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Resp > ASTHMA and COPD > Flashcards

ASTHMA and COPD Flashcards

1
Q

aetiology of airway obstruction in COPD

A

outside to inside

  • alveolar walls
  • smooth muscle
  • mucosa
  • lumen
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2
Q

what does atopic mean?

A

allergic

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3
Q

characteristics of athma

A
  • airway hyper-responsiveness
  • reversible airflow obstruction
  • airway inflammation
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4
Q

evolution of asthma

A
  • bronchoconstriction
  • chronic airway inflammation
  • airway remodelling - laying down collagen scar tissue
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5
Q

what happens to the basement membrane during remodelling?

A

it thickens

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6
Q

what happens to the submucosa during remodelling?

A

collagen deposition

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7
Q

what happens to the smooth muscle during remodelling?

A

hypertrophy

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8
Q

which interleukin allows TH2 cells to activate B cells?

A

IL-4

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9
Q

Which interleukin causes eosinophils to differentiate and activate?

A

IL-5

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10
Q

Which interleukins cause mast cells to express IgE receptors?

A

IL-4 and IL-13

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11
Q

what is the inflammatory cascade in asthma?

A
  1. genetic predisposition
  2. eosinophilic inflammation = anti inflammatory medication eg corticosteroids, cromones, theophylline
  3. meditaors TH2 cytokines = antileukotrines or antihistamines eg anti-IgE, anti-interleukin-5
  4. twitchy smooth muscle (hyperreactivity) = brochodilators eg B2 agonists, muscarinic antagonists
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12
Q

what drugs will melt away eosinophil inflammation and restore mucosal architecture?

A

steroid inhalers

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13
Q

clnical syndrome of asthma

A
  • episodic symptoms and signs
  • diurinal variability - nocturnal / early morning
  • non-productive cough, wheeze
  • triggers
  • associated atopy - increased IgE (rhinitis, conjunctivitis, eczema)
  • blood eosinophilia > 4%
  • repsonsive to steroids or beta agonists
  • family history
  • wheezing due to turbulent airflow
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14
Q

diagnosis of asthma

A
  • history and examination
  • diurinal variation of peak flow rate
  • reduced forced expiratory ration (FEV1/FVC < 75%)
  • reversibility to inhaled salbutamol (>15%)
  • bronchospasm on triggers
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15
Q

COPD disease process

A

inflammation + mucociliary dysfunction + tissue damage = development of obstruction and ongoing disease progression

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16
Q

characteristics of COPD

A
  • exacerbations

- reduced lung function

17
Q

symptoms of COPD

A
  • progressive breathlessness
  • worsening quality of life
  • non-atopic
  • ## daily productive cough
18
Q

what happens when you smoke (COPD)?

A
  1. cigarette smoke
  2. activated alveolar macrophage release neutrophil chemotactic factor cytokines, mediators,
  3. proteases are then released which break down connective tissue and stimulate mucus hyper secretion
  4. progressive airflow limitation

these steps lead to emphysema (alveolar wall destruction) and chronic bronchitis (mucus hyper secretion)

19
Q

chronic bronchitis

A
  • chronic neutrophilic inflammation
  • mucus hypersecretiun
  • mucociliary dysfunction
  • altered lung microbiome
  • smooth muslce psam and hypertrophy
  • partially reversible
20
Q

emphysema

A
  • alveolar destruction
  • impaired gas exchange
  • loss of bronchial support
  • irrreversible
21
Q

asthma COPD overlap syndrome

A

COPD with blood eosinophils > 4%

  • responds better to ICS with regard to exacerbation reduction
  • difficult to distinguish between smokers who have airway remodelling
22
Q

FVC in asthma and COPd

A

COPD FVC = reduced

asthma FVC = normal

23
Q

Asthma list

A 
Non smokers 
Allergic
Early or late onset
Intermittent symptoms
Non productive cough
Non progressive 
Eosinophilic inflammation
Diurnal variability
Good corticosteroid response
Good bronchodilator response
Preserved FVC and TLCO
Normal gas exchange
24
Q

COPD list

A 
Smokers
Non allergic
Late onset
Chronic symptoms
Productive cough
Progressive decline
Neutrophilic inflammation* 
No diurnal variability
Poor corticosteroid response*
Poor bronchodilator response
Reduced FVC  and TLCO
Impaired gas exchange
25
Q

what is the diagnosis of sever asthma?

A
  • peak flow <50%
  • tachycardia >110bpm
  • > 25 resp/min
  • cant complete sentences
26
Q

what is the diagnosis of moderate acute asthma?

A
  • PEV>50-75%

- increasing symptoms

27
Q

what is the diagnosis of acute severe asthma?

A
  • PEF 33%-50%
  • resp rate > 25
  • heart rate > 110
  • inability to complete sentences
28
Q

what is the diagnosis of life-threatening asthma?

A
  • PEF <44%
  • O2 < 92%
  • altered conscious level
  • cyanosis
  • exhaustion
  • hypertension
  • silent chest
29
Q

what is panacinar emphysema?

A

alpha 1 antitrypsin

- resp bronchiole to alveoli enlarged

30
Q

what is centriacinar emphysema?

A
  • coal dust and tobacco

- enlargement of resp bronchiole

31
Q

what is the management of COPD?

A
  • set this up as obstruction and symptoms progress and as exacerbations frequently increase
    1. SABA - salbutamol
    2. LABA - formoterol
    3. LABA/LAMA
    4. ICS - beclomethasone/LABA/LAMA

Resp (30 decks)

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