SBOT
Short burst oxygen therapy -not really advised for COPD Palliative care
29
Prevention of exacerbation
Seasonal influenza vaccination (one-off pneumococcal vaccination) Inhaled steroids (in conjunction with long acting bronchodilator) Other agents -anticholinergics - ipratropium/ tiotropium -mucolytics (carbocysteine) Pulmonary rehabilitation (used for symptom control as well)
30
Regulation of ventilation
GRAPHS
31
Respiratory failure type I - PaO2 - PaCO2 - common causes - O2
``` PaO2 <8KPa Low or normal PaCo2 Common causes -acute: pneumonia, asthma -chronic: fibrosing lung disease O2: yes, give them oxygen ```
32
Respiratory failure type II - PaO2 - PaCO2 - common causes - O2
``` PaO2 <8KPa PaCO2 >6.0KPa Common causes -acute: overdose, trauma -chronic: COPD, neuromuscular O2: yes but care in chronic -too much oxygen switches off hypoxic drive ```
33
Treatment for respiratory failure
Non-Invasive Ventilation (NIV) - employed after optimum medical Rx - cyclical non-invasive positive p delivered by face/ nasal mask - supplemental O2 supply - acute use for respiratory acidosis - usually pt trigger with back-up respiratory rate - delivered by trained nursing/ physio staff - requires ABG/ transcutaneous CO2 monitoring
34
Contraindications to noninvasive positive pressure ventilation (relative not absolute)
``` Cardiac/ respiratory arrest Nonrespiratory organ failure Facial or neurological surgery, trauma, or deformity Upper airway obstruction Inability to cooperate/ protect airway Inability to clear secretions High risk for aspiration ```
35
Nonrespiratory organ failure as contraindications to NIV
Severe encepalopathy (e.g. GCS <10) Supper upper GI bleeding Haemodynamic instability or unstable cardiac arrhythmia
36
Prevalence of asthma in UK
5.4 million 1 adult in 12 1 child in 11
37
Airway during an asthma attack (DIAGRAM)
``` Narrowed Swollen submucosa Excess mucous Thickened smooth muscle layer Tightened bands of smooth muscle ```
38
Respiratory symptoms of asthma
``` Wheeze Cough Dyspnea (shortness of breath) Chest tightness Nocturnal duration ```
39
Structured clinical assessment for asthma (FLOW CHART and DIAGRAMS)
Recurrent episodes of symptoms Symptom variability Absence of symptoms of alternative diagnosis Recorded observation of wheeze Personal history of atopy (genetic tendency to develop allergy) Historical record of variable PEF or FEV1
40
Possible triggers of asthma
``` Exertion Dust Change in T Emotional situations e.g. anxiety Occupation ```
41
Signs of asthma
``` Eczema Nasal polyps Cushingoid (excess cortisol) Wheeze Peripheral/ central cyanosis ```
42
Signs of asthma upon exacerbation
``` Elevated respiratory rate Elevated heart rate SpO2 Inability to complete sentences Audible wheeze ```
43
Treatment of asthma
Short acting beta2 agonists as required - consider moving up if using 3 doses a week or more -refer pt for specialist care if using high dose therapies
44
Method of delivery of inhaled drugs - asthma
Metered dose inhaler MDI via spacer Breath actuated
45
Metered dose inhaler
(SABA/ LABA/ ipatropium/ ICS) | -inhale with simultaneous depression of canister with breath hold for 10s
46
MDI via spacer
10 puffs of salbutamol via spacer equivalent to nebuliser Give 4 puffs initially then 2 puffs every 2 mins up to max of 10 puffs -if not good with inhaler
47
Pts at risk of developing near-fatal or fatal asthma
A combination of severe asthma and adverse behavioural or psychosocial features
48
Severe asthma is recognised by one or more of:
Previous near-fatal asthma -e.g. previous ventilation/ respiratory acidosis Previous admission for asthma (especially if in last year) Requiring 3 or more classes of asthma med Heavy use of beta2 agonist Repeated attendances at ED for asthma care (especially in last year) "Brittle" asthma
49
Adverse behavioural or psychosocial features recognised by one or more of:
``` Non-compliance with treatment/ monitoring Failure to attend Fewer GP contacts Frequent home visits Self discharge from hospital Psychosis, depression, other psychiatric illness or deliberate self harm Current or recent major tranquiliser use Denial Alcohol/ drug abuse Obesity Learning difficulties Employment problems Income problems Social isolation Childhood abuse Severe domestic, marital or legal stress ```
