Podcast
Questions and Answers
What percentage of deaths from lung cancer are attributed to smoking?
What percentage of deaths from lung cancer are attributed to smoking?
- 90% (correct)
- 50%
- 70%
- 30%
Besides lung cancer, which of the following is a leading cause of smoking-related deaths?
Besides lung cancer, which of the following is a leading cause of smoking-related deaths?
- Heart disease (correct)
- Kidney failure
- Alzheimer's disease
- Liver cirrhosis
A patient presents with a persistent cough, wheezing, and a history of recurrent antibiotic and steroid treatments, what is the most likely initial diagnostic consideration?
A patient presents with a persistent cough, wheezing, and a history of recurrent antibiotic and steroid treatments, what is the most likely initial diagnostic consideration?
- Underlying respiratory condition exacerbated by a foreign object (correct)
- Acute bronchitis
- Pneumonia
- Common cold
Which of the following chemical substances found in cigarettes is also used to preserve dead bodies?
Which of the following chemical substances found in cigarettes is also used to preserve dead bodies?
If a study 20 years after 1995 found that smoking-related deaths had decreased proportionally with the overall decrease in total deaths, approximately how many smoking related deaths would be expected, assuming the same proportional reduction?
If a study 20 years after 1995 found that smoking-related deaths had decreased proportionally with the overall decrease in total deaths, approximately how many smoking related deaths would be expected, assuming the same proportional reduction?
Which components of cigarette smoke are identified as accumulating in the lungs and adhering to the tar coating in the bronchioles?
Which components of cigarette smoke are identified as accumulating in the lungs and adhering to the tar coating in the bronchioles?
In the context of the '5 A's' model for smoking cessation, what is the immediate next step after a healthcare provider 'Asks' about tobacco use?
In the context of the '5 A's' model for smoking cessation, what is the immediate next step after a healthcare provider 'Asks' about tobacco use?
According to the information, passive smoking is NOT cited as a cause of which of the following conditions?
According to the information, passive smoking is NOT cited as a cause of which of the following conditions?
According to NICE guidance on smoking cessation, what is the INITIAL recommended action for smokers who are admitted to the hospital?
According to NICE guidance on smoking cessation, what is the INITIAL recommended action for smokers who are admitted to the hospital?
For smokers who express unwillingness to quit, NICE guidance suggests a 'harm-reduction approach'. What does this approach primarily involve?
For smokers who express unwillingness to quit, NICE guidance suggests a 'harm-reduction approach'. What does this approach primarily involve?
Beyond nicotine withdrawal management, what additional benefit is associated with offering Nicotine Replacement Therapy (NRT) to smokers who are hospitalized, even if they are not initially intending to quit?
Beyond nicotine withdrawal management, what additional benefit is associated with offering Nicotine Replacement Therapy (NRT) to smokers who are hospitalized, even if they are not initially intending to quit?
Which dental health issue is specifically identified as being an increased risk for smokers?
Which dental health issue is specifically identified as being an increased risk for smokers?
What is the combined therapeutic approach for smoking cessation within a hospital setting, as emphasized in the provided information?
What is the combined therapeutic approach for smoking cessation within a hospital setting, as emphasized in the provided information?
What is the estimated percentage of harm reduction associated with e-cigarettes compared to traditional smoking, according to a 2015 PHE review?
What is the estimated percentage of harm reduction associated with e-cigarettes compared to traditional smoking, according to a 2015 PHE review?
Which of the following has not been identified as a concern related to e-cigarette use?
Which of the following has not been identified as a concern related to e-cigarette use?
According to the Cochrane review (Nov 22), what is the primary finding regarding the effectiveness of e-cigarettes for smoking cessation compared to Nicotine Replacement Therapy (NRT)?
According to the Cochrane review (Nov 22), what is the primary finding regarding the effectiveness of e-cigarettes for smoking cessation compared to Nicotine Replacement Therapy (NRT)?
What is EVALI?
What is EVALI?
In the context of respiratory failure, what distinguishes Type 2 respiratory failure from Type 1?
In the context of respiratory failure, what distinguishes Type 2 respiratory failure from Type 1?
Why is it crucial to avoid administering high doses of oxygen to individuals with chronic breathing issues, such as those with COPD?
Why is it crucial to avoid administering high doses of oxygen to individuals with chronic breathing issues, such as those with COPD?
Which of the following is not typically assessed when examining a patient's general appearance during a respiratory examination?
Which of the following is not typically assessed when examining a patient's general appearance during a respiratory examination?
Besides smoking, which occupational exposure is significantly linked to respiratory issues, particularly in the construction industry?
Besides smoking, which occupational exposure is significantly linked to respiratory issues, particularly in the construction industry?
