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Pulmonology and Thoracic surgery > Asthma, Bronchiectasis, Bronchitis, COPD > Flashcards

Asthma, Bronchiectasis, Bronchitis, COPD Flashcards

1
Q

Asthma

  • definition
  • symptoms
  • risk factors
A

-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

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2
Q

Asthma

  • when to suspect?
  • diagnosis
  • differential diagnosis
A
  • 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

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3
Q

Asthma

-classification

A

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

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4
Q

Asthma

-medications

A

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
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5
Q

Asthma

-medications - stepwise approach

A
  1. SABA as needed
  2. low dose ICS
  3. low (or medium) dose ICS + LABA
  4. medium dose ICS + LABA
  5. high dose ICS + LABA
  6. high dose ICS + LABA + anti-IgE drug
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6
Q

Asthma

-a most common cause of exacerbation

A

Respiratory viruses

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7
Q

Bronchiectasis

  • definition
  • risk factors
A
  • 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

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8
Q

Bronchiectasis

  • pathophysiology
  • symptoms
A
  • 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…
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9
Q

Bronchiectasis

  • diagnostic criteria
  • etiology
A

-clinical symptoms + CT

  • 50% unknown
  • congenital - immunodeficiency, primary ciliary dyskinesia, cystic fibrosis
  • acquired - GERD, airway obstruction
  • post-infection, asthma, fungal allergy
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10
Q

Bronchiectasis

-morphological types (4)

A
  • Cylindrical - most common, dilated bronchi
  • Varicose - dilated bronchi + local stenosis
  • Cystic - most severe
  • Traction bronchiectasis - commonly asymptomatic, secondary to other lung pathologies
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11
Q

Bronchiectasis

  • CT changes
  • other diagnostics methods
A
  • 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

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12
Q

Bronchiectasis

-differential diagnosis (5)

A
  • GERD + chronic aspiration
  • cystic fibrosis
  • immunodeficiency
  • primary ciliary dyskinesia
  • non-tuberculous mycobacteria
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13
Q

Bronchiectasis

-treatment (5)

A
  • smoking cessation
  • breathing exercises, postural drainage
  • antibiotics –> to treat exacerbation (amoxicillin…)
  • inhaled corticosteroid
  • bronchodilators
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14
Q

Bronchiectasis

-indication for surgery (4)

A
  • localized + absence of systemic cause + cystic
  • severe lung destruction
  • persistent tuberculosis or fungi in that area
  • end stage –> lung transplant
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15
Q

Acute bronchitis

  • definition
  • etiology
A

-lower respiratory tract infection characterized by inflammation of the bronchi

  • most commonly viral
  • bacteria, mixed, inhaled irritants infections
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16
Q

Acute bronchitis

-symptoms (4)

A
  • 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
17
Q

Acute bronchitis

-clinical forms (3)

A

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

18
Q

Acute bronchitis

  • diagnosis
  • management
A
  • 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
19
Q

Chronic bronchitis

  • definition
  • etiology (4)
A
  • 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
20
Q

Chronic bronchitis

  • pathophysiology
  • symptoms
A
  • overproduction and hypersecretion of mucus by goblet cells
  • productive cough –> color of sputum depends on the presence of secondary bacterial infection
21
Q

Chronic bronchitis

  • diagnosis
  • management
A
  • 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
22
Q

COPD

  • definition
  • main symptoms (3)
  • risk factors
A
  • 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
23
Q

COPD

  • pathology
  • when to suspect (4)
A
  • 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)

24
Q

COPD

-diagnosis (6)

A
  • 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
25
Q

COPD

-severity and FEV1 values

A

mild: >80%
moderate: 50-79%
severe: <50%

26
Q

COPD

-phenotypes

A
  1. Emphysematic
  2. Asthma/COPD - variable airflow limitation, sputum eosinophils, blood eosinophils, positive bronchodilator test
  3. Frequent exacerbations - >2 exacerbations per year in the last year which were treated with antibiotics and corticosteroids OR >1 per year, which requires hospitalization
  4. Infrequent exacerbations
27
Q

COPD

-treatment

A

-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

28
Q

ASTHMA (5) VS. COPD (5)

A

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
29
Q

Systemic effects of COPD (6)

A

-skeletal muscle dysfunction, osteoporosis, osteopenia, pulmonary hypertension, increased risk of cardiovascular diseases, depression

Pulmonology and Thoracic surgery (8 decks)

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