SOB Flashcards
How to do investigate for Asthma?
Spirometry (FEV1/FVC <0.7 shows an obstructive pattern). Shows reversibility if >12% with SABA
FeNO test (>35-40 parts/billion)
PEFR (varies by >20% for >3 weeks)
Whats the general management of asthma?
1) SABA
2) SABA + ICS (inhaler used >2 a week)
3) SABA + ICS + LTRA
4) LABA + ICS +/- LTRA
5) LABA + increased ICS +/- LTRA
6) Trials e.g. Theophylline or LAMA
7) Oral Corticosteroids
Examples of each asthma treatment?
SABA = salbutamol ICS = beclometasone, budenoside LTRA = montelukast LABA + ICS = symbicort Oral CS = prednisolone
Asthma life-threatening symptoms?
PEF <33% best effort or predicted.
Can they talk
Altered conscious levels, exhaustion, arrhythmia, hypotension, cyanosis, silent chest. poor respiratory effort
Admit to 24hrs
Asthma Severe signs?
PEF 33%-50%
RR >25
HR >110
Inability to complete sentences in one breayj
A-E for asthma?
Basic obvs, PEFR, ABG (including K+ and Glucose)
Near fatal asthma signs?
Increased pCO2
Admit to hospital
General Treatment for acute asthma admittance?
1) O2
2) Neb. Salbutamol 5mg + Neb Ipratropium Bromide 0.5mg
3) PO Prednisolone 40-50mg 5days + IV hydrocortisone 100mg
If no response, senior support:
IV magnesium sulphate -> IV aminophylline -> ITU + Intubation
Acute asthma non-admittance treatment?
Quadruple inhaled ICS instead of PO prednisolone. Salbutamol back to back
What is COPD made of?
Emphysema and Bronchitis
Hx for COPD?
SOB, productive cough e.g. white or green, some wheeze
General Abx for COPD?
Amoxicillin which you then step up?
RFs for COPD?
Increased Age, FHx, occupation and smoking
Signs of COPD?
tar staining, cyanosis, barrel chest, reduced expansion, hyper-resonance on percussion.
Auscultation = reduced air movement, wheezing + COARSE crackles (hair-like)
Signs of RHF
Crackle examples?
Fine = interstitial lung disease Coarse = COPD + pneumonoa
What are COPD classifications?
FEV/FVC 80% is mild
50-80 = moderate
30-50 = severe
<30 = very severe
COPD investigations?
Spirometry
ABG
Bloods e.g. alpha1antitypsin for early onsent and minimal smoking or FHx, Hb, U&Es
CXR or further CT chest
How to distinguish between COPD and asthma?
Serial peak flow measurements
COPD management?
1) SABA or SAMA
2) No asthma = LABA + LAMA
2) Asthmatic or atopy features= LABA + ICS
3) LAMA + LABA + ICS
COD management examples?
SABA = salbutamol ICS = budenoside or beclometasone LABA + ICS = Symbicort (budenoside + formoterol) LABA = formeterol, salmeterol LAMA = tiotrpium, ipratropium?? Oral CS = Prednisolone
COPD general management?
Smoking Cessation !!
Annual influenza vaccination
pneumococcal vaccination.
Imrpoed survival = smoking cessation, long-term O2, lung volume reduction surgery
Criteria for long-term O2?
pO2 <7.3kPa
or 7.3-8 with following one: secondary polycythaemia, nocturnal hypoxaemia, peripheral oedema, pulmonary hypertension
Acute COPD treatment?
1) 24% O2 blue venturi (don’t immediately go higher as it kills hypoxic drive)
2) Neb salbutamol 5mg + Nebiprabro 0.5mg. PO prednisolone 4-5days 40-50mg + IV hydrocortisone 200mg +/- IV amoxicillin
Senior support = IV Aminophylline
Describe CPAP?
CPAP - continuous positive pressure throughout inspiration and expiration. Splints the airway open.
Treatment for Obstructive sleep apnoea (OSA) or T1RF (pneumonia/Pulmonary oedema)
Describe BiPAP (NIV)?
Provides a differing air pressure throughout inspiration and expiration.
iPAP (20cmH20) to ventilate
ePAP (10cmH2O) for alveolar recruitment and removal of waste gas
What is not a cause of respiratory clubbing?
COPD
What are causes of respiratory clubbing?
SQCC, emypema, interstitial lung disease, cystic fibrosis
What is interstitial lung disease examples?
Idiopathic pulmonary fibrosis, hypersensitivit pneumonitis, sarcoidosis
Pulmonary fibrosis sympotoms?
SOBOE, dry cough and no wheeze
RFs for pulmonary Fibrosis?
Animal, vegetable dusts, smoking status, occupation, drugs e.g.