A 17-year-old presents with acute type 1 respiratory failure and a history of vaping. What is the MOST LIKELY single diagnosis based solely on this information?
A 17-year-old presents with acute type 1 respiratory failure and a history of vaping. What is the MOST LIKELY single diagnosis based solely on this information?
Imagine a patient presenting with respiratory distress. Their arterial blood gas results show a PaO2 of 7.5 Kpa on room air and a PaCO2 of 7 Kpa. Furthermore, the patient is exhibiting signs of confusion and drowsiness, and you note significant peripheral edema upon examination. Considering the underlying principles of respiratory physiology, predict the MOST LIKELY underlying cause of their respiratory failure. (Assume all options are possible given sufficient additional context that is not provided)
Imagine a patient presenting with respiratory distress. Their arterial blood gas results show a PaO2 of 7.5 Kpa on room air and a PaCO2 of 7 Kpa. Furthermore, the patient is exhibiting signs of confusion and drowsiness, and you note significant peripheral edema upon examination. Considering the underlying principles of respiratory physiology, predict the MOST LIKELY underlying cause of their respiratory failure. (Assume all options are possible given sufficient additional context that is not provided)
Which pathological change is MOST characteristic of emphysema?
Which pathological change is MOST characteristic of emphysema?
What is the underlying cause of Cor Pulmonale?
What is the underlying cause of Cor Pulmonale?
A patient with COPD presents with a PaO2 of 55 mmHg and a PaCO2 of 50 mmHg. Which type of respiratory failure is the patient MOST likely experiencing?
A patient with COPD presents with a PaO2 of 55 mmHg and a PaCO2 of 50 mmHg. Which type of respiratory failure is the patient MOST likely experiencing?
What is the PRIMARY underlying mechanism in Obesity Hypoventilation Syndrome (OHS) that leads to elevated CO₂ levels?
What is the PRIMARY underlying mechanism in Obesity Hypoventilation Syndrome (OHS) that leads to elevated CO₂ levels?
A worker in a flavoring factory presents with a severe, irreversible obstruction of small airways. Which condition is MOST likely responsible?
A worker in a flavoring factory presents with a severe, irreversible obstruction of small airways. Which condition is MOST likely responsible?
Which of the following conditions is characterized by a collection of pus in the pleural space?
Which of the following conditions is characterized by a collection of pus in the pleural space?
Which of the following is a defining characteristic of chronic bronchitis, as it relates to COPD?
Which of the following is a defining characteristic of chronic bronchitis, as it relates to COPD?
A patient presents with copious sputum production. Which of the following conditions is MOST likely the cause?
A patient presents with copious sputum production. Which of the following conditions is MOST likely the cause?
Which of the following conditions is MOST directly associated with both nocturnal hypoxia and daytime sleepiness?
Which of the following conditions is MOST directly associated with both nocturnal hypoxia and daytime sleepiness?
In the context of respiratory disease, if a patient presents with hypoxemia but a PaCO2 within normal limits, and their condition stems from an intrinsic lung issue, which specific type of respiratory failure is MOST likely the primary concern?
In the context of respiratory disease, if a patient presents with hypoxemia but a PaCO2 within normal limits, and their condition stems from an intrinsic lung issue, which specific type of respiratory failure is MOST likely the primary concern?
What is the primary diagnostic criterion for Type 2 respiratory failure?
What is the primary diagnostic criterion for Type 2 respiratory failure?
A patient with COPD has an FEV1 post bronchodilator that is 60% of the predicted value. According to the guidelines, how would their COPD severity be classified?
A patient with COPD has an FEV1 post bronchodilator that is 60% of the predicted value. According to the guidelines, how would their COPD severity be classified?
When using oximetry alone to assess for obstructive sleep apnea, what constitutes a significant finding?
When using oximetry alone to assess for obstructive sleep apnea, what constitutes a significant finding?
What is the primary treatment for a pleural empyema?
What is the primary treatment for a pleural empyema?
Which intervention is most crucial in preventing the development or progression of emphysema?
Which intervention is most crucial in preventing the development or progression of emphysema?
What is the underlying mechanism that leads to cor pulmonale in the context of chronic lung diseases?
What is the underlying mechanism that leads to cor pulmonale in the context of chronic lung diseases?
What is the primary strategy for preventing Popcorn Lung (bronchiolitis obliterans)?
What is the primary strategy for preventing Popcorn Lung (bronchiolitis obliterans)?
Which of the following is a key pathological feature of ALI/ARDS (Acute Lung Injury/Acute Respiratory Distress Syndrome)?
Which of the following is a key pathological feature of ALI/ARDS (Acute Lung Injury/Acute Respiratory Distress Syndrome)?
