Asthma, Bronchiectasis, Bronchitis, COPD Flashcards
Asthma
- definition
- symptoms
- risk factors
-chronic inflammation of the airways and increased bronchial reactivity
- wheezing, breathlessness, chest tightness, cough
- REVERSIBLE airway obstruction
-worsen or cause exacerbation –> smoking, pollution, allergy, GERD, obesity, hormonal changes
Asthma
- when to suspect?
- diagnosis
- differential diagnosis
- episodic wheezing and/or shortness of breath
- increased bronchial reactivity
- spirometry - FEV1/FVC < lower limit
- positive bronchodilator test: increase in FEV1 >12% –> if positive –> then don’t need to do bronchoprovocation
- PEF variability >20%
- Positive bronchoprovocation test: decrease in FEV1 >20% of the normal value after methacholine
-COPD, acute bronchitis, exacerbation of chronic bronchitis
Asthma
-classification
mild: controlled on low dose ICS
moderate: controlled on low dose ICS (or medium dose) and LABA
severe: high dose ICS + second controller is necessary (sometimes doesn’t even work)
PEF >80%, FEV1 variability <20% = controlled
PEF <60%, FEV1 variability >30% = uncontrolled
Asthma
-medications
Long term treatment: inhaled glucocorticosteroids + reliever (LABA or SABA)
-if severe: leukotriene inhibitors, anti-IgE, theophylline
Exacerbation: systemic glucocorticosteroids + inhaled short-acting beta-agonists
- Salbutamol + Prednisolone 20-40mg 2-4 weeks + increased dose of ICS for at least 3m.
- if demand does not decrease –> hospitalization
Asthma
-medications - stepwise approach
- SABA as needed
- low dose ICS
- low (or medium) dose ICS + LABA
- medium dose ICS + LABA
- high dose ICS + LABA
- high dose ICS + LABA + anti-IgE drug
Asthma
-a most common cause of exacerbation
Respiratory viruses
Bronchiectasis
- definition
- risk factors
- chronic purulent inflammation of the bronchi –> wall destruction, irreversible airways dilation, chronic inflammation secretion, and bacteria accumulation
- permanent dilation of the airways
-bronchial ciliary disorder, cystic fibrosis, immunodeficiency, non-tuberculous mycobacteria, traction bronchiectasis due to lung fibrosis
Bronchiectasis
- pathophysiology
- symptoms
- chronic inflammation and impaired mucociliary clearance
- a vicious cycle of recurrent infections with subsequent damage
- chronic cough, sputum, recurrent chest infections
- dyspnea, hemoptysis, chest pain
- persistent local opacities (consolidation), wheezing, rhonchi, crackles
- exacerbation: different sputum color and amount, fever, increase CRP…
Bronchiectasis
- diagnostic criteria
- etiology
-clinical symptoms + CT
- 50% unknown
- congenital - immunodeficiency, primary ciliary dyskinesia, cystic fibrosis
- acquired - GERD, airway obstruction
- post-infection, asthma, fungal allergy
Bronchiectasis
-morphological types (4)
- Cylindrical - most common, dilated bronchi
- Varicose - dilated bronchi + local stenosis
- Cystic - most severe
- Traction bronchiectasis - commonly asymptomatic, secondary to other lung pathologies
Bronchiectasis
- CT changes
- other diagnostics methods
- bronchodilation >1.5 times the norm + signet ring sign (bolinhas)
- tram track sign, tree in bud sign, finger in glover sign
- stenosis of dilated bronchi
- consolidation
- honeycombing - late stages
-lung function tests: FEV1 decrease, airflow obstruction, mixed obstructive/restrictive or restrictive
Bronchiectasis
-differential diagnosis (5)
- GERD + chronic aspiration
- cystic fibrosis
- immunodeficiency
- primary ciliary dyskinesia
- non-tuberculous mycobacteria
Bronchiectasis
-treatment (5)
- smoking cessation
- breathing exercises, postural drainage
- antibiotics –> to treat exacerbation (amoxicillin…)
- inhaled corticosteroid
- bronchodilators
Bronchiectasis
-indication for surgery (4)
- localized + absence of systemic cause + cystic
- severe lung destruction
- persistent tuberculosis or fungi in that area
- end stage –> lung transplant
Acute bronchitis
- definition
- etiology
-lower respiratory tract infection characterized by inflammation of the bronchi
