2 Obstructive airways disease Flashcards
What respiratory symptoms are there
- Cough (dry, sputum, blood)
- Wheeze (expiratory)
- Stridor (inspiratory)
- Dyspnoea (distress on effort)
- Pain (general/inspiratory)
What respiratory signs are there
- chest movement with respiration
- rate of respiration (12-15/min)
- air entry - symmetrical? reduced?
- vocal resonance (if air in lungs you can’t hear them speak when your ear is against their chest)
- percussion note
What respiratory investigations can you have done?
- sputum examination
- chest radiograph
- pulmonary function (PEFR, FEV1, FEV1/VC)
- bronchoscopy
- VQ scan
What different respiratory diseases are there
- infections
- airflow obstruction (asthma, COPD, restrictive pulmonary change)
- gas exchange failure
- tumours
What chronic obstructive respiratory diseases are there
asthma and COPD
What is the main difference between asthma and COPD
asthma: ‘reversible’ airway obstruction
COPD: irreversible, gets worse with time
What things can exacerbate asthma
- infections
- exercise
- cold air
What happens in an asthma attack
- airway smooth muscle constriction
- inflammation of the mucosa (swelling)
- increased mucus secretion
What does a patient complain of in asthma
cough, wheeze, SoB
worse early morning (diurnal variation)
How does asthma affect someones peak expiratory flow rate?
the narrower their airways, the longer it will take for air to get out of the lungs
What can trigger asthma
- infections
- environmental stimuli (dust/smoke/chemicals)
- cold air
- ‘atopy’ (people who get asthma also have other problems like allergies)
What happens to an asthmatic patient’s FEV1 after the inhalation of an allergen (KNOW)
The early asthmatic response is IgE dependent, related to mast cell degranulation, and is blocked by B2 agonists
The late response is due to cellular inflammation, associated with increased bronchial responsiveness, and is blocked by corticosteroids. Has an increased hyper-responsiveness e.g. increased diurnal rhythm (blocked by steroids)
What does the high phasic immune response of asthma attacks mean for treatment of them
For first attack: beta 2 agonists
For second attack: steroids
What is the natures of the immunology of asthma
sudden and delayed onset
What inhalers would someone with mild asthma have
- blue (beta agonist)
- brown (steroid)
If someone has anything other than a blue or brown inhaler what does this mean
they at least have moderate asthma
If someone has ever been hospitalised for asthma what does this mean
they have severe asthma
If someone with moderate or severe asthma had an attack in your surgery what should you do
call an ambulance
What are the respiratory drugs
- beta-adrenergic agonists
- anticholinergic
- corticosteroids
- leukotriene inhibitors
- chromones
- theophyllines
What do beta-adrenergic agonists do
- relax bronchial smooth muscle (reduce bronchoconstriction, reduce resting bronchial tone)
- protective against stimuli
- short and long acting
- nebulised as effective as IV
what do antichonlinergics do
- act on muscarininc receptors
- reduce basal tone only (good in COPD)
what do theophyllines do
- used in severe asthma
- adenosine inhibition
what do corticosteroids do
- immune cell and epithelial cell actions
- use if beta2 agonist > 3 times each week
what is the most effective asthma treatment
corticosteroids