A 6-month-old infant is brought to the emergency department, and after a thorough investigation, the cause of death remains undetermined. The child's parents are smokers. Which condition is most concerning?
A 6-month-old infant is brought to the emergency department, and after a thorough investigation, the cause of death remains undetermined. The child's parents are smokers. Which condition is most concerning?
A researcher is designing a study to investigate the effects of chronic bronchitis on lung function. Which diagnostic criterion must participants meet to be included in the study?
A researcher is designing a study to investigate the effects of chronic bronchitis on lung function. Which diagnostic criterion must participants meet to be included in the study?
What is the primary anatomical abnormality that defines bronchiectasis?
What is the primary anatomical abnormality that defines bronchiectasis?
Which of the following medication classes is LEAST likely to be used as a first-line treatment in the acute management of asthma symptoms?
Which of the following medication classes is LEAST likely to be used as a first-line treatment in the acute management of asthma symptoms?
For a patient at high risk of pulmonary embolism, such as following major surgery, which preventative measure is MOST directly aimed at reducing clot formation in deep veins?
For a patient at high risk of pulmonary embolism, such as following major surgery, which preventative measure is MOST directly aimed at reducing clot formation in deep veins?
In Type 1 respiratory failure, which arterial blood gas value is typically within or below the normal range?
In Type 1 respiratory failure, which arterial blood gas value is typically within or below the normal range?
What is the MOST immediate therapeutic goal of Continuous Positive Airway Pressure (CPAP) in the treatment of Obstructive Sleep Apnea (OSA)?
What is the MOST immediate therapeutic goal of Continuous Positive Airway Pressure (CPAP) in the treatment of Obstructive Sleep Apnea (OSA)?
Progressive and irreversible scarring of the lung tissue, leading to reduced lung compliance and impaired gas exchange, is the hallmark of which respiratory disease?
Progressive and irreversible scarring of the lung tissue, leading to reduced lung compliance and impaired gas exchange, is the hallmark of which respiratory disease?
Why is controlled oxygen therapy, aiming for a target saturation rather than high-flow oxygen, crucial in managing Type 2 respiratory failure?
Why is controlled oxygen therapy, aiming for a target saturation rather than high-flow oxygen, crucial in managing Type 2 respiratory failure?
What is the primary route of transmission for Mycobacterium tuberculosis, the causative agent of tuberculosis?
What is the primary route of transmission for Mycobacterium tuberculosis, the causative agent of tuberculosis?
Obesity Hypoventilation Syndrome (OHS) is characterized by daytime hypercapnia. Which arterial PaCO2 level, measured during wakefulness, is MOST indicative of this condition?
Obesity Hypoventilation Syndrome (OHS) is characterized by daytime hypercapnia. Which arterial PaCO2 level, measured during wakefulness, is MOST indicative of this condition?
A patient with long-standing bronchiectasis, managed with regular physiotherapy and antibiotics for exacerbations, presents with worsening symptoms including increased sputum production and hemoptysis, despite adherence to their treatment plan. Considering the underlying pathophysiology of bronchiectasis, which of the following would be the MOST crucial next step in investigating the potential cause of their deteriorating condition?
A patient with long-standing bronchiectasis, managed with regular physiotherapy and antibiotics for exacerbations, presents with worsening symptoms including increased sputum production and hemoptysis, despite adherence to their treatment plan. Considering the underlying pathophysiology of bronchiectasis, which of the following would be the MOST crucial next step in investigating the potential cause of their deteriorating condition?
CPAP (Continuous Positive Airway Pressure) is primarily used as a first-line therapy for which of the following conditions?
CPAP (Continuous Positive Airway Pressure) is primarily used as a first-line therapy for which of the following conditions?
The 'Back to Sleep' campaign is a public health initiative focused on preventing which specific infant health crisis?
The 'Back to Sleep' campaign is a public health initiative focused on preventing which specific infant health crisis?
COVID-19, caused by the SARS-CoV-2 virus, is classified as what type of respiratory infection?
COVID-19, caused by the SARS-CoV-2 virus, is classified as what type of respiratory infection?
What is the key differentiating factor in the mechanism of action between BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure)?
What is the key differentiating factor in the mechanism of action between BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure)?
According to the information provided, which of the following environmental factors is recognized as a significant risk factor for childhood middle ear disease?
According to the information provided, which of the following environmental factors is recognized as a significant risk factor for childhood middle ear disease?
Which of the following subjective assessment tools is used to quantify the level of daytime sleepiness, often in the context of sleep disorders?
Which of the following subjective assessment tools is used to quantify the level of daytime sleepiness, often in the context of sleep disorders?
In the management of Type 2 respiratory failure associated with a COPD exacerbation, why might BiPAP (Non-Invasive Ventilation) be clinically preferred over CPAP (Continuous Positive Airway Pressure)?
