Podcast
Questions and Answers
Which medication is recommended for managing asthma by controlling inflammation?
Which medication is recommended for managing asthma by controlling inflammation?
What should be considered as triggers in asthma management?
What should be considered as triggers in asthma management?
What is a key characteristic of COPD?
What is a key characteristic of COPD?
How can peak flow measurements assist in asthma management?
How can peak flow measurements assist in asthma management?
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Which of the following statements about nebulisers is correct?
Which of the following statements about nebulisers is correct?
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What does the anti-IgE medication, omalizumab, primarily target?
What does the anti-IgE medication, omalizumab, primarily target?
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What is the recommended approach to assess COPD severity?
What is the recommended approach to assess COPD severity?
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What does bronchial thermoplasty aim to improve in asthma management?
What does bronchial thermoplasty aim to improve in asthma management?
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Which of the following symptoms is typically associated with asthma?
Which of the following symptoms is typically associated with asthma?
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What is a key diagnostic clue indicating COPD?
What is a key diagnostic clue indicating COPD?
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Which of the following is NOT a common trigger for asthma symptoms?
Which of the following is NOT a common trigger for asthma symptoms?
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What is a common risk factor for pulmonary embolism (PE)?
What is a common risk factor for pulmonary embolism (PE)?
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Which statement regarding lung cancer is true?
Which statement regarding lung cancer is true?
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Which of the following findings is indicative of a pneumothorax?
Which of the following findings is indicative of a pneumothorax?
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Which condition is most likely characterized by inspiratory wheeze?
Which condition is most likely characterized by inspiratory wheeze?
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What is the economic burden of asthma on the NHS?
What is the economic burden of asthma on the NHS?
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What is the primary goal of using a Peak Flow diary in asthma management?
What is the primary goal of using a Peak Flow diary in asthma management?
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Which of the following is NOT considered a common trigger for asthma exacerbations?
Which of the following is NOT considered a common trigger for asthma exacerbations?
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In COPD management, which medication class is primarily used for immediate relief of symptoms?
In COPD management, which medication class is primarily used for immediate relief of symptoms?
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What diagnostic investigation is primarily used to evaluate suspected pulmonary embolism (PE)?
What diagnostic investigation is primarily used to evaluate suspected pulmonary embolism (PE)?
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What is a characteristic clinical sign of lung cancer that differentiates it from other respiratory conditions?
What is a characteristic clinical sign of lung cancer that differentiates it from other respiratory conditions?
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Which of these treatment strategies is recommended for patients with asthma as a preventer?
Which of these treatment strategies is recommended for patients with asthma as a preventer?
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How does smoking influence asthma management?
How does smoking influence asthma management?
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Which of the following leisure activities is linked to occupational exposure as a potential asthma trigger?
Which of the following leisure activities is linked to occupational exposure as a potential asthma trigger?
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What respiratory investigation is used to assess blood gases and oxygenation status?
What respiratory investigation is used to assess blood gases and oxygenation status?
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According to Ockham's razor, what principle should guide clinical diagnosis?
According to Ockham's razor, what principle should guide clinical diagnosis?
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Which of the following respiratory conditions has the highest economic burden on the NHS?
Which of the following respiratory conditions has the highest economic burden on the NHS?
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Which symptom is not commonly associated with lower respiratory tract conditions?
Which symptom is not commonly associated with lower respiratory tract conditions?
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What is a significant risk factor that contributes to higher mortality rates in respiratory diseases?
What is a significant risk factor that contributes to higher mortality rates in respiratory diseases?
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Which of the following is a characteristic sign that may indicate heart failure rather than a respiratory condition?
Which of the following is a characteristic sign that may indicate heart failure rather than a respiratory condition?
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In evaluating potential pneumonia, which symptom is most commonly associated with this respiratory condition?
In evaluating potential pneumonia, which symptom is most commonly associated with this respiratory condition?
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Which diagnostic clue might suggest the presence of a pulmonary embolism (PE)?
Which diagnostic clue might suggest the presence of a pulmonary embolism (PE)?
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Which general symptom is least likely to be a trigger for asthma exacerbations according to common clinical understanding?
Which general symptom is least likely to be a trigger for asthma exacerbations according to common clinical understanding?
