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Airflow obstruction Flashcards

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1
Q

Diagnosis of airflow obstruction is done using a

A

Spirometer

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2
Q

Shape of obstructive in a flow diagram:

A

Can see a ‘dent’

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3
Q

Shape of restrictive in a flow diagram:

A

Smaller/all reduced

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4
Q

Normal FEV1/FVC

A

> 75%

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5
Q

Abnormal FEV1/FVC

A

<70%

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6
Q

Why might an airway be narrowed?

A

Mucus
Hypertrophy of bronchial smooth muscle
Breakdown of alveolar walls so airways collapse

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7
Q

Ex of conditions in which airway is obstructed by mucus:

A

Infection (acute bronchitis)

Chronic bronchitis

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8
Q

Ex of condition in which bronchial smooth muscle hypertrophies

A

Asthma

COPD

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9
Q

Ex of condition in which alveolar walls break down

A

Emphysema

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10
Q

Asthma is an example of what time of hypersensitivity reaction?

A

Type 1

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11
Q

Asthma is reversible/irreversible

A

Reversible

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12
Q

What does ‘reversible airflow obstruction’ mean?

A

Reversible with time or bronchodilators

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13
Q

Asthma is characterised by:

A
  • Reversible
  • Airway inflammation
  • Hyperactivity of airway
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14
Q

Airway hyperactivity =

A

Increased tendency to spasm

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15
Q

How to diagnose asthma:

A

Hx - should be variable airway narrowing (bad periods which are self-limiting)
- Demonstrate variability using PF monitoring/bronchodilator reversibility studies/treatment trials

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16
Q

What increase of FEV1 in response to a bronchodilator is diagnostic of asthma?

A

> 15%

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17
Q

Bronchial hyperreactivty study =

A

Give a substance like histamine, mannitol etc.

Measure drop in FEV1

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18
Q

What kind of variation does peak flow have?

A

Diurnal

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19
Q

What can be given to an asthmatic to help them recognise exacerbations or when they need to use treatment?

A

Peak flow monitor

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20
Q

How can we find eosinophilia?

A
  • Sputum eosinophila

- measure exhaled NO

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21
Q

Exhaled NO is a marker for

A

Eosinic airway inflammation

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22
Q

FENO =

A

Fraction exhaled nirtic oxide

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23
Q

Triggers for asthma:

A 
Dust 
Air pollution
Pet dander
Foods: peanuts, wheat
Chemicals
Pollen
Mould
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24
Q

What dominate asthmatic inflammation?

A

Th2 cells

eosinophils

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25
Th1 t cells
promote cell immunity | IgG
26
Th2 cells
Enhance mast cells, eosinophils and IgE
27
What type of immunoglobulin to Th2 cells stimualte the production of
IgE
28
Name some cytokines released by Th2
IL-4 | IL-5
29
IL-4 =
IgE | Mast cells
30
Mast cells release
Histamine Leukotrienes Prostaglandin
31
IL-5 =
Eosinophils
32
Eosinophils release
Histamine | Leukotrienes
33
"A genetic tendency to develop allergic diseases" =
Atopy
34
3 conditions a person with atopy is likely to develop
Asthma Allergic rhinitis Atopic dermatitis
35
What are drug developers now interested which attract eosinophils to the airways?
IL-5
36
Acute airway change in asthma =
``` Smooth muscle contraction Sensory nerve action Mucus hypersectrion Plasma leakage Oedema Inflammatory infiltrate ```
37
Chronic airway changes in asthma:
Subepithelial fibrosis | Smooth muscle hypertrophy
38
Chronic airway changes occur when
Asthma is ongoing, untreated, cannot be suppressed
39
2 conditions under the COPD umbrella:
Chronic bronchitis | Emphysema
40
In comparison to asthma, COPD is
Non-reversible Doesn't respond to bronchodilators/steroids Doesn't markedly change
41
Air becomes what in COPD
Trapped
42
What increases in COPD?
Expiatory residual volume/ total lung capacity
43
Emphysema is based on ... Chronic bronchitis is based on ....
Emphysema = structural changes | Chronic bronchitis = clinical symptoms
44
What happens in emphysema
Alveoli are damaged, elastin broken down Lose elasticity, enlarge Septa breakdown Difficult for lungs to recoil - collapse on expiration
45
What causes the breakdown of elastin in emphysema?
Inflammatory reaction - release leukotrienes, IL-8, TNF-a and proteases
46
What usually stops airways collapsing in expiration?
Elastic recoil/elastin
47
Most common pattern of emphysema associated with smoking =
Centrilobar
48
Panacinar emphysema is associated with =
Alpha-1 antitrypsin deficiency
49
What is alphae 1-antritrypsin?
A protease inhibitor which protects alveoli from unintended collateral damage from macrophages
50
What can happen with a paraseptal emphysema?
Pneumothorax
51
What can be seen on imaging in emphysema?
Bollous
52
Bollous =
Presence of abnormally large air space surrounded by relatively normal lung tissue
53
Chronic bronchitis definition:
Productive cough for at least 3 months/year for 2 consecutive years
54
What happens in chronic bronchitis?
``` Mucus gland hypertrophy Goblet cell hyperplasia Smooth muscle hypertrophy Inflammatory cells infiltrate Excess mucus ```
55
What inflammatory cells are involved in chronic bronchitis?
Neutrophils and lymphocytes
56
risk factors for COPD:
``` Smoking Occupational Passive smoke/cannabis Chronic asthma Biofules Familial (alpha 1 antitrypsin deficiency) ```
57
What is released by alveolar macrophages to clean up debris?
Proteases
58
Blue bloaters =
Chronic bronchitis
59
Pink puffers =
Emphysema
60
Shape of chest in emphysema can be
Barelled - due to air trapping
61
V/Q < 1 =
Perfusion is higher than ventilation
62
What can happen when perfusion is higher than ventilation?
pO2 falls pCo2 increases Pulmonary vasoconstriction
63
Consequences of pulmonary vasocontriction
Pulmonary hypertension --> cor pulmonale
64
Cor pulmonale =
Right sided heart failure
65
What happens in bronchiectasis?
Bronchial dilation | Chronic sputum production
66
What does cronchiectasis increase?
Infections
67
What does bronchiectasis resemble clinically?
COPD | Asthma

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