In the management of Type 2 respiratory failure associated with a COPD exacerbation, why might BiPAP (Non-Invasive Ventilation) be clinically preferred over CPAP (Continuous Positive Airway Pressure)?
What is the primary pharmacological rationale for utilizing combined Nicotine Replacement Therapy (NRT), such as a nicotine patch in conjunction with nicotine gum or inhalator, for smoking cessation?
What is the primary pharmacological rationale for utilizing combined Nicotine Replacement Therapy (NRT), such as a nicotine patch in conjunction with nicotine gum or inhalator, for smoking cessation?
How does the prompt and effective treatment of pneumonia or other chest infections contribute to respiratory health from a broader, preventative perspective?
How does the prompt and effective treatment of pneumonia or other chest infections contribute to respiratory health from a broader, preventative perspective?
A 4-year-old child with a history of recurrent middle ear infections lives in a household where both parents smoke indoors. Considering the provided information, which comprehensive intervention strategy would most effectively address both the child's immediate condition and the underlying environmental risk factor?
A 4-year-old child with a history of recurrent middle ear infections lives in a household where both parents smoke indoors. Considering the provided information, which comprehensive intervention strategy would most effectively address both the child's immediate condition and the underlying environmental risk factor?
What pathological process BEST describes pleural empyema?
What pathological process BEST describes pleural empyema?
Which of the following is the MOST common etiological factor in the development of pleural empyema?
Which of the following is the MOST common etiological factor in the development of pleural empyema?
What is the INITIAL, primary intervention strategy for managing pleural empyema?
What is the INITIAL, primary intervention strategy for managing pleural empyema?
If initial chest tube drainage proves INADEQUATE in resolving an empyema, which subsequent intervention is MOST likely to be considered?
If initial chest tube drainage proves INADEQUATE in resolving an empyema, which subsequent intervention is MOST likely to be considered?
Which approach offers the GREATEST potential for preventing the development of pleural empyema in susceptible patients?
Which approach offers the GREATEST potential for preventing the development of pleural empyema in susceptible patients?
Which of the following BEST characterizes the airflow limitation seen in Chronic Obstructive Pulmonary Disease (COPD)?
Which of the following BEST characterizes the airflow limitation seen in Chronic Obstructive Pulmonary Disease (COPD)?
What is the PREDOMINANT etiological factor implicated in the development of COPD within the United Kingdom?
What is the PREDOMINANT etiological factor implicated in the development of COPD within the United Kingdom?
How is chronic bronchitis DEFINED clinically?
How is chronic bronchitis DEFINED clinically?
Which of the following BEST describes the primary pathological change observed in emphysema?
Which of the following BEST describes the primary pathological change observed in emphysema?
In the context of COPD, under what specific circumstance should clinicians strongly consider screening for alpha-1 antitrypsin deficiency, irrespective of smoking history?
In the context of COPD, under what specific circumstance should clinicians strongly consider screening for alpha-1 antitrypsin deficiency, irrespective of smoking history?
What is the hallmark pathological feature of emphysema?
What is the hallmark pathological feature of emphysema?
Which of the following is the primary treatment approach for pleural empyema?
Which of the following is the primary treatment approach for pleural empyema?
What is the MOST common etiological factor in the development of COPD within the United Kingdom?
What is the MOST common etiological factor in the development of COPD within the United Kingdom?
A patient presents with a chronic productive cough lasting for at least three months each year for two consecutive years. This clinical definition aligns with which respiratory condition?
A patient presents with a chronic productive cough lasting for at least three months each year for two consecutive years. This clinical definition aligns with which respiratory condition?
What is the primary intervention to prevent empyema?
What is the primary intervention to prevent empyema?
Which genetic deficiency is MOST strongly associated with the development of emphysema, particularly in individuals without a significant smoking history?
Which genetic deficiency is MOST strongly associated with the development of emphysema, particularly in individuals without a significant smoking history?
Which of the following best describes the airflow limitation seen in COPD?
Which of the following best describes the airflow limitation seen in COPD?
If initial chest tube drainage fails to adequately resolve an empyema, which secondary intervention should be considered next?
If initial chest tube drainage fails to adequately resolve an empyema, which secondary intervention should be considered next?
A patient with COPD develops right-sided heart failure as a direct consequence of their chronic lung disease. This condition is known as:
A patient with COPD develops right-sided heart failure as a direct consequence of their chronic lung disease. This condition is known as:
Under what specific circumstance should clinicians strongly consider screening for alpha-1 antitrypsin deficiency in a patient presenting with COPD?
Under what specific circumstance should clinicians strongly consider screening for alpha-1 antitrypsin deficiency in a patient presenting with COPD?