50
Acute asthma severity (KNOW THIS)
``` Mild (routine): -75% PEF % best -pt should bewell Moderate (semi urgent): -50-75% PEF % best Severe (urgent): -33-49% best PEF -RR > 25/min -HR > 110/min -not talking LT (urgent): -<33% best PEF -bradycardia -SaO2 <92, silent chest ```
51
Acute asthma management
O2 40-60%: drive nebulisers with O2 B2 agonists are mainstay Oral steroids should be given within an hour (asap) B2 agonists and anticholinergics in those who fail to progress IV beta2 agonists (very rare) reserved for those where inhaled route cannot be relied upon
52
Lung cancer epidemiology
``` Main cause of cancer related death in UK 2nd most common cancer in UK 2nd most common cancer in males (14%) and females (12%) 69 new cases for every 100,000 persons 85% NSCLC/ 15% SCLC ```
53
Lung cancer % operable at diagnosis
10%
54
Risk of spread lung cancer
From primary tumours to nodes and distal organs | -bone, liver, lung pleura cavity
55
What predicts survival of lung cancer
T N M1A/1B Symptoms can be dependent upon stage of disease -some pts can present late with widespread metastatic disease (and still be feeling well)
56
Major subtypes of NSCLC (non-small-cell)
Squamous cell Adenocarcinoma Adenocarcinoma in situ (aka bronchoalveolar carcinoma)
57
Lung cancer - chest symptoms
Sob - lobar collapse, effusion, lymphangitis Chest pain - rib involvement, chest wall invasion Cough Haemoptysis - usually due to endobronchial involvement
58
Lung cancer - constitutional symptoms
Weight loss Low appetite Low energy levels
59
Lung cancer - paraneoplastic syndromes (uncommon)
High Ca (PTH release or bone involvement) SIADH Hypertrophic pulmonary osteoarthropathy Lambert Eaton Syndrome
60
High calcium syndrome
``` PTH release (hold on to water) or bone involvement Nausea, confusion, abdominal pain and constipation ```
61
SIADH
Confusion, fits, lethargy
62
Lambert Eaton Syndrome
Neuromuscular weakness
63
Lung cancer - metastatic disease
SVC obstruction (SVCO) due to mediastinal disease Brain metastasis - confusion, nausea, headache Bone metastasis - pathological fracture, pain Liver metastasis - abdominal pain
64
Signs of lung cancer
``` Finger nail clubbing Cachexia Horner's syndrome (tumour in apex of lung, chomps through brachial plexus --> drooping eyelid and miosis) Neck nodes Chest signs Palpable liver SVCO ```
65
Diagnosis of lung cancer
Chest X-ray CT PET scan for radical treatable disease Tissue biopsy
66
Diagnosis of lung cancer - tissue biopsy
Bronchoscopy Thoracoscopy for pleural disease Surgical
67
Diagnosis of lung cancer - Chest x-ray
``` Cheap Good screening tool Won't detect mediastinal disease necessarily Won't detect small nodules Not a staging tool ```
68
Diagnosis of lung cancer - CT
Staging tool Detailed info Requires IV contrast Contrast not allowed in pts with chronic kidney disease Cannot detect microscopic disease e.g. in med nodes
69
Diagnosis of lung cancer - PET scan for radical treatable disease
``` Infusion of FD glucose Detects cancer, infection and vasculitis Very sensitive Expensive False positive rate Care needed in DM ```
70
WHO performance status
0: able to carry out all normal activity w/o restriction 1: restricted in strenuous activity but ambulatory and able to carry out light work 2: ambulatory and capable of self-care but unable to carry out any work activities; up and about >50% of waking hours 3: symptomatic and in chair/ bed for >50% of day but not bedridden 4: completely disabled; cannot carry out any self-care; totally confined to bed/ chair
71
Treatment of lung cancer for NSCLC
Dependent upon stage and WHO performance status Radiation therapy/ surgery for limited disease WHO PSo-1/2 Chemo (platinum + 3rd gen drug) for extensive disease Immunotherapy Oral EGFR mAb for EGFR +ve disease WHO PS 0-3 BSC for pts not fit for active treatment
72
Immunotherapy
