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BDS2 BAMS Respiratory Tract > Asthma & COPD > Flashcards

Asthma & COPD Flashcards

1
Q

what are the respiratory symptoms

A 
cough
wheeze
stridor
dyspnea 
pain
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2
Q

what are factors to consider with a cough

A

whether it is productive or dry
what color is the sputum
is there blood

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3
Q

what is a wheeze

A

a wheeze is a noise you make when you breathe out. It is an organ sounding noise and means there is a problem with the airway whether it be tightened, blocked or inflamed

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4
Q

what is stridor

A

this is a noise you make when you breathe in. It is due to a blockage in the airway

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5
Q

what is dyspnea

A

shortness of breath

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6
Q

what are the diff types of pain

A

can be general or inspiratory

possible due to inflammatory changes in the chest wall

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7
Q

what are respiratory signs

A 
chest movements with respiration 
rate of respiration 
air entry
vocal resonance
percussion note
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8
Q

Why does respiratory rate increase in asthma

A

There is an increase in respiratory rate in asthma due to bad ventilation

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9
Q

how can air entry be assessed

A

look to see if reduced or symmetrical

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10
Q

what is assessed in vocal resonance

A

is there solid/liquid inside the lungs?

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11
Q

what is percussion note

A

tap to see the noise. If it is a resonant noise then it is hollow. If it is a dull noise it isnt hollow.

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12
Q

what are respiratory investigations

A 
sputum examination 
chest radiograph 
pulmonary function 
bronchoscopy 
VQ scan - ventilation/perfusion mismatch
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13
Q

how is pulmonary function tested

A

PEFR - max flow rate
FEV1 - forced expiratory volume in one second
FEV1/VC - measure of respiratory function

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14
Q

what is ventilation/perfusion mismatch

A

o Condition in which one or more areas of the lung receive oxygen but no blood flow or they receive blood flow but no oxygen due to some diseases and disorders

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15
Q

what is the normal respiratory rate

A

12-15

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16
Q

what are respiratory diseases

A

infections
airflow obstruction
gas exchange failure
tumors

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17
Q

what are examples of respiratory infections

A

pneumonia

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18
Q

what are examples of airflow obstructive diseases

A

asthma
chronic obstructive pulmonary disease
restrictive pulmonary change

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19
Q

what can gas exchange failure be due to

A

reduced surface area, fibrosis, fluid

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20
Q

what are common triggers for exacerbations for chronic airflow obstruction

A

infections
exercise
cold air

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21
Q

what is asthma

A

reversible airflow obstruction

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22
Q

what us asthma due to

A

bronchial hypersensitivtiy

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23
Q

what is bronchial hypersensitivity

A

it is the immune system’s overreaction to minor stimulation. Something happens and triggers a disproportionate immune response

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24
Q

describe the immune response in asthma

A

The mast cells degranulate triggering the immune response causing constriction, inflammation of the airway lining and oedema of the inside of the tube making the diameter smaller. The mucous glands also go into hypersecretion adding to this narrowing

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25
Q

what are the 3 things that contribute to an asthma attack

A

Muscle constriction, mucosal secretion & oedema are what mainly contribute to the asthma attack.

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26
Q

what produces a wheeze in asthma

A

narrowing of the airway causing airflow differences.

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27
Q

what is the function of the cough in asthma

A

try and bring up the mucous

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28
Q

what does asthma experience

A

diurnal variation - worse int early morning

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29
Q

what is the peak expiratory flow rate

A

This is how fast you can get air out of your lungs
can change as the airway narrows
the more narrow the airway the slower the PEFR

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30
Q

what are asthma atriggers

A

infection
environmental stimuli
cold air
atopy

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31
Q

what are environmental stimuli that can cause asthma

A

o Dust
o Smoke
o Chemicals at work

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32
Q

how does cold air effect asthma

A

more of an issue for children, causes a wheeze due to the change in temperature of gas

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33
Q

what is atopy

A

atopy’ – people with asthma often have other conditions related to the immune system. Atopy refers to the genetic tendency to develop allergic diseases

34
Q

why is a skin prick test done for asthmatics

A

Can do a skin prick test to see whether skin reacts but it is not that efficient as it is testing the sensitivity of the skin not the lungs but it does help narrow the range of possible triggers

35
Q

what type of immune response does asthma show

A

biphasic

36
Q

describe the biphasic pattern of asthma

A

hours later it can get worse again.
Normal pattern of asthma is that there is an initial problem and then a late problem because some mediators that are released work slowly while some work quickly. This is important as if someone has an asthma attack if they are treated and appear to have recovered it is important to do something else as otherwise the later response will kick in and it will get worse again.

37
Q

what is required for asthma

A

You need the initial treatment, beta2 agonists but if you do not use steroids then you will not tackle the second phase

38
Q

describe the immunology for asthma

A

Mast cell degranulates and there is an upregulation of the immune response
It is an issue with asthma as this response is occurring to something innocuous

39
Q

describe asthma treatment

A

Asthma is treated in a strategic way by working out whether they have mild/moderate/severe asthma
How they are treated in an emergency differs depending on the severity.