Flashcards
Chronic Bronchitis
Chronic Bronchitis
Inflammation and excess mucus production in the bronchial tubes, leading to cough and difficulty breathing.
Emphysema
Emphysema
Destruction of alveoli (air sacs) in the lungs, causing shortness of breath.
COPD (Chronic Obstructive Pulmonary Disease)
COPD (Chronic Obstructive Pulmonary Disease)
A group of lung diseases that block airflow and make it difficult to breathe.
Lung Cancer
Lung Cancer
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Toluene
Toluene
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Polonium 210 and Lead 210
Polonium 210 and Lead 210
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Polycyclic Aromatic Hydrocarbons
Polycyclic Aromatic Hydrocarbons
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5 A's
5 A's
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Passive Smoking
Passive Smoking
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Harm Reduction Approach
Harm Reduction Approach
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Smoking Cessation Medication
Smoking Cessation Medication
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Bedside Counseling
Bedside Counseling
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E-cigarettes
E-cigarettes
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Smoking cessation support
Smoking cessation support
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E-cigarettes harm reduction
E-cigarettes harm reduction
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EVALI
EVALI
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Respiratory symptoms assessment
Respiratory symptoms assessment
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Respiratory social history
Respiratory social history
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General appearance (respiratory)
General appearance (respiratory)
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Normal CTPA
Normal CTPA
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Pulmonary embolus
Pulmonary embolus
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Type 1 respiratory failure
Type 1 respiratory failure
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Type 2 respiratory failure
Type 2 respiratory failure
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Pleural Empyema
Pleural Empyema
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Cor Pulmonale
Cor Pulmonale
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Popcorn Lung
Popcorn Lung
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Bronchiectasis
Bronchiectasis
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Pulmonary Fibrosis
Pulmonary Fibrosis
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Asthma
Asthma
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Tuberculosis (TB)
Tuberculosis (TB)
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Obstructive Sleep Apnoea (OSA)
Obstructive Sleep Apnoea (OSA)
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Obesity Hypoventilation Syndrome (OHS)
Obesity Hypoventilation Syndrome (OHS)
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Cot Death (SIDS)
Cot Death (SIDS)
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Middle Ear Disease
Middle Ear Disease
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COPD
COPD
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Mild OSA Severity
Mild OSA Severity
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Moderate OSA Severity
Moderate OSA Severity
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Severe OSA Severity
Severe OSA Severity
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Apnea
Apnea
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Hypopnea
Hypopnea
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Pulmonary Embolus (PE)
Pulmonary Embolus (PE)
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COVID-19
COVID-19
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CPAP
CPAP
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BiPAP (NIV)
BiPAP (NIV)
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Smoking Cessation Approaches
Smoking Cessation Approaches
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Arterial Blood Gas (ABG)
Arterial Blood Gas (ABG)
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Sleep Studies
Sleep Studies
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Antibiotics
Antibiotics
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Nicotine Replacement Therapy
Nicotine Replacement Therapy
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Empyema Cause
Empyema Cause
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Empyema Treatment
Empyema Treatment
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Pleural Decortication
Pleural Decortication
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Empyema Prevention
Empyema Prevention
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COPD Definition
COPD Definition
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COPD Cause (UK)
COPD Cause (UK)
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Chronic Bronchitis (Clinical)
Chronic Bronchitis (Clinical)
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Emphysema Mechanism
Emphysema Mechanism
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Cor Pulmonale Definition
Cor Pulmonale Definition
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COPD Cause
COPD Cause
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Study Notes
Overview of Adult Respiratory Medicine
- A 45-year-old male presented with cough and wheeze, with no prior relevant medical history.
- He was treated with two courses of antibiotics (abx) and steroids.
- The patient had lost a crown in his sleep five months prior to the consultation.
- He visited the emergency department (ED) due to being unwell with right-sided chest pain for six months
- There was a significant build-up of fluid in the lungs, leading to an abscess in the pleural cavity.
- Radiography showed a mandible fracture and empyema due to Fusobacterium.
- Post treatment he recovered well showing "+ 16 months" on radiography
- Radiography showed a tooth.
Smoking
- Annually, over 100,000 smokers in the UK die from smoking-related causes.
- Half of all regular smokers will eventually die due to their addiction.
Deaths Caused by Smoking-Related Diseases
- Lung cancer is the most common smoking-related cause of death.
- This is then followed by heart disease and Chronic Obstructive Pulmonary Disease (COPD).
- In 1995, smoking caused 121,700 out of 644,000 deaths in the UK.
Smoking and Disease
- 90% of deaths from lung cancer are attributed to smoking.
- 80% of deaths from emphysema and chronic bronchitis (COPD) are attributed to smoking.
- 17% of deaths from cardiac disease are attributed to smoking.
