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Airway Disease Flashcards

1
Q

What is asthma?

A

An obstructive condition characterized by IgE hypersensitivity inducing mast cell degranulation and airway obstruction from Th2 cell mediated sensitisation by interacting with dendritic cells, mediated by IL-4 and IL-5.

This results in bronchial wall oedema and mucous gland hypersecretion and bronchoconstriction due to inflammation.

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2
Q

What are the clinical features of asthma?

A

Cough, shortness of breath
Wheeze and Chest tightness.

These are typically, variable, worst at night and assoicated with allergic triggers and non-allergic triggers such as cold air and exercise. Predominately, cough may be the only symptom.

It is important to rule out nasal symptoms, GERD associatd with hoarse voice, throat clearing and acid in mouth, aspirin sensitivity, family history and social situations

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3
Q

What are the main cytokines involved in asthma pathophysiology?

A
  • IL-4
  • IL-5
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4
Q

What are the clinical presentations of asthma in an emergency department?

A
  • Dyspnoea
  • Wheezing breath sounds
  • Hyper-resonance to percussion

Obstruction to airflow creates air trapping and hyper-inflation o the lungs with a barrel chest

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5
Q

What are the triggers for asthma attacks?

A

Aspirin, a non-selective COX inhibitor which induces arachidionic acid metabolites to enter the lipo-oxygenate pathway involving pro-inflammatory leukotrienes that induce bronchoconstriction.

  • Beta blockers
  • Viral upper respiratory tract infections
    *Cold air
    *Exercise
    *Allergies
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6
Q

What complications are associated with asthma?

A
  • Respiratory failure type 2
  • Pneumothorax: hyperfinaltion can cause the lungs to rupture and air to leak from parenchyma into the pleural cavity
  • Silent chest, with short inspiration and long expiration.
  • Pulsus paradoxus may occur due to negative intrapleural pressure and lung hyperinflation and cause a septum shift which impedes ventricualr filling during inspiration
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7
Q

What is status asthmaticus?

A

A medical emergency characterized by hypoxaemia, hypercapnia, and secondary respiratory failure. There is an acute bronchospastic phase after allergen exposure, followed by a later inflammatory phase of airway swelling and oedema due to eosinophilic mediation.

On examination, patients are typically tachycardia, tachypnoea and conversationally dyspnoeic.

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8
Q

What are common triggers for asthma attacks?

A
  • Aspirin
  • Beta-blockers
  • Viral upper respiratory infections
  • Cold air
  • Exercise
  • Allergies
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9
Q

What are the clinical features of asthma?

A
  • Cough
  • Shortness of breath
  • Wheeze
  • Chest tightness
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10
Q

What is the atopic triad associated with asthma?

A
  • Urticaria
  • Asthma
  • Dermatitis
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11
Q

What are the diagnostic tests for asthma?

A
  • CXR: usually normal but may show hyperinfaltion
  • 12 lead ECG: typically normal
  • ABG: may show respiratory acidosis
  • Peak flow tests Shows day-to-day variability and airway hyperresponsivenes
  • Pulmonary function tests such as FEV1/FVC ratio, where a reduced ratio indicates obstructive lung disease and is reversible following administration of a bronchodilator
  • Diffusion limitation capacity for carbon monoxide, where normal or increased indicates asthma
  • FBC for eosinophil count, sputum analysis for eosinophilia and biomarkers such as FINO.
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12
Q

What is used to test bronchial hyperreactivity?

A

Methacholine can be used to test bronchial hyperreactivity following administration, which will show a reduced FEV1, because it is a parasympathomimetic bronchoconstrictor.

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13
Q

What des a peak flow less than 40% indicate?

A

Peak expiratory flow less than 40% indicates asthma exacerbation.there should be day to day variability with response to treatment, with reduced FEV1

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14
Q

What is the significance of a reduced FEV1/FVC ratio?

A

Indicates obstructive lung disease.

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15
Q

What is the role of methacholine in asthma diagnosis?

A

Used to test bronchial hyperreactivity.

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16
Q

What are the types of asthma management?