Inhibition of PDL suppression by tumours on T-cells - allows them to fight malignancy - pts must have sufficient PDL1
73
Treatment of lung cancer for SCLC
Systemic Cisplatin based Chemotherapy -disease extensive at presentation Treat within 7/7 of diagnosis to due speed of deterioration If localised disease - f/u radiation therapy
74
Interstitial lung disease names (FLOW CHART)
Interstitial lung disease Diffuse parenchymal lung disease Lung fibrosis
75
Classification of interstitial lung disease
Idiopathic Drug reaction Extrinsic allergic alveolitis/ hypersensitivity pneumonitis Associated with rheumatological disease
76
Symptoms of intersititial lung disease
Dysnpea Cough Consitutional symptoms Onset of symptoms may identify aetiology Extrinsic allergic alveolitis - post exposure Idiopathic pulmonary fibrosis - chronic Acute intersitial pneumonia - rapid onset
77
Signs of intersitial lung disease
Signs associated with CT diseases/ rheumatoid arthritis Nail clubbing Sclerodactyly (associated with systemic sclerosis) Signs of steroid use Chest - audible crackles; distribution may influence diagnosis Chest - squeaks - suggest small airways disease
78
Idiopathic pulmonary fibrosis aka cryptogenic fibrosis
``` Male Older population Median survival 3yrs Associated with clubbing Mainly lower zone preponderance Classically restrictive spirometry and < transfer factor Diagnosis can be made from CT FEV1/FVC ratio >70% ```
79
Idiopathic pulmonary fibrosis treatment
``` Supportive Pulm rehab Pirenidone (anti-fibroblast activity with effect on survival and lung function) when FVC<80% Nintenadib (anti-fibroblast FVC 50-80%) Opiates/ palliative care in later stages Role of steroids controversial ```
80
Extrinsic allergic alveolitis
Trigger may not identifiable Classical triggers occupation- baker, farmer, moulds Disease has predominant upper zone predominance
81
Treatment for extrinsic allergic alveolitis
Antigen avoidance Trial of corticosteroid therapy Calcium and vitamin D supplementation Possible bisphosphonate
82
Sleep apnea
Excessive daytime sleepiness with disordered nocturnal irregular breathing 0.5-4% population prevalence cf Type 1 DM Severity defined by Apnea-Hypopnea Index
83
Apnea-Hypopnea Index
Mild: AHI 5-14/hr Moderate: AHI 15-30/hr Severe: AHI >30/hr
84
Apnea definition
Cessation of flow for 10s
85
Hypopnea definition
< of flow for 10s by >30%
86
Types of sleep apnea
3 - obstructive sleep apnea (OSA) - central sleep apnea - mixed apnea
87
Risk factors for OSA
``` Obesity >17 inch collar Men x2-3 likely Age Cranio-facial and upper airway abnormalities e.g. short mandible, tonsillar/ adenoid hypertrophy, wide craniofacial base ```
88
CAT score
Number of different symptoms and pt subjectively scores themselves 0-5 Ranked out of 40
89
BODE index
Number of different parameters - BMI - dyspnea scale score - distance walked in 6 mins
90
Sleep apnea symptoms
``` Excessive daytime sleepiness Impaired concentration Snoring Unrefreshing sleep Choking episodes during sleep Witnessed apnoeas Restless sleep Irritability/ personality change Nucturia (waking up to urinate at night) < libido ```
91
Obstructive sleep apnea
Snoring and apnoeas observed when upper airway collapses
92
Epworth sleepiness scale
``` Questionnaire with 0-24 scale 11-14 mild sleepiness 15-18 moderate sleepiness >18 severe sleepiness -screening tool when assessing daytime somnolence ```
93
Other tests for sleepiness
Sleep latency test and maintenance of wakefulness
94
Some potential causes of excessive daytime sleepiness in adults
``` Fragmented sleep (quality of sleep) Sleep deprivation (quantity of sleep) Shift work Depression Narcolepsy Hypothyroidism Restless leg syndrome/ periodic limb movement disorder Drugs -sedatives -stimulants (caffeine, theophyllines, amphetamines) -beta-blockers -selective serotonin reuptake inhibitors (SSRIs) Idiopathic hypersomnolence Excess alcohol Neurological conditions ```
95
Neurological conditions as potential causes of excessive daytime sleepiness in adults
Dystrophica myotonica Previous encephalitis Previous head injury Parkinsonism
96
Diagnosis of sleeping disorders??
