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Asthma and COPD Flashcards

1
Q

what is asthma?

A

recurrent and reversible (in short term) obstruction to the airways due to an abnormal response to a stimulus

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2
Q

epidaemiology of asthma?

A

5-10% of population in industrialised countries
common in children
can be genetically predisposed (atopic)

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3
Q

what is the asthma triad?

A

reversible airflow obstruction

airway hyperresponsiveness airway hyperinflammation.

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4
Q

what changes does lung remodelling in chronic asthma cause?

A 
Increased mucous production
Thickening of smooth muscle
Accumulation of interstitial fluid
Epithelial damage resulting in exposed nerve endings
Sub-epi fibrosis
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5
Q

what is the prognosis for untreated asthma?

A

Bronchoconstriction
Chronic airway inflammation
Airway remodelling
Inflammatory cascade

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6
Q

why does lung remodelling occur in chronic asthma?

A

chronic inflammation

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7
Q

how does an asthmatic present?

A 
wheeze on expiration
struggling to breathe
tight chest
cough
dinural variability
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8
Q

which tests can be used in the diagnosis of asthma?

A

Spirometry
Challenge tests
Peak flow
Exercise testing

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9
Q

spirometry result of an asthmatic?

A

FEV1/FVC ratio reduced

FEV1 severly reduced

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10
Q

triggers for asthmatics?

A 
dust, pet dander, hair, smoke 
cold
exercise
viral URI
BB
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11
Q

describe the immune response in asthma attack

A
  1. Antigen
  2. Dendritic cell phagocystoses antigen and presents MHC-II receptors
  3. CD4 from Th2 cell interacts with MHC-II and antigen binds to TCR causing Th2 cell to release IL-4 and IL-5
  4. IL-4 acts on plasma cells to secrete IgE antibodies which trigger mast cells to degranulate (releasing inflammatory mediators)
  5. IL-5 acts on eosinophils to activate it to release leukotrienes + cytokines (to recruit) + proteases
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12
Q

what does the histamine and leukotrienes produced in the inflammatory response in asthma cause?

A

NARROWING OF AIRWAY BY:

  • bronchoconstriction
  • mucous hypersecretion + build up
  • inflamed mucosa
  • increased vascular permeability (bring more immune cells)
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13
Q

which pulmonary function tests do you use to diagnose an asthmatic when symptomatic vs asymptomatic?

A

symptomatic: spirometry + bronchodilator to relieve
asymptomatic: challenge tests

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14
Q

describe what you do to diagnose asthma in spirometry and what the results are.

A

measure FVC and FEV1 and calculate ratio (FEV1 reduced, ratio <80%)
then give bronchodilator and repeat (if FEV1 significantly improved then likely asthma - as shows reversible)

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15
Q

Describe what you would do in a challenge test for asthma.

A

Test FVC and FEV1
Give a bronchoconstrictor (eg: methacholine)
repeat tests and if worsens a lot then asthma

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16
Q

Treatment progression for asthma

A

Avoid triggers

  1. SABA
    • ICS (low dose)
    • LABA
  4. (med dose) ICS OR + LTRA
  5. (high dose) ICS OR + LTRA (if not already added) OR + tiotropium (LAMA) OR + theophylline (methylxanthine)
    • monoclonal antibody therapy (rare)
17
Q

acute asthma attack treatment?

A
  • high flow O2 (60%)
  • oral prednisolone (CS)
  • nebulised high dose salbutamol (SABA) +/- ipratropium (SAMA)
  • +/- IV aminophylline (methylxanthine)
18
Q

what is COPD?

A

chronic obstructive pulmonary disorder causing airflow restriction on expiration which worsens over time

19
Q

what is chronic bronchitis?

A

chronic inflammation of bronchi and bronchioles

20
Q

what is emphysema?

A

loss of elastic recoil due to damage of alveolar sacs (causes hyperinflation)

21
Q

what causes COPD?

A

smoking

air pollution

22
Q

how do COPD patients present?

A

progressively worsening SOB
productive cough
maybe wheeze
recurrent infections

23
Q

which investigations are used to diagnose COPD and why/results?

A 
ABG (detect type 2 resp failure)
CXR (see hyperinflation)
CT scan
Spirometry (FEV1/FVC ratio <70% and FEV1 reduced)
MRC scale (assess dyspnoea)
CAT (assess COPD severity as whole)
24
Q

Treatment progression of COPD

A
  • Smoking cessation
  • Flu vaccine
  • Pulmonary rehab
  • SABA/SAMA (occasional symptoms)
  • LABA/LAMA (1st line)
  • +ICS
    • PDE4 inhibitor
    • macrolides
    • O2 therapy
  • surgery (lung vol reduction - reduce hyperinflation)
  • transplant
25
Q

why would lung reduction surgery be used in severe COPD?

A

to reduce hyperinflation

26
Q

prognosis of COPD?

A

palliative - alleviate symptoms

27
Q

you should not give __ on its own ONLY in combo with LABA

A

LAMA (never on its own)

28
Q

why shouldn’t you give ICS as monotherapy in COPD?

A

monotherapy is associated with pneumonia, muscle weakness and resp failure

29
Q

acute treatment of COPD

A

O2 24-28%
nebulised high dose salbutamol + ipratropium
oral prednisolone
antibiotics if infection (amoxycillin/doxycycline)

Respiratory (8 decks)

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