A
  • Bronchodilators
  • Anti-inflammatories
  • Leukotriene receptor antagonists
  • Anti-histamines
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17
Q

What is the aetiology of asthma?

A

Atopic, associated with IgE-antigen complexes
Non-eosinophilic disease, which is assoicated with a poorer response to corticosteroid
Genetics
Hygeine hypothesis, where reduced exposure in early life to endotoxins increases the allergic Th2 mediated response that creases allergen sensitivity in later life
Environment

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18
Q

What is occupational asthma?

A

Occupational asthma occurs after sensitisation where
Immunological: repeated exposure to the allergen
Non-immunological: exposure to high concentrations of allergen.

It should be screened in patients by assessing whether symptoms worsen at work and improve on weekends/holidays away from work. They should be referred to an occupational asthma specialist. Management includes early diagnosis and removal from exposure. Their PEF should. Be recorded every 2hous from waking to sleep for 4 weeks

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19
Q

What characterizes brittle asthma?

A

Brittle asthma is a rare form of severe asthma characterised by wide variation of PEF, despite heavy dose of steroids

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20
Q

What are the types of brittle asthma?

A
  • Type 1: maintained PEF variability, affecting females between 15 and 55, assoicated with skin prick test positivity and food intolerance.
  • Type 2: acute exacerbations requiring mechanical ventilation for respiratory insufficiency and are mainly free of symptoms otherwise
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21
Q

What is difficult/refractory asthma?

A

Characterized by continuous corticosteroid use with frequent exacerbations and poor bronchodilator response. There is a poor bronchodilator response to B2 agonists and they fail to completely reverse their airflow obstruction following a course off oral a prednisolone. They require high dose inhaled corticosteroids with long acting inhaler B2 agonists.

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22
Q

How should steroid resistant patients with refractory asthma be managed?

A

Patients that are steroid resistant in this group should be manage with alternative medication such as macrolide antibiotics which have an anti-inflammatory effect, at reducing airway reactivity and eosinophil inflammation.

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23
Q

What should be assessed in a clinical history for asthma?

A
  • Wheeze
  • Cough
  • Breathlessness
  • Chest tightness
    These will be worse during the night or early morning and is seasonal
  • Triggers
  • Family history of asthma and allergic rhinitis
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24
Q

How to assess morbidity for asthma?

A

-> have you experienced difficulties sleeping due to asthma?
-> have usual asthma symptoms occured during the day?
-> have these asthma symptoms interfered with normal activities?

