Respiratory System Flashcards
How should spacers be cleaned and how often should they be replaced?
Once a month in mild detergent then allow to dry WITHOUT rinsing- clean mouthpiece.
Replace every 6-12 months
What are the aims of asthma treatment?
No daytime symptoms No night time waking No need for rescue meds No asthma attacks No limits on exercise Minimal side effects from medicines Normal lung function FEV1 + PEF >80%
How is asthma managed in ADULTS?
Differentiate between NICE and BTS/SIGN guidance.
**SABA- salbutamol/ terbutaline throughout.
Step 1: Both say low dose ICS first
Step 2: NICE -add LTRA,
BTS/SIGN - add LABA
Step 3: NICE- increase ICS to med dose or add LABA
BTS/SIGN- increase ICS to medium dose or add LTRA/ SR theophylline/ LAMA
Step 4: NICE- increase ICS to high dose/ add SR theophylline / LAMA
BTS/SIGN- increase ICS to high dose/ add 4th drug.
BTS/SIGN also recommend immunosuppressant (methotrexate) and monoclonal antibodies under specialist for severe asthma in adults and children >6
When should you consider stepping up the asthma management ladder?
More than one SABA a month
More than 3 SABA doses a week
Waking at night due to asthma
Asthma attack in the last 2 years
What is the MART regimen?
Maintenance and reliever regimen.
That is when you combine an ICS with a LABA such as with fostair- the device is used both regularly and PRN.
Which are the monoclonals used in asthma?
What types of asthma are they licensed in?
Omalizumab- for IGE (allergic) asthma
Mepolizumab and reslizumab- for eosinophilic asthma
How is asthma chronic managed in children over 5?
Differentiate between NICE and BTS/SIGN guidance.
- SABA throughout: salbutamol/ terbutaline
- Child is <16 for NICE but <12 for BTS/SIGN guidelines
Step 1: Both say low dose ICS (BTS/SIGN call it very low)
Step 2: Add LTRA
BTS/SIGN say add LTRA/ LABA
Step 3: Add LABA/ increase ICS to paed mod dose
BTS/SIGN say add LTRA/LABA/MR theophylline/ increase ICS to low dose
Step 4: Add MR theoph/ increase ICS to paed high dose
BTS/SIGN say add LTRA/ MR theoph/ oral steroids/ increase ICS to paed mod dose.
How is asthma chronic managed in children under 5?
Differentiate between NICE and BTS/SIGN guidance.
** SABA throughout: salbutamol/ terbutaline
STEP 1:
NICE:
8 week trial of paed mod dose ICS
After 8 weeks:
-If symptoms don’t resolve- wrong diagnosis
-If symptoms recur in 4 weeks, start paed low dose ICS
-If symptoms recur beyond 4 weeks, repeat 8 week trial
BTS/SIGN
Start very low dose ICS (or LTRA if not tolerated)
STEP 2: Both say add LTRA
STEP 3: Both say stop LTRA and refer to specialist.
Can LABA (eterol) inhalers be used alone?
NO increased risk of asthma attacks
When should you consider stepping down asthma treatment?
Well controlled for at least 3 months
How should ICS inhalers be stopped?
Reduce by 25-50% each time- should be the last to be stopped.
What is classed as severe ACUTE asthma in adults?
Where should this be managed?
peak flow 33-50%
resp rate ≥ 25
heart rate ≥ 110
Unable to complete sentences
Manage in hospital
What is classed as life-threatening ACUTE asthma in adults?
peak fllow ≤ 33%
oxygen sats (SPO2) ≤ 92%
cyanosis, hypotension, arrhythmia, confusion
What is the treatment for acute asthma in adults?
oxygen to maintain sats between 94-98%
high dose SABA (nebs driven by oxygen)
oral pred 40-50mg/ IV hydrocortisone at least 5 days
If poor response to SABA: add ipratropium nebs
If life threatening, IV aminophylline/ magnesium
What is classed as severe asthma in children?
peak flow 33-50%
oxygen sats (SPO2) ≤ 92%
resp rate ≥ 40 (if 2-5 years) / ≥ 30 (if over 5 years)
heart rate ≥ 140 (if 2-5 years) / ≥ 125 (if over 5 years)
What is classed as life-threatening ACUTE asthma in children?
peak flow ≤ 33%
hypotension, confusion, exhaustion
What is the treatment for acute asthma in children over 2?
How does this differ in children under 2?
oxygen to maintain sats between 94-98%
high dose SABA (nebs driven by oxygen)
oral pred IV hydrocortisone at least 3 days
If poor response to SABA: add ipratropium nebs
If life threatening, IV aminophylline/ magnesium/ IV salbutamol
Aminophylline and magnesium should not be used in children under 2
What follow up should occur after a patient has had an acute asthma attack?
Written asthma action plan
GP informed with 24 hours of discharge
If severe/life threatening, follow up with respiratory specialist for at least a year.
How is chronic COPD managed?
Reliever: SABA/ SAMA
If FEV1 ≥ 50%
Step 1: LABA (eterol) /LAMA (ium)
Step 2 (if LABA chosen at step 1): LABA + ICS
Step 3: LAMA + LABA + ICS
If FEV1<50% (more ill)
Step 1: LAMA/ LABA+ICS (or LAMA+LABA)
Step 2: LAMA + LABA + ICS
If symptoms persist, MR theophylline can be trialled
If productive cough, try a mucolytic
How is acute COPD managed?
Nebulised salbutamol/ipratropium IV aminophylline if nebs dont work Oral pred 30mg for 7-14 days If signs of infection: amox/doxy/clarith 5 days Oxygen
How should oxygen be given in patients at risk of hypercapnic respiratory failure?
What is the target oxygen sats?
24% or 28% venturi mask + an oxygen alert card stating what oxygen sats are needed during an exacerbation.
Oxygen must be 28% or less
target- 88-92%
When does long term oxygen therapy prolong survival in severe COPD?
If PaCO2 <7.3kPa
Which patient groups are at risk of hypercapnic respiratory failure?
COPD, severe CF, severe TB, opioid overdose
What is the main warning for patients on home oxygen?
No smoking- risk of fires