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What is a primary physiological sign that differentiates asthma from chronic obstructive pulmonary disease (COPD)?
What is a primary physiological sign that differentiates asthma from chronic obstructive pulmonary disease (COPD)?
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Which condition is suggested by dry cough and crackles along with occupational exposure?
Which condition is suggested by dry cough and crackles along with occupational exposure?
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Which of the following statements best describes Ockham's razor?
Which of the following statements best describes Ockham's razor?
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What is a key indication of asthma severity during physical examination?
What is a key indication of asthma severity during physical examination?
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Which of the following respiratory investigations is primarily used to diagnose asthma?
Which of the following respiratory investigations is primarily used to diagnose asthma?
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What common respiratory sign is observed in asthma but may also indicate a serious condition if life-threatening?
What common respiratory sign is observed in asthma but may also indicate a serious condition if life-threatening?
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Which risk factor is linked to an increase in asthma exacerbations?
Which risk factor is linked to an increase in asthma exacerbations?
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What type of respiratory sound would most likely indicate an obstruction?
What type of respiratory sound would most likely indicate an obstruction?
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Which component in respiratory investigations is used to evaluate chronic diseases like COPD and asthma?
Which component in respiratory investigations is used to evaluate chronic diseases like COPD and asthma?
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Which of the following treatments is primarily aimed at providing prolonged control of asthma symptoms?
Which of the following treatments is primarily aimed at providing prolonged control of asthma symptoms?
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Which investigative method is used to analyze blood gas levels in patients with respiratory conditions?
Which investigative method is used to analyze blood gas levels in patients with respiratory conditions?
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What is a significant aspect of managing asthma exacerbations effectively?
What is a significant aspect of managing asthma exacerbations effectively?
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In the context of asthma medications, which combination is most effective as a maintenance treatment?
In the context of asthma medications, which combination is most effective as a maintenance treatment?
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What does the peak expiratory flow rate (PEFR) monitoring help to indicate in asthma patients?
What does the peak expiratory flow rate (PEFR) monitoring help to indicate in asthma patients?
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What is a common misconception regarding the use of nebulisers in asthma management?
What is a common misconception regarding the use of nebulisers in asthma management?
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Which physiological mechanism primarily drives eosinophil-mediated asthma?
Which physiological mechanism primarily drives eosinophil-mediated asthma?
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In chronic obstructive pulmonary disease (COPD), what is the primary irreversible change that occurs within the lungs?
In chronic obstructive pulmonary disease (COPD), what is the primary irreversible change that occurs within the lungs?
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What is a critical consideration when assessing triggers in asthma management?
What is a critical consideration when assessing triggers in asthma management?
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In asthma management, which treatment is specifically designed for patients with IgE-driven disease?
In asthma management, which treatment is specifically designed for patients with IgE-driven disease?
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Which of the following respiratory conditions is associated with a variable wheeze and nocturnal cough?
Which of the following respiratory conditions is associated with a variable wheeze and nocturnal cough?
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Which clinical symptom is indicative of a possible pneumothorax?
Which clinical symptom is indicative of a possible pneumothorax?
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What characteristic feature distinguishes COPD from asthma during evaluation?
What characteristic feature distinguishes COPD from asthma during evaluation?
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Which sign is most likely associated with heart failure rather than a primary respiratory condition?
Which sign is most likely associated with heart failure rather than a primary respiratory condition?
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Which factor is most likely to contribute to higher mortality rates in respiratory diseases within disadvantaged groups?
Which factor is most likely to contribute to higher mortality rates in respiratory diseases within disadvantaged groups?
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Which respiratory investigation is primarily used to assess for infections, fibrosis, and cancer in the lungs?
Which respiratory investigation is primarily used to assess for infections, fibrosis, and cancer in the lungs?
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What characterizes asthma as opposed to chronic obstructive pulmonary disease (COPD)?
What characterizes asthma as opposed to chronic obstructive pulmonary disease (COPD)?
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Which of the following factors may negatively impact a patient's asthma control?
Which of the following factors may negatively impact a patient's asthma control?
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Which statement best describes Hickam's Dictum in the context of patient diagnosis?
Which statement best describes Hickam's Dictum in the context of patient diagnosis?
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What type of respiratory sound is commonly associated with obstruction?
What type of respiratory sound is commonly associated with obstruction?