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25
What are the initial objective tests for asthma?
Initial Objective tests for asthma diagnosis include eosinophil count, Fractional exhaled nitric oxide (FeNO), spiromotry and to assess for reversible bronchodilation with peak expiratory flow. -> results of spirometry and FeNO may be altered and appear normal for those taking inhaled corticosteroids
26
What are the objectiv tests for asthma diagnosis in adults?
Measure blood eosinophil count or FeNO Measure bronchodilators reversibility with spirometry -> increase by 12% or more in FEV1 after using bronchodilator indicates asthma Peak expiratory flow measured twice daily for 2 weeks-> variability over 20% indicates asthma
27
What are the tests for diagnosing asthma in children 5-16 years old?
Measure FeNO level -> over 35 ppl indicates asthma Reversible bronchodilators test with spirometry -> FEV1 increase of 12% or more indicates asthma Measurement of PEF twice daily to assess variability -> 20% or more indicates asthma Skin prick testing for positive sensitisation response to house dust mite Measure total IgE level and blood eosinophil count
28
How to diagnose asthma in children under 5?
Perform typical objective tests, however, if not possible, treat with inhaled corticosteroids and review on regular basis, with attempting tests every 6 to 12 months
29
What should be assessed in patinets with uncontrolled asthma?
Alternative diagnosis/comorbidity Suboptimal adherence or inhaler technique Smoking Occupational exposures Psychosocial factors Environmental factors such as season, air pollution or indoor mould exposure
30
What are the steps for managing intermittent asthma?
Step 1: SABA for symptomatic relief.
31
What is the first step in managing persistent asthma?
Step 1: low dose inhaled corticosteroid. 10 puffs per day or 2+ canisters per month indicates poorly controlled disease
32
What is the second line treatment of asthma ?
Medium dose inhaled corticosteroid. Titrate steroid dose to symptoms with lowest effective dose. Risks include hypertension, diabetes, cataracts, gastric erosion and osteoporosis at high doses.
33
What is the third line treatment of asthma?
Long acting bronchodilators with low dose corticosteroid
34
What is the fourth line treatment of asthma?
LABA with medium dose corticosteroid OR addition of leukotrienes antagonist/theophylline/slow release oral B2 agonist -> theophyllines require therapeutic drug monitoring
35
What is the 5th line treatment of asthma?
LABA with high dose corticosteroid
36
What is the last form of treatment for asthma?/
Continuous use of Oral steroids with LABA and high dose inhaler
37
Which treatment is important for asthma?
Omalizumub is a recombinant monoclonal antibody subcutaneous injection against IgE which has been proven to reduce early and late asthmatic responses. It is ideal in the use of severe persistent asthma which is unstable despite optimised standardised .
38
Which medication is ideal for patients with allergic induced asthma?
For patients with allergic induced asthma or aspirin exacerbated, leukotriene receptor antagonists are ideal.
39
Which drug is ideal for unstable severe asthma?
Omalizumub is a recombinant monoclonal antibody subcutaneous injection against IgE which has been proven to reduce early and late asthmatic responses. It is ideal in the use of severe persistent asthma which is unstable despite optimised standardised Treatment.
40
What is the treatment for acute asthma exacerbation?
SABA in combination with SAMA for bronchodilation with IV magnesium Corticosteroids such as methylprednisone or prednisone BiPAP for breathing or provide high flow oxygen.
41
What is a severe asthma exacerbation?
Severe asthma is indicated by a PEFR of 33-50%, with a respiratory rate over 25 and heart rate over 110 and patient is unable to complete a sentence in one breath. silent chest, cyanosis, poor respiratory effort, bradycardia, exhaustion, confusion and coma.
42
How should an acute asthma exacerbation be investigated?
When monitoring asthmatic patient arrival to A&E, record PEFR 15-30 min after starting treatment, and then regular checks to measure response to treatment. Record O2 saturation and maintain at over 92% Obtain ABG for pH and PaCO3 Document heart rate and respiratory rate Measure glucose (risk of hyperglycaemia) and potassium (hypokalemia risk with the use of beta agonists) CXR to exclude infection or pneumothorax and provide high flow oxygen
43
How should an acute asthma exacerbation be managed?
B2 agonist inhaled or nebulised, with either repeated or continuous doses Anticholinergic such as ipatriomium bromide in combination with B2 agonist improves bronco dilation Oral corticosteroids IM adrenaline for those approaching cardiac arrest
44
What does MART therapy stand for?
Maintenance and reliever therapy which is ideal for asthmatics with poor adherence to treatment regimen, frequent reliever usage of uncontrolled symptoms.
45
46
What are the objective tests for diagnosing asthma in children aged 5 to 16?
* Measure FeNO level * Reversible bronchodilator test with spirometry * Measurement of PEF
47