Polysomnography | Pulse oximetry
97
Pulse oximetry pros
Cheap Easy to use Can be used at home
98
Pulse oximetry cons
Can show false negative | Less sensitive in thin pts/ issues with tissue perfusion
99
How does pulse oximetry work
Measure 4% desaturation rate (ODI) | - >10 events per hour suspicious
100
Pursed lips meaning
Pt coping strategy to allow symptomatic improvement Lips brought together Working hard to breath out Creates "auto-PEEP" to allow prolonged opening of distal airways to allow emptying of lungs > p within windpipes/ bronchioles which splits them open
101
Taking history of COPD
Duration of onset of symptoms Change in vol and character of sputum Severity of chronic illness - use of supplemental oxygen Smoking occupational (e.g. coal mining) history PYH = (cigs consumption/day) x no. of years smoked divided by 20 >10 PYH - significant
102
Treatment for COPD
``` Visit GP for assessment of infective exacerbation of COPD Antibiotics given if 2 of -increasing dyspnoea -sputum vol -sputum purulence Oral prednisolone -7-10 days (0.6mg/kg/day) = 30-40mg/day -more rapid improvement in physiology -shortens hospital discharge -must weigh severity against side effects ```
103
How NIV works
Pushes in pressure to expand the lungs, helping them inflate/ deflate Lowers CO2 level? Tight fitting mask
104
Diagnosis of asthma
``` PEF A%M (peak flow) -fluctuation of 20% indicates asthma -poorly sensitive, around 20% would be diagnosed Bronchodilatory response -salbutamol via spacer -20-50% increase indicates asthma -only diagnoses about 50% FEV1/FVC ratio -around 80% of pts would be diagnosed ```
105
Taking history of asthma
Duration of onset of symptom Any infective features/triggers-dust/pets/exercise/anxiety Severity of illness – previous hospital/ED/ITU admissions Other medications
106
Bedside test for asthma
Peak flow meter
107
Treatment of suspected asthma
Consider monitored initiation of treatment with low dose ICS | -if they get better through this they have asthma
108
5 step ladder of asthma treatment (DIAGRAM)
Regular preventer - low dose ICS Initial add-on therapy - add inhaled LABA to low-dose ICS (normally as combination inhaler) Additional add-on therapies High dose therapies Continuous or frequent use of oral steroids
109
Polysomnography pros
Limited vs full | -full considered gold standard
110
Polysomnography cons
Full PSG requires hospital admission
111
How polysomnography works
Measurement of EEG, eye and limb movements, nasal flow, thoraco-abdo movement, ECG and oxygen saturation
112
Morbidity associated with OSA
Untreated x2-3 risk of RTA (DVLA) Associated with CHD, CCF, PAH & Hypertension & CVD Insulin resistance (Metabolic syndrome) & T2 DM Concurrent obesity is a confounding factor in studies > risk of post-operative complications
113
Treatment of sleep apnea
FUNDAMENTAL TREATMENT: Weight loss/lifestyle change Continuous Positive Airway Pressure (CPAP) Mandibular Advancement Device (MAD) Pharmocotherapy & surgery?