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During an asthma exacerbation, which clinical sign typically indicates the severity of the condition?
During an asthma exacerbation, which clinical sign typically indicates the severity of the condition?
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Which of the following is a key feature of chronic inflammation seen in asthma?
Which of the following is a key feature of chronic inflammation seen in asthma?
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What does an elevated d-dimer level in bloodwork typically indicate?
What does an elevated d-dimer level in bloodwork typically indicate?
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Which risk factor is most commonly linked to childhood asthma exacerbations?
Which risk factor is most commonly linked to childhood asthma exacerbations?
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Which condition is most likely indicated by the combination of pleurisy and a productive cough?
Which condition is most likely indicated by the combination of pleurisy and a productive cough?
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Study Notes
Asthma
- Common, atopic patient
- Chronic inflammation of the airways
- Hyper-responsive and reversible
- Inflammatory cells infiltrate the airways
- Smooth muscle hypertrophy
- Thickening of the airway
- Trigger by pollution, occupational exposure, allergens, bacteria and viruses, cold air
Asthma History
- Risk factors: smoking, family history, childhood infections, pollution, prematurity, occupation (chemicals, dusts, spores)
- Key history points: Wheeze, have they ever been hospitalised/ITU admission, have they required steroids/rescue pack, nocturnal cough, worse at night, worse at work/better on holiday, atopy, eczema, hayfever, illness (viral/bacteria)
- Risks of exacerbations: poor inhaler technique, continued triggers, smoking (active vs passive)
Asthma signs and investigations
- Wheeze
- Dry cough (unless infected)
- Breathlessness (usually acutely, progressive while unwell, responsive to treatment (usually))
- Not speaking in full sentences (acute)
- Hypoxia and cyanosis in life-threatening exacerbations
Peak flow
- Twice a day
- Know their best and calculate predicted
Asthma summary management
- Peak flow diary
- Stop smoking/vaping
- Avoid/limit triggers
- Vaccinations (Flu)
- Inhalers: B2 agonist (salbutamol): relief (BLUE) (SABA), steroid: preventer (BROWN) (ICS), long acting B2 agonist (LABA), Combo (Fostair (LABA/ICS), Symbicort (LABA/ICS))
- CHECK inhaler technique!
COPD
- Emphysema & Chronic bronchitis
- Over a million GP appointments a year
- Smoking: >80% cause
- Irreversible airways disease
Respiratory investigations
- Bloodwork: Anaemia, infection, eosinophilia, BNP, calcium, thyroid, ?d-dimer, cultures
- Peak flow: Asthma
- Spirometry: COPD, asthma, fibrosis
- Chest X-Ray (CXR): infection, fibrosis, cancer, collapse
- CT scan: PE, cancer, fibrosis, complex infections
- Sleep studies/overnight oximetry: Obstructive sleep apnoea
- ABG: Hypoxia, COPD, Asthma
Common respiratory conditions with associated investigations
- Asthma: common, atopic patient, chronic inflammation of the airways, hyper-responsive and reversible, inflammatory cells infiltrate the airways, smooth muscle hypertrophy, thickening of the airway, trigger by pollution, occupational exposure, allergens, bacteria and viruses, cold air
- COPD: slowly progressive, smoking, low peak flow
Diagnostic clues:
- Is it asthma? Variable, wheeze, nocturnal cough, triggers, atopy, low peak flow
- Is it COPD? Slowly progressive, smoking, low peak flow
- Is it a pneumothorax? Pleuritic pain, quiet breath sounds, CXR findings
- Is it a PE? Risk factors (immobility, malignancy, previous PE/DVT), pleurisy, haemoptysis, swollen leg
- Is it heart failure? Swollen ankles, orthopnoea, crackles, JVP
- Is it pneumonia? Fever, rigors, pleurisy, productive cough, bronchial breathing, crackles, CXR- Consolidation
- Is it cancer? Smoking, weight loss, PMH (?secondary cancer)
- Is it interstitial lung disease? Occupational exposure, hobbies, drugs, crackles, dry cough
- Sore throat/Rhinorrhoea: Upper respiratory tract infection (URTI)
- Stridor: Obstruction
Respiratory sounds
- Crackles: wet vs dry, coarse
- Bronchial breathing: hollow sound
- Wheeze: inspiratory (stridor), expiratory
Who are these people?