One in Three Cancer Deaths Can Be Attributed to Smoking
- Tobacco smoke has tar, carbon monoxide, and nicotine.
- British tobacco also contains flavorings, sugars, and moisturizers.
- Sugars are added to make the smoke easier to inhale.
- Moisturizers are used to increase the shelf life of the product.
- Tar is a product of a burning cigarette, not an additive
Components Attributed to Cancer from Smoking
- Arsenic: Found in car batteries.
- Acetaldehyde: A carcinogenic chemical compound.
- Ammonia: Used to make fertilizers and cleaning products.
- Acetone: Found in nail varnish remover.
- Butadiene: Used in manufacturing synthetic rubber.
- Benzene: A petrol additive known to be carcinogenic.
- Formaldehyde: A carcinogen used to preserve dead bodies.
- Toluene: Used in pain thinners and permanent markers.
- Methylamine: Used in the production of methamphetamine.
- Berillium
- Cadmium
- Chromium - All used in Battery Manufacturing
- Polonium 210 and Lead 210: Build up in the lungs and stick to the tar coating of the bronchioles.
- Polycyclic aromatic hydrocarbons: Genotoxic substances that cause cell mutations.
Smoking and Dental Health
- Smoking can cause bad breath.
- It can also cause increased risk of periodontal disease, increased plaque, discolouration of teeth, delayed healing post-dental procedures, and oral cancers.
5 A's of Smoking Cessation
- Ask: Systematically identify all tobacco users at every visit.
- Advise: Strongly urge all tobacco users to quit.
- Assess: Determine willingness to make a quit attempt.
- Assist: Aid the patient in quitting, and provide counseling and medication.
- Arrange: Ensure follow-up contact.
Passive Smoking
- Passive smoking can cause Lung Cancer,
- It can cause Heart Disease.
- It can cause respiratory disease in childhood, cot death, middle ear disease, and asthma.
Smoking Cessation - NICE (National Institute for Health and Care Excellence) Guidance
- Key components include the 5 A's (ask, advise, assess, assist, arrange).
- Smoking is assessed in all admissions for first available opportunity.
- Hospitals should provide advise of smoking bans.
- NRT (Nicotine Replacement Therapy) should be available on first contact.
- Individuals who are unwilling or not ready to stop smoking can be offered a harm-reduction approach.
- They can be advised about using nicotine-containing products along with support to obtain licensed nicotine-containing products.
- Approaches to stopping smoking should also be suggested as appropriate.
Smoking Cessation - NICE Guidance
- Smokers who do not want to quit, should be offered nicotine replacement; with patients being twice as likely to quit in the future.
- This can help with nicotine withdrawal in hospital.
Smoking Cessation Treatment
- Treatment can involve E-cigarettes containing Nicotine.
- Medication; Varenicline, Cytisine, and combined NRT.
- Bedside Counseling ASAP with Behavioral Support.
- All staff who smoke should be advised to stop.
- Systems should be put in place to help staff who smoke to receive advice and guidance to stop
PHE - Independent Expert Review Aug 2015
- E-cigarettes are thought to be around 95% less harmful than smoking.
- Nearly half of the population (44.8%) don't realize e-cigarettes are much less harmful.
- There is no evidence so far that e-cigarettes are a route into smoking for children or non-smokers.
BTS (British Thoracic Society) 2016
- Shows that there are no serious adverse events in RCT (randomised controlled trials), and Prospective Studies.
- There is no standard e-cig model
- No Long Term Effect studies
- 34% of studies had a conflict of interest.
- Diacetyl (sweetener, previously used in popcorn) in 75%, can cause popcorn lung in exposed workers
E-Cigarettes
- In 2015 - 2.6 million adults used cigarettes,.
- It's projected that 5.6 million adults, will use them in 2024.
- 53% were former smokers, so they reduced smoking numbers but didn't quit
Cochrane Review Nov 22
- There have been 78 studies on cigaretes, over 22,000 people.
- More likely to stop smoking at least 6/12 cf NRT.
- 8-12/100 might stop cf 6/100
Other Info
- From a case on 24th Feb 2020, a 17 year old attended a Chinese wedding.
- They had one week before the consultation viral URTI symptoms, and acute type 1 resp failure (LOW OXYGEN Levels in his blood).
- 3 months later there was Repatriated to Local Hospital.
- Prednisolone and Ursodeoxycholic Acid for secondary Sclerosing Cholangitis Critical Myoneuropathy, morphine, Diazepam, Clonidine are relevant to conditions discussed.
- EVALI (e-cigarette or vaping product use associated lung injury) is also relevant.
- OP physio and OT, Zimmer Frame is relevent to conditions discussed.
- EVALI was first Recognized Summer 2019. With 2/3 being male.
