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circulation and breathing > asthma and airways disease > Flashcards

asthma and airways disease Flashcards

1
Q

what is the most common respiratory disease

A

asthma

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2
Q

what is the epidemiology of asthma

A
  • high prevelance in UK, america, australlia
  • lower prevelance in lower income countries e.g. ethiopia has a prevelance of 2%
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3
Q

what are the tisk factors of asthma

A
  • family history
  • age (peak prevelance around 6-12)
  • presence of other allergic/ atopic conditions
  • social deprivation
  • smoking
  • air pollution
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4
Q

what is the 3 pathological basis of asthma

A
  1. increased airway obstruction
  2. airway inflammation
  3. bronchial hyper reactivity
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5
Q

what is the most common type of asthma

A

-type 2 eosinophilic asthma (common in adults, allergic asthma common in children)

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6
Q

what are the triggers for asthma

A
  • indoor sensitisation (house dust mite, moulds)
  • outdoor sensitisation (tree pollen, grass pollen)
  • viral infections
  • air poullatants
  • medications (aspirin)
  • sulfites in food stuff
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7
Q

what are the symptoms of asthma

A
  • coughing
  • shortness of breath
  • weezing
  • recurrant chest infections
    can depend on season
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8
Q

how does a peak flow diary work and what are the adv and disadv

A
  • measure expiratory flow and keep a diary this could be over a few days or a few weeks etc
  • more than 20% variabiltiy suggestive of asthma
  • adv includes cheap, easy, repeatable
  • disadv include need forced exhalation so effort dependant, not specific to asthma, patients need to keep track
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9
Q

how does spirometery work

A
  • measures flow volume and prodcues a flow volume loop
  • adv allows to calculate fev1, fev1/fvc ratio, definitive test for airway obstruction and reversibility
  • diadv include patient needs to do trest during exacerbation and normal test does not exclude asthma
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10
Q

what is the FeNO test

A
  • biomarker
  • NO is a biomarker for eosinophilic inflammation
  • diadv elevated in other conditions such as rhinitis, just a measurment of a specific inflammation
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11
Q

what is the bronchial challenge

A
  • inhalation of metacholine (or manittol) and the concentration required to cause 20% fall in fev1 is measured
  • adv measure airway hyperresponsivness
  • disadv may not be tolerated by some, time consuming, cannot be done on everyone
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12
Q

what can inhaled asthma medications be classified into

A
  • short and long acting beta agoonists
  • long and short acting muscarinic antagonists
  • inhaled corticosteroids
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13
Q

what is an example of a short acting beta agonsit for asthma

A

salbutamol

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14
Q

what is an example of a long acting beta agonist for asthma

A
  • salmetarol
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15
Q

what is an example of a short acting muscarinic antagonist for asthma

A
  • ipratropium
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16
Q

what is an example of a long acting muscarinic antagonist for asthma

A
  • tiotropium
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17
Q

what is an example of an inhaled corticosteroid for asthma

A
  • beclomethasone
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18
Q

how can the oral asthma medications be divided into

A
  • oral corticosteorids
  • leukotriene receptor antagonist (blocks production of leukotrienes)
  • theophylines (cause bronchodilation via several mechanism
19
Q

what is an example of a leukotriene receptor antagonists for oral asthma medication

A

montelukast- blocks production of leukotrienes

20
Q

what is an example of a theophylines- oral medication of asthma

A
  • aminophylinne
21
Q

what is an example of a oral corticosteroid for asthma

A
  • prednisolone- reduce inflammation by altering production if inflammatory mediators
22
Q

what is an example of anti IgE injectible asthma medication

A
  • omalizumab
23
Q

what is an example of an anti IL5 injectible asthma medication

A
  • mepolizumab/benralzumab
24
Q

what is an example of an anti IL4 injectible asthma medication

A

duplimubab

25
Q

what is an example of an anti thymic storm lymphopoitin (TSLP) for asthma

A
  • tezepelumab (inhibits antigen presentation)
26
Q

what are the three types of inhalers

A
  • pMDI
  • dry mist inhaler
  • soft mist inhaler
27
Q

what is the disadvantage of dry mist inhaler

A
  • need full inhalation force (quick and deep breaths in)
  • can be diffficult for children, elderly, suring severe asthma attacks
28
Q

what is the issue with pMDIs

A
  • works by using hydrofluorocarbon propellant
  • HCFs are powerful greenhouse gases
  • contrubute to 3-4% CO2 footprint of NHS
29
Q

should all patients be on dry mist inhaler

A
  • no as not all patients woulndt be able to take quick and deep inahlation to use a DPI
  • some patients (mainly with COPD) lack rthe necessary inspiratory flow to use a DPI
30
Q

how can asthma be classified

A
  • moderate asthma (PEF>50-75%)
  • acute severe asthma (PEF 33-50%
  • life threatening asthma (PEF<33%)
31
Q

What are signs of moderate asthma

A
  • PEF 50-75%
  • SpO2> 92%
  • no features of acute severe asthma
32
Q

what are the signs of acute severe asthma

A
  • 33-50% PEF
  • SpO2>92%
  • cannot complete sentance in one breath
  • respiration >25/min
33
Q

what are the signs of life threatening asthma

A
  • PEF <33%
  • siltent chest, cyanosis, poor respirtory effort
  • exhaustion, altered consciousness
  • arryhthmias, hypotensions
  • SpO2>92%
34
Q

what is MART

A
  • maintenance and reliever therapy
  • taken daily and during exacerbations/acute onsets
  • includes ICS, LABA used as both maintenance and reliever
  • seperate reliever salbutamol not required
35
Q

what is AIR

A
  • anti inflammatory reliever
  • combinated of ICS and LABA, only taken when patient has symptoms
36
Q

what are the risk factors of COPD

A
  • tobacco smoking
  • environmental exposures such as biomass feul exposure and air pollution
37
Q

what are the symptoms of copd

A
  • breathlessness
  • wheezing
  • chronic cough/ sputum production
  • recurrant respiratory tract infections
38
Q

what two conditons come under COPD

A
  • chronic bronchitis (persistent airway inflammation and mucus hypersecretion)
  • emphysema (desturction of alveolar sacs leading to impaired gas exchange, also adds to airway obstruction by changing the sturucture of the lung surrounding the bronchioles
39
Q

what is the key patholgoy in COPD

A
  • airflow obsturction
  • gas trapping and hyperinflation
  • impaired gas exchange and ventilation/perfusion mismatch
  • pulmonary hypertension (due to hypoxia leading to vasoconstriction)
  • exacerbations
  • increased comorbitidies
40
Q

hwat test do you need to do to diagnose someone with COPD

A
  • spirometery to measure airflow obstruction
41
Q

what values can we dereive from spirometry for COPD

A
  • FEV1
  • FVC
  • PEAK FLOW
  • FEV1/FVC ratio
42
Q

what is the most cost effective way of treating COPD

A
  • flu vaccines
  • followed by stop smoking suport with pharmocotherapy
  • most expensive is triple therapy
43
Q

what is pulmonary rehabilitation

A
  • pulmonary rehabilitation is a specialised programe of exercise and education designed to help people with lungs problems such as COPD
  • peopl with stable COPD and a score of 3 or above on the MRC dyspnoea are reffered to pulmonry rehabilitation
44
Q

treating COPD exarcerbations

A
  • Short acting bronchodilators
  • oral corticosteorids
  • antibiotics
  • ventilaiton support

circulation and breathing (26 decks)

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