- Ockham’s Razor: theory that the simplest explanation is the correct one!
- Hickam’s dictum: ‘A patient can have as many diseases as they damn well please!’
- Remember that many things might be going on at once, patients often have many co-morbidities!
Burden of respiratory disease
- 3rd biggest cause of death
- Lung cancer
- COPD
- Asthma
- All: £11 billion to the NHS
- Mortality rates higher in disadvantaged groups
Respiratory Disease Burden
- Respiratory diseases are the third biggest cause of death
- 1 in 5 people are affected by respiratory conditions
- Increased incidence over winter
- Asthma: £3 Billion, COPD: £1.9 Billion, total NHS cost: £11 Billion
- Higher mortality in disadvantaged groups due to smoking, air pollution, poor housing, occupational hazards
Respiratory Anatomy & Physiology
- Covers the structure and function of the respiratory system
Common Respiratory Symptoms & Signs
- Upper Respiratory Tract: Rhinorrhoea, Nasal congestion, Sore throat
- Lower Respiratory Tract: Breathlessness, Haemoptysis, Cough (productive/dry/nocturnal), Wheeze (inspiratory/expiratory)
- Other signs: Cyanosis of lips/earlobes/fingertips, Crackles (wet/dry/coarse), Bronchial breathing (hollow sound)
Diagnostic Clues
- Asthma: Variable wheeze, nocturnal cough, triggers, atopy, low peak flow
- COPD: Slowly progressive, smoking, low peak flow
- Pneumothorax: Pleuritic pain, quiet breath sounds, CXR findings
- PE: Risk factors (immobility, malignancy, previous PE/DVT), pleurisy, haemoptysis, swollen leg
- Heart failure: Swollen ankles, orthopnoea, crackles, JVP
- Pneumonia: Fever, rigors, pleurisy, productive cough, bronchial breathing, crackles, CXR- consolidation
- Cancer: Smoking, weight loss, past medical history (secondary cancer)
- Interstitial lung disease: Occupational exposure, hobbies, drugs, crackles, dry cough
- Sore throat/Rhinorrhoea: Upper respiratory tract infection (URTI)
- Stridor: Obstruction
Ockham's Razor & Hickam's Dictum
- Ockham's Razor: The simplest explanation is usually the correct one
- Hickam's Dictum: A patient can have many diseases at the same time
Respiratory Investigations
- Bloodwork: Anaemia, infection, eosinophilia, BNP, calcium, thyroid, d-dimer, cultures
- Peak flow: Asthma
- Spirometry: COPD, asthma, fibrosis
- Chest X-Ray (CXR): Infection, fibrosis, cancer, collapse
- CT Scan: PE, cancer, fibrosis, complex infections
- Sleep studies/overnight oximetry: Obstructive sleep apnoea
- ABG: Hypoxia, COPD, Asthma
Common Respiratory Conditions
- Describes common respiratory conditions with associated investigations
Asthma
- Common, atopic patient
- Chronic inflammation of the airways
- Hyper-responsive and reversible
- Inflammatory cells infiltrate the airways
- Smooth muscle hypertrophy
- Thickening of the airway
- Triggered by pollution, occupational exposure, allergens, bacteria/viruses, cold air
Asthma History
- Risk factors: Smoking, family history, childhood infections, pollution, prematurity, occupation (chemicals, dusts, spores)
- Key history points: Wheeze, hospitalisation, ITU admission, steroid use, rescue pack requirement, nocturnal cough, worse at night, worse at work/better on holiday, atopy (eczema, hayfever), illness, viral/bacterial infections
Asthma Signs & Investigations
- Signs: Wheeze, dry cough, breathlessness (acute, progressive), responsive to treatment, not speaking in full sentences (acute), hypoxia and cyanosis in life-threatening exacerbations
- Investigations: Peak flow (twice a day), bloods (IgE, eosinophils), spirometry (obstructive), CXR, sputum sample
Asthma Management (Non-acute)
- Peak flow diary: Monitor control
-
Inhalers:
- B2 agonist [salbutamol]: Relief
- Steroid: preventer
- Long acting B2 agonist (LABA)
- Combo inhalers (LABA/ICS)