- It can cause Acute Lung Injury, requiring mechanical Ventilation in about 25% in one series,
- ECMO (Extracorporeal membrane oxygenation) Rare, with 2.4% mortality in 2800 Patients admitted.
Respiratory Examination
- Consider symptoms for variablility, and exacerbation rate, including functional status.
- Important to ask about SMOKING, OCCUPATIONAL - Asbestos working in Construction, ACCOMMODATION and those who share it
- IMPORTANT ASPECTS OF EXAMINATION include General Appearance.
- There should be communication - to see if they can get out a sentence, when breathing pattern includes Neck and Belly getting involved.
Respiratory Examination - Extra Details to consider for examination
- BMI (body mass index) must be included and standard observations such as
- RR (respiration rate)
- 02 sat (Oxygen saturation)
- HR (Heart rate)
- BP (Blood pressure)
Gas Exchange & Conditions & Emphysema
- Gas Exchange - How o2 from the Mouth getting to the Organs of the Body
- White bits represent blood vessels
- Vessels and alveoli are damaged or gone. - For those with Emphysema
- Looks like Honeycombing lots of Scaring, for PULMONARY FIBROSIS patients
- "Too Big Airways" - For those with BRONCHIECTASIS
Pulmonary Embolus
- Blood Clots causing Low Oxygen and Restricting Blood Flow.
- Respiratory failure results from a PO2 < 8Kpa on air.
Two Types of Respiratory Failure
- Type 1 - Normal CO2
- Type 2 - CO2 > 6 Kpa (cant get rid of the CO2 in the body)
Differential Diagnosis/Type 1/Acute Respiratory Failure
- Pneumonia
- Covid 19 - PE (Pulmonary Embolism)
- Asthma
- ALI/ARDS (Acute Injury to the Lung like the Big Vaper)
- Pulmonary oedema
- Chest trauma
Differential Diagnosis/Type 2/Chronic Respiratory Failure
- Pulmonary Fibrosis
- Emphysema
- Pulmonary Hypertension
Breathing Issues/Oxygen
- Type 2 Respiratory failure, may be sensitive to Oxygen
- Consider COPD, Asthma, Bronchiectasis, Decompensated Obstructive sleep apnoea/Obesity Hypoventilation (OSA/OHS), Pulmonary Oedema, Neuromuscular, Thoracic Cage Abnormalities, and Drugs - Morphine and Heroin OD
- Those with Breathing Issues are used to having High Levels of Co2, so its dangerous to give them high doses of oxygen as their brain can sometimes shut off, when giving oxygen.
- Dont get 02 Saturation above 96% whoever they may be.
- 70% is considered Airway Obstruction – Harder to get rid of the CO2 in the body.
Gold Standard of Lungs
- No Gold Standard but must have Symptoms and Variable Airflow Obstruction related to airway inflammation.
- Inital assessment based on Measuring Airflow Obstruction and careful Assessment of Symptoms
COPD (Chronic Obstructive Pulmonary Disorder)
- Chronic bronchitis and Emphysema an Umbrella Term covering the “IRREVERSIBLE" aspect of CHRONIC BRONCHITIS, EMPHYSEMA and ASTHMA.
- NICE (National Institute for Health and Care Excellence) recommends to Consider a Diagnosis of COPD in Patients over 35, Who are Smokers or EX-SMOKERS, and With symptoms.
- Main COPD symtoms include Exertional Breathlessness, Chronic Cough, Regular Sputum Production, Frequent Winter 'Bronchitis', Wheeze
- Clinical Features of ASTHMA doesn't include those symptoms.
COPD Severity
- COPD Severity is measured using a FEV1 post bronchodilator
- Mild : ≥ 80% (must be symptomatic)
- Moderate 50-79% pred
- Severe 30-49% pred
- Very Severe <30% pred
Managing COPD
- Management includes Short Acting Bronchodilators, Long-Acting Bronchodilators, Inhaled Corticosteroids
- Management also considers Combination therapy, and Mucolytics
- For IHCS Asthma START EARLY AND START LOW
- COPD Usually ‘High' Dose and Combination and FEV1 < 50% and more than 1 exacerbation in 12 months
Acute COPD and Oxygen
- To handle Acute Conditions , use Early Steroids and Bronchodilators, with Appropriate Oxygen for Asthma
- aim sats 94-98%
- COPD - aim sats 88-92% via venturi
- If patient experiences an Exacerbation of COPD decide how that feels and give them NON-INVASIVE VENTILATION (NIV) IN FAILURE mainly used for COPD
COPD treatment
- Treatment can include Unloads Respiratory Muscle Pump, Bi-level pressure (BIPAP) IPAP 12cm, EPAP 4cm
- CPAP used for Type 1 Respiratory Failure in HDU setting.
