Asthma & COPD Flashcards
what are the respiratory symptoms
cough wheeze stridor dyspnea pain
what are factors to consider with a cough
whether it is productive or dry
what color is the sputum
is there blood
what is a wheeze
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
what is stridor
this is a noise you make when you breathe in. It is due to a blockage in the airway
what is dyspnea
shortness of breath
what are the diff types of pain
can be general or inspiratory
possible due to inflammatory changes in the chest wall
what are respiratory signs
chest movements with respiration rate of respiration air entry vocal resonance percussion note
Why does respiratory rate increase in asthma
There is an increase in respiratory rate in asthma due to bad ventilation
how can air entry be assessed
look to see if reduced or symmetrical
what is assessed in vocal resonance
is there solid/liquid inside the lungs?
what is percussion note
tap to see the noise. If it is a resonant noise then it is hollow. If it is a dull noise it isnt hollow.
what are respiratory investigations
sputum examination chest radiograph pulmonary function bronchoscopy VQ scan - ventilation/perfusion mismatch
how is pulmonary function tested
PEFR - max flow rate
FEV1 - forced