- Other interventions: Stop smoking/vaping, avoid/limit triggers, vaccinations (flu, Covid), check inhaler technique (use spacer when possible), annual review, tablets if poor control, leukotriene antagonists, theophylline, steroids
Asthma Phenotypes
- There are different types of asthma
BTS/SIGN Asthma Guidelines
- Provide guidance on managing asthma
Asthma Management Principles
- Consider triggers (allergies, occupation)
- Ensure concordance (engagement) and check inhaler technique
- Control inflammation with inhaled steroids
- Use long acting B2 agonists (ICS/LABA inhalers)
- Consider leukotriene receptor antagonists, theophyllines, long acting anticholinergics (tiotropium)
Nebulisers
- Used in asthma and COPD
- Contents: Salbutamol 2.5mg, Ipratropium 500 micrograms, Saline nebs
- Used for specific antibiotics in CF/bronchiectasis (Colomycin, gentamicin)
Spacers
- 10 puffs in a spacer is the same as a neb
- No need for patients to buy expensive machines
Advanced Asthma Treatment
- IgE-driven disease: Anti IgE (omalizumab)
- Eosinophil-driven disease: Anti IL-5 (mepolizumab...), Anti IL-4 alpha subunit
- Bronchial thermoplasty: Treatment for severe asthma
Asthma Discharge Checklist
- Provides information for patients leaving hospital following an asthma admission
Peak Flow
- Common measure of airflow in and out of the lungs
- Monitors asthma control
- Guides assessment of asthma exacerbation severity
Peak Flow Recording
- Stand up, deep breath in, seal mouth, short exhale, best of three attempts
- Record twice a day
- Patients know their usual PEFR
- Predicted based on height
Acute Asthma Severity
- There are different levels of asthma severity in acute presentations
Emphysema & Chronic Bronchitis
- COPD: Emphysema and Chronic bronchitis combined
- Chronic productive cough for at least 2 consecutive years
- 2nd commonest cause of hospital admission
- Over 1 million GP appointments a year
- Irreversible airways disease
- 80% caused by smoking
Main Problems with COPD
- Details the key issues associated with COPD
Introduction
- Respiratory diseases are the 3rd leading cause of death.
- One in five people are affected by respiratory diseases.
- Respiratory diseases are a significant burden on the NHS, costing £11 billion annually.
- Mortality rates are higher in disadvantaged groups due to factors like smoking, air pollution, poor housing, and occupational hazards.
Common Respiratory Conditions & Symptoms
-
Upper Respiratory Tract
- Rhinorrhea (runny nose)
- Nasal Congestion
- Sore Throat
-
Lower Respiratory Tract
- Breathlessness
- Haemoptysis (coughing up blood)
- Cough (productive/dry, nocturnal)
-
Signs
- Cyanosis (blue discoloration of lips, earlobes, fingertips)
- Crackles in the lungs (wet/dry, coarse)
- Bronchial breathing
- Wheeze (inspiratory/expiratory)
Diagnostic Clues
-
Asthma
- Variable symptoms,wheeze, nocturnal cough, triggers, atopy (allergies), low peak flow
-
COPD
- Slowly progressive, smoking history, low peak flow
-
Pneumothorax
- Pleuritic pain (sharp chest pain), quiet breath sounds, chest X-ray findings
-
Pulmonary Embolism (PE)
- Risk factors: Immobility, malignancy, previous PE/DVT, pleurisy, haemoptysis, swollen leg
-
Heart Failure
- Swollen ankles, orthopnea (difficulty breathing when lying down), crackles, JVP (jugular venous pressure)
-
Pneumonia
- Fever, rigors (shivering), pleurisy, productive cough, bronchial breathing, crackles, consolidation on chest X-ray
-
Cancer
- Smoking history, weight loss, previous history of cancer
-
Interstitial Lung Disease
- Occupational exposure, hobbies, medications, crackles, dry cough
-
Sore throat/Rhinorrhea
- Upper Respiratory Tract Infection (URTI)
-
Stridor
- Obstruction
Ockham’s Razor and Hickam’s Dictum
- Ockham’s Razor: The simplest explanation is often the correct one.
- Hickam’s Dictum: A patient can have as many diseases as they damn well please.