114
CPAP
(Continuous positive airway pressure) Delivery of constant pressure by face/nasal mask Abolition of apneas/hypopneas with improvement in oxygen saturation Very effective Adherence variable Essential to maintain licence validity
115
Mandibular advancement device role
Role when CPAP not tolerated Mild-Moderate OSA Adherence is key to success
116
Manndibular advancement device mechanism
``` Anterior displacement of the mandible -variable results of trials MAD better than no-MAD -CPAP better than MAD for -< of AHI/ODI -sleep fragmentation MAD better than CPAP for patient preference MAD better than UPPP for AHI/ODI but snoring same for both. ```
117
Pharmacotherapy in obstructive airways disease
``` Short acting bronchodilators -salbutamol (ventolin), terbutaline (bricanyl turbohaler) Long acting bronchodilators -salmeterol (severent) -formoterol (oxis turbohaler) -formoterol (atimos MDI) Anticholinergic agents -ipatropium (Atrovent) -tiotropium (Spiriva) -glycoporronium (Seebri) -aclidinium (Elkira) Inhaled steroids -beclometasone (Clenil, Qvar) -budesonide (Pulmicort) -fluticasone (Flixotide) -ciclesonide (Alvesco) Oral steroids -prednisolone -deflazacort Theophyllines -nuelin SA -slophyllin Antileukotrienes -montelukast -zafilukast ```
118
Short acting bronchodilators
``` Relief of symptoms For PRN use Use in COPD & Asthma Immediate bronchodilation 4-6hour duration Increase in cAMP with reduction in cell Ca2+ leading to relaxation of smooth muscle ```
119
Short acting bronchodilators side effects
``` Increased HR & palpitations Tremor Hypokalaemia Headache Nervousness ```
120
Long acting bronchodilators
Alternative to increasing dose of steroids Given by inhaled route Not to be used in monotherapy in Asthma High selectivity for B2 adenoceptor in pulmonary tissue Can increase glucocorticord receptor availability
121
Long acting bronchodilators side effects
Concern of sudden cardiac death when used in monotherapy
122
Anticholinergic agents (block action of ACh)
Relief of symptoms Primarily for COPD Reduction in exacerbation frequency in COPD Improvement in FEV1 Mode of action Blockade of muscarinic receptors M1-3 Systemic absorption low
123
Side effects of anticholinergic agents
Possible effect on urinary retention Dry mouth Possible adverse cardiovascular effects (seen in severe cardiac disease)
124
Inhaled steroids
*Mainstay of asthma medication* Prevent symptoms < risk of exacerbations and death Usually 2x daily medication Not useful in acute attack Binds to cytosolic GR with reduction in cytokines < bronchoconstriction and airway inflammation
125
Side effects of inhaled steroids
Oral candida Voice change Risk of skin bruising, bone mineral density change and cataracts with high dose
126
Oral steroids
Given in acute asthma or chronically in severe asthma Avoid if possible as long term therapy but essential if asthma worsens Clearer role in eosinophilic asthma Time to efficacy 4hours for IV & PO routes
127
Side effects of oral steroids
``` Weight gain Hyperglycaemia Skin change Hypertension Eye change (cataracts) Mood change < bone mineral density ```
128
Theophyllines (help to relieve breathlessness by relaxing muscles in your airways so they open up, and the air can flow through them more easily)
``` Tablets and intravenous Useful in acute and chronic asthma Method of action unclear Possibly acting upon cAMP via PDE inhibition Possibly acting upon HDAC pathway Requires serum level monitoring Drug interactions ```
129
Side effects of theophyllines
``` Nausea Vomiting Palpitations Headaches Dyspepsia Arrhythmias Confusion ```
130
Antileukotrienes
Oral Useful in chronic asthma Not useful in acute asthma and not used in COPD Role in exercise induced asthma & patients with aspirin hypersensitivity Leukotrienes within phospholipid cell membranes and derived from inflammatory cells Can promote smooth muscle contraction and inflammatory changes in airway wall
131
Side effects of antileukotrienes
``` Headache N&V Sleep disturbance Sore throat GI disturbance ```
132
1st line pharmacotherapy for Obstructive Airways (FOR REST SEE TABLE)
Asthma and COPD: short-acting B2 agonists PRN
133
Oxygen therapy
``` O2 is potentially dangerous drug Delivered by mask, nasal cannulae or ET tube Controlled i.e. concentration known -venturi systems, e.g. 24,28,35,60…% Uncontrolled i.e. concentration guessed -full face masks -cannulae – highly dependent on RR ```
134
Aim for acutely unwell pts on oxygen therapy
In majority of acutely unwell pts aim for SpO294-98% unless concern of hypercapnea
135
Aim for COPD and oxygen therapy
In COPD (or other conditions prone to type 2 RF e.g. OSA) – aim for SpO2>88-92% until ABG taken
136
Combination treatments
Used for COPD not asthma
137
Hypoxic drive
Form of respiratory drive in which the body uses oxygen chemoreceptors instead of carbon dioxide receptors to regulate the respiratory cycle -typical of COPD

Respiratory (5 decks)

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