What are common findings in acute asthma exacerbations?
* Hypomagnesaemia * Hypokalemia
48
What is the treatment for acute asthma exacerbation?
* SABA + SAMA * Corticosteroids * BiPAP or high flow oxygen
49
What is the impact of pregnancy on asthma?
Asthma may improve, worsen, or remain unchanged during pregnancy.
50
What is COPD characterized by?
Irreversible airway obstruction and progressive deterioration of lung function.
51
What are the major components of COPD?
* Emphysema * Bronchitis
52
What is the hygiene hypothesis in relation to asthma?
Reduced exposure to endotoxins in early life increases allergic Th2 mediated response.
53
What is the role of omalizumab in asthma treatment?
A recombinant monoclonal antibody against IgE for severe persistent asthma.
54
Fill in the blank: Asthma is associated with the _______ triad.
[atopic]
55
What is COPD characterized by?
Irreversible airway obstruction, minimal variability in symptoms, and progressive deterioration of lung function ## Footnote Includes emphysema and bronchitis.
56
What are the clinical features of COPD?
* Dyspnoea that worsens over time * Productive cough * Decreased exercise tolerance * Wheeze ## Footnote Clinical signs include hyperexpanded barrel chest and use of respiratory muscles.
57
What is the most common type of emphysema?
Centriacinar emphysema ## Footnote Localized to the respiratory bronchioles, predominantly found in the upper lungs, associated with smokers.
58
What are the types of emphysema?
* Centriacinar emphysema * Panacinar emphysema * Paraseptal emphysema ## Footnote Each type has distinct associations and characteristics.
59
What factors do macrophages release that contribute to COPD pathology?
* Leukotriene B4 * Interleukin-8 ## Footnote These factors lead to mucus hypersecretion and inflammation.
60
What is the purpose of bronchodilator therapy in COPD?
To improve FEV1 by increasing smooth muscle airway dilatation ## Footnote Includes short-acting and long-acting beta agonists.
61
What is the ideal maintenance oxygen therapy range for COPD patients?
88%-92% ## Footnote This range helps prevent hypoxia while minimizing risks.
62
What is the BODE index used for?
To predict the risk of mortality in patients with unstable COPD ## Footnote Based on BMI, obstruction (FEV1), dyspnoea, and exercise capacity.
63
What is chronic bronchitis defined by?
Daily morning cough with excessive mucus production for 3 months in 2 successive years ## Footnote In absence of tumor.
64
What is the significance of the MRC scale in COPD?
Measures dyspnoea severity from 1-5 ## Footnote 1 indicates no dyspnoea except with strenuous exercise, 5 indicates dyspnoea impairs dressing.
65
What tests are used to investigate COPD?
* Pulmonary function test with spirometry * Diffusing capacity of carbon monoxide (TLCO) * CXR ## Footnote CXR shows hyperinflated lung fields and flattened diaphragms.
66
What are common triggers for COPD exacerbations?
* Smoking * Exposure to passive smoke * Viral or bacterial infection * Air pollution * Physical inactivity * Seasonal variation ## Footnote These factors can worsen symptoms and lead to hospital visits.
67
What is the role of pulmonary rehabilitation in COPD management?
An exercise and education program tailored for COPD patients ## Footnote Improves quality of life and reduces dyspnoea-related activity deterrents.
68
What is the recommended treatment for chronic bronchitis?
* Bronchodilators (SABA, LABA, anticholinergic) * Corticosteroids * Antibiotics (macrolides) ## Footnote Focus on reducing inflammation and mucus production.
69
What are the classifications of airflow obstruction based on FEV1?
* Mild: FEV1 50-79% * Moderate: FEV1 30-49% * Severe: FEV1 less than 30% ## Footnote These classifications help assess the severity of COPD.
70
What is the purpose of non-invasive ventilation in COPD management?
To improve gas exchange and reduce breathing work ## Footnote Helps with ventilation and matching ventilation to perfusion (V/Q).
71
What is the role of long-term oxygen therapy in COPD?
Indicated for patients with severe airflow obstruction, low oxygen saturation, and polycythemia risk ## Footnote Patients should be assessed for risks associated with therapy.
72
What are the key components of pharmacological management in COPD exacerbation?
* Nebulizers for unstable patients * Systemic corticosteroids * Theophylline if inadequate response to bronchodilators ## Footnote Medication delivery should be adjusted based on the patient's condition.
73
What are the signs of cor pulmonale in COPD patients?
* Ankle oedema * Raised JVP * Bounding pulse * Asterixis ## Footnote These signs indicate right heart failure due to pulmonary hypertension.
74
What is the importance of smoking cessation in COPD management?
Critical intervention to prevent disease progression and exacerbations ## Footnote Includes education on avoiding passive smoke exposure.
75
What is a life-threatening feature of asthma attack?
Silent chest, where airways are so constricted that a wheeze cannot be heard. Sp02 less than 932% Use of accessory neck muscles Tachycardia

Year 3 (349 decks)

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