Respiratory Investigations
-
Bloodwork
- Anaemia, infection, eosinophilia (elevated eosinophils), BNP (brain natriuretic peptide), calcium, thyroid, D-dimer, cultures
-
Peak Flow
- Used to monitor asthma control
-
Spirometry
- COPD, asthma, fibrosis
-
Chest X-Ray (CXR)
- Infection, fibrosis, cancer, collapse
-
CT Scan
- PE, cancer, fibrosis, complex infections
-
Sleep Studies/Overnight Oximetry
- Obstructive sleep apnea
-
ABG (Arterial Blood Gas)
- Hypoxia (low oxygen levels), COPD, asthma
Asthma
- Common atopic (allergic) condition
- Chronic inflammation of the airways, causing hyperresponsiveness and reversibility
- Inflammatory cells infiltrate the airways
- Smooth muscle hypertrophy (thickening)
- Thickening of the airway wall
- Triggers: Pollution, occupational exposure, allergens, virus/bacteria, cold air
Asthma History
-
Risk factors:
- Smoking
- Family history
- Childhood infections
- Pollution
- Prematurity
- Occupation (chemicals, dusts, spores)
-
Key history points:
- Wheeze
- Hospitalization/ITU admissions
- Use of steroids/rescue inhalers
- Nocturnal cough
- Worsening symptoms at night
- Improvement on holiday
- Atopy (eczema, hayfever)
- Exacerbation risks: Poor inhaler technique, continued triggers, smoking, illness
Asthma Signs & Investigations
-
Signs:
- Wheeze
- Dry cough (unless infected)
- Breathlessness (acute or progressive)
- Responsive to treatment (usually)
- Difficulty speaking in full sentences (acute)
- Hypoxia and cyanosis during severe exacerbations
-
Investigations:
- Peak flow (twice daily)
- Bloods: IgE, eosinophils
- Spirometry (obstructive pattern)
- Chest X-ray
- Sputum sample
Asthma Management (Not Acute)
- Peak flow diary: Monitoring control
-
Inhalers:
- Short-acting beta-agonist (SABA) (salbutamol): Relief
- Inhaled corticosteroids (ICS): Prevention
- Long-acting beta-agonist (LABA)
- Combined inhalers (ICS/LABA)
-
Other interventions:
- Smoking cessation
- Avoidance/limitation of triggers
- Vaccinations (influenza, COVID)
- Annual review
-
Other medications:
- Leukotriene antagonists
- Theophylline
- Steroids (oral)
Asthma Phenotypes
- Different asthma phenotypes (types) exist.
BTS/SIGN Asthma Guidelines
- Consider triggers: Allergies and occupation.
- Ensure concordance and correct inhaler technique.
- Control inflammation with inhaled steroids, long-acting beta-agonists, leukotriene receptor antagonists, theophylline, and long-acting anticholinergics (tiotropium).
Nebulisers
- Used in asthma and COPD
- Commonly used medications in a nebulizer: Salbutamol, ipratropium bromide, saline
- Used for certain antibiotics in cystic fibrosis and bronchiectasis
Importance of Spacers
- Using a spacer with an inhaler can be as effective as a nebulizer.
Advanced Asthma Treatments
-
IgE-driven disease:
- Anti-IgE therapy (omalizumab)
-
Eosinophil-driven disease:
- Anti-IL5 therapy (mepolizumab, etc.)
- Anti-IL4 alpha subunit therapy
-
Bronchial thermoplasty:
- Heat treatment to reduce airway smooth muscle mass
Asthma Discharge
- Patients should be provided with a discharge checklist to ensure understanding of their condition and management
Peak Flow
- Used to monitor asthma control.
- Simple measurement of air flow in and out of the lungs.
- Can help assess asthma exacerbation severity.
- Recommendations:
- Record standing upright.
- Deep breath in, form a seal around the mouth, short, sharp breath out.
- Perform three attempts and record the highest reading.
- Record twice daily.
- Patients should know their usual peak flow readings.
- A predicted peak flow can be calculated based on height.
Acute Asthma Severity
- Severity of an acute asthma exacerbation can be classified using guidelines.
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Description
Test your knowledge on asthma, its risk factors, and the key historical points to consider when assessing patients. This quiz covers aspects of chronic inflammation, signs, and potential triggers associated with asthma to prepare you for clinical scenarios. Ideal for medical students and healthcare professionals.