- most commonly viral
- bacteria, mixed, inhaled irritants infections
Acute bronchitis
-symptoms (4)
- cough, sputum (with or without - white, yellow…), substernal chest pain when coughing, wheezing, dyspnea (not that common)
- important to ask if it is before or after the meal
- important to rule out pneumonia
- if it happens too often –> consider COPD, bronchiectasis, immunodeficiency
Acute bronchitis
-clinical forms (3)
I. cough
II. purulent sputum
III. wheezing obstruction
-cough can start 3-4 after the flu and can last for up to 4 weeks or more
Acute bronchitis
- diagnosis
- management
- usually not necessary if there are no complications. Chest x-ray only to rule out pneumonia
- Indication for imaging: fever, increase HR and RR, dyspnea, bloody sputum, focal consolidation
- symptomatic: antitussives, expectorants
- antibiotics (role is limited)
- bronchodilators and inhaled corticosteroids
Chronic bronchitis
- definition
- etiology (4)
- productive cough lasting at least 3 months, with recurrence for at least 2 consecutive years
- frequent respiratory infections, chronic gastroesophageal reflux, inhaled irritants, exposure to cigarette smoke
Chronic bronchitis
- pathophysiology
- symptoms
- overproduction and hypersecretion of mucus by goblet cells
- productive cough –> color of sputum depends on the presence of secondary bacterial infection
Chronic bronchitis
- diagnosis
- management
- auscultation, RR, O2 saturation
- x-ray, spirometry (once a year)
- CT if bronchiectasis risk
- if no remission –> no treatment required
- physiotherapy –> if mucus secretion is increased
- during exacerbation –> warm liquids, broncholytics, antibiotics
COPD
- definition
- main symptoms (3)
- risk factors
- chronic respiratory symptoms + persistent bronchial obstruction due to airways and/or lung damage
- 3rd most common cause of death in the world
- IRREVERSIBLE bronchial obstruction
- cough, sputum, shortness of breath
- smoking, genetics, pollution, frequent childhood infections, poor-socioeconomic conditions
COPD
- pathology
- when to suspect (4)
- easier for air to move in than out
- emphysema, bronchiolar wall thickening, mucus in the lumen, collapse bronchioles
-the presence of risk factors, patient’s age (>45), radiological signs of emphysema, symptoms (chronic cough and sputum production, barrel chest, shortness of breath)
COPD
-diagnosis (6)
- 1st spirometry and chest x-ray
- bronchodilator test - FEV1/FVC <0.7
- bronchoscopy with salbutamol –> spirometry 10min later –> no reversibility
- lung diffusion test - decrease
- serum a1- antitrypsin
- CT - bronchiectasis + emphysema
COPD
-severity and FEV1 values
mild: >80%
moderate: 50-79%
severe: <50%
COPD
-phenotypes
- Emphysematic
- Asthma/COPD - variable airflow limitation, sputum eosinophils, blood eosinophils, positive bronchodilator test
- Frequent exacerbations - >2 exacerbations per year in the last year which were treated with antibiotics and corticosteroids OR >1 per year, which requires hospitalization
- Infrequent exacerbations
COPD
-treatment
-only to improve quality of life –> it cannot stop lung deterioration
- smoking cessation, O2 therapy, physical therapy
- mild: SAMA or/and SABA
- moderate: LABA and/or LAMA, if not effective –> treatment of phenotype
Asthma/COPD type: ICS and LABA
Frequent exacerbation: LAMA + LABA or LABA + ICS
Rare exacerbation and emphysematic: LAMA or LABA
Bronchiectasis: LAMA and LABA
ASTHMA (5) VS. COPD (5)
ASTHMA
- reversible bronchial obstruction
- symptoms are episodic
- sputum eosinophilia
- different age, mostly young patients
- inhaled corticosteroids do show improvement
COPD
- irreversible bronchial obstruction
- symptoms are persistent/ chronic
- systemic symptoms
- usually mid-age and older patients
- inhaled corticosteroids do not show improvement
Systemic effects of COPD (6)
-skeletal muscle dysfunction, osteoporosis, osteopenia, pulmonary hypertension, increased risk of cardiovascular diseases, depression