40
Q

what is treatment for mild asthma

A

usually a blue puffer and a brown inhaled steroid to be used every day

41
Q

what is Tx for severe asthma

A

More severe may take a high dose inhaled steroid, long acting beta agonists and oral steroids

42
Q

who is classed as a severe asthmatic

A

If the patient has ever been admitted to hospital or taken steroid tablets more than once a year then they are classed as a severe asthmatic

43
Q

what are the respiratory drugs

A 
beta-adrenergic agonists 
anticholinergic
corticosteroids
leukotriene inhibitors
chromones 
theophyllines
44
Q

what to beta adrenergic agonists do

A

o Relax bronchial smooth muscle
 Reduce bronchoconstriction
 Reduce bronchial tone

45
Q

what are the different types of beta adrenergic agonists

A

short and long acting

protective against stimuli

46
Q

what do anticholinergic drugs to

A

act on muscarinic receptors
reduce basal tone only
good in COPD

47
Q

what are corticosteroids

A

o Has immune cell and epithelial cell action

o They help prevent mucosal oedema/mucosal secretion/bronchial constriction

48
Q

when should you use a corticosteroid

A

o Use if beta2 agonist is used more than 3 times a week

49
Q

how should steroid be given in a severe attack

A

injection

50
Q

what is the problem if the corticosteroids are taken everyday

A

possible adrenal serpression/osteoporosis

51
Q

when is a spacer recommended for corticosteroids

A

if dose exceeds 800 ug in adults

52
Q

what are theophyllines

A

good for helping ventilation

used in severe asthma due to potential adverse effects

53
Q

what are the different layers to the pyramid of asthma risk assessment

A 
red 
others
LA B2 agonist 
LD inhaled steroid
SA B2 agonist
54
Q

what is COPD

A

MIXED airway reversible obstruction and destructive lung disease

55
Q

what happens in COPD

A

Airways are inflamed causing them to narrow

Abnormal alveoli means that there is a reduction of surface area for gas exchange and lung function

56
Q

what is emphysema

A

Emphysema is the destruction of alveoli and the dilation of others to fill the space
The remaining alveoli are still lined by gas exchange tissue but the surface area is reduced.

57
Q

what are the classifications of COPD

A 
gold 1 or 2 (mild/moderate) 
gold 3 (severe)
gold 4 (very severe)
58
Q

what will a gold 4 COPD patient experience

A

wheeze and cough
breathless on mild exertion
over inflated lungs
cyanosis

59
Q

how can COPD progress to respiratory failure

A

from:
reduced surface area for gas exchange
thickening of alveolar mucosal barrier

60
Q

what can poor ventilation occur due to

A

airway narrowing

restrictive lung defects

61
Q

what are the causes of COPD

A

smoking
environmental lung damage
hereditary

62
Q

what is environmental lung damage

A

these are occupational lung diseases (coal, silica, beryllium, asbestos). Also causes the fibrosis of the lungs not just the tumour

63
Q

what in COPD is hereditary

A

emphysema

some lack the enzymes required to maintain the integrity of the alveoli

64
Q

what are the two types of occupational lung disease

A

fibrosis

tumors

65
Q

how does fibrosis from occupation lung disease occur

A

from coal, silicon, beryllium, asbestos

66
Q

what can asbestos also lead to other than fibrosis

A

mesothelioma

tumor of the pleural lining

67
Q

describe management of COPD

A 
smoking cessation
long acting bronchodilator
inhaled steroids
systemic steroids
oxygen support
pulmonary rehabiliation therapy
68
Q

what is type 1 respiratory failure

A

alveolar related

oxygen in the gas moves from the gas into the blood - the thicker the barrier the harder it is for it to get through

69
Q

what is type 2 respiratory failure

A

hypercapnia

happens in ventilation

70
Q

what can type 2 respiratory failure be due to

A

o Airway blockage or narrowing – maybe from a chest infection or oedema of mucosa lining
o Ventilation problems – muscles. Chronic COPD is usually bearable until an infection presents resulting in the
o Acute or chronic – infections

71
Q

what is failure of ventilation defined as

A

When PaCO2 > 6.7kPa
It occurs only in acute respiratory failure (type 2)
There is a 20% reduction in ventilation needed.

72
Q

What happens due to chronic ventilation failure

A

renal compensation for acidosis

73
Q

what are contributions to chronic ventilation failure

A
  • Reduced compliance
  • Airway obstruction
  • Muscle dysfunction
74
Q

what is normal breathing control

A

In normal breathing CO2 drive controls ventilation.

Oxygen saturation is usually okay

75
Q

what is breathing control in COPD

A

In COPD there is a CO2 tolerance and hypoxia drives ventilation.

76
Q

why can giving oxygen in patients with COPD be detrimental

A

It is important that you consider the fact that oxygen may be detrimental for someone with COPD as hypoxia is the driver for their breathing

77
Q

when is oxygen used in COPD

A

in the acute stages use oxygen until medical help arises

78
Q

what should you watch in those that use oxygen in COPD

A

their respiratory rate and SaO2

79
Q

how should oxygen be used in the chronic state of COPD

A

with care

fixed percentage delivery

80
Q

what are the two ways home oxygen therapy can occur

A

via cylinder

via oxygen concentrator

81
Q

why should oxygen support be used 24/7

A

Oxygen support should be used properly otherwise there will not be significant improvements. An acute cardiac event is more likely if good oxygen levels are not maintained most of the time

82
Q

what is COPD relations to dentistry

A

Their ability to attend for treatment possibly due to their home oxygen
Use of inhaled steroids comes with a candida risk as steroid can land in the mouth causing immunosuppression leading to fungal infections. This can be tackled by rinsing the mouth and using a spacer device.
Smokers are at risk of oral cancer and COPD patients are largely smokers

BDS2 BAMS Respiratory Tract (4 decks)

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