Domililiary NIV
- TYPE 2 RESPIRATORY FAILURE is secondary to other causes:
- Obesity hypoventilation syndrome (OHS)/severe OSA, Neuromuscular diseases like MND and Kyphoscoliosis.
- CPAP for OSA and mild OHS
Lung Cancer
- There were 2 cases from Clinic in One Week of a 32-YEAR-OLD, with Massive Cancer as shown with CT (Computed Tomography) and a 41- FEMALE with Cancer at the top right shown with PET CT (positron emission tomography) and CT scan.
- Commonest CANCER WORLDWIDE and Second most common Cancer in the UK with with nearly 40% of cases presenting as Emergency Admissions and a 1-Year Survival Rate for these patients being Poor 8%.
- Non-smokers account for 15% of cases.
- Male-to-Female ratio over time has changed from:
- 1973: 6:1
- 2008: 1.5:1
- 2022: 1.1:1
Lung Cancer Cause and Cure
- It is the Commonest cause of cancer-related death in the UK, with LOW Cure Rates
- The Suggested Reasons the Lung Cancer is presented with:
- Aggressive Biology of Lung Cancer: With symptoms appearing when Locally Advanced or there's Metastatic Spread, and due to No widespread Screening Test
Management for Lung Cancer
- Health Professionals should know Cough is more frequent in Early-Stage Lung Cancer.
- Hamephtisis and SOB can present 180 days pre diagnosis
Medical Background & Case Study
- 57 year old woman with:
- LRTI in May 2007, resolved
- Ran a Half Marathon in September
- LRTI Post-Marathon didn't clear
- Continued Running up to the day before the clinic visit
- Personal Medical and Social History: Acne
Smoking and Alchol History of Example case
- Smoking History: Ex smoker for 26 years.
- Alchol intake = 40 units per week
- occupation= Teacher
- With a T4 Lesion on the bronchial Left Upper Lobe and Squamous Cell Carcinoma, with PET scan Results of T3,4, N2,M0
- Referred to Clinical Oncology and completed Treatment by April, followed by a Portugal Holiday
Follow up & Updates with example Case Study
- Left lung changes consistent with radio therapy scar tissue
- At 3 months, there was a return to exercise. With the Patient back to running at work with an Completed marathon 6 months later, having entered a study for EGFR
- patient Had Partial Response, but stopped EGFR treatment due to Skin Rash
- More Recent updates are that in February 2010 the Patient in the Case Study Celebrated their 60th birthday during recent holiday
- However Patient had a Complete Trachea Occlusion, leading to a final debulking of the a March 2010 - but not ammendable
- The Patient Died around 2 months later It details a - Cancer referall for:
- a 36 year old from zambia, moved to the UK
- 1 Month History of Cough, with some with improvement from ABX.
- Notes indicated referall due to weight loss - and neck lump identified by USS FNA.
TB overview
- TB is caused by MYCOBACTERIUM TUBERCULOSIS
- Common factors include Diabetes, Homelessness, HIV AIDS ,Alcoholism and Malnutrition
- Symptoms include night sweats, fever fatigue weight loss
- It has a Standard TB Treatment for Pulmonary TB with initial 2 months with Four Drugs Followed by 4 months by Isoniazid
- Isoniazid also called INH
OSA overview
- In Obstructive Sleep Apnoea (OSA). pathogenesis includes:
- Upper Airway obstruction
- Activity is limited through reduce dilator muscles during sleep
- Neuro- transmitter edition
- Upper airway changes
- OSA symptoms/sleepiness with intermittent hypoxia, sleep fragmenting, oxidative damage in Brain which can be tested.
- Excessive day time sleepiness -2 / symptoms 5 hour.
- Sleepiness is assessed using the Chance of Dozing scale (Epworth Sleep Score), with 8 Questions ( with score of 0-3)
- Ess Score of 11 or less = Normal
- Ess Score of 11-14 = Mid Sleepiness, 15-18 Moderater and over = Severe.
- 8 Questions, max score: 24
AHI tests
- Test for OSA
- Using Oximemtry ALONE which is a Limited steep study Test for 3%, Baselines as indicators for sleep
- Also with High in nasal flow indicating degree of SEVERITY
OSA/sleep prevalance in some studies
- Prevalence of OSA*
- 4% males
- 5-15 + hypoventilation / h
- 10 *adults report Sleep related issues
-
-
- 2 - partner + somme
-
OSA - risks and associations
- Obesity - Types of risk =DM hypertension leading to a 30% of DM patients with increased risk
- Imparity level + 2.5 for car crashes. Inability to drive
OSA treatment
- CPAP (continuous positive airway pressure), is used in severe and sleepy patients with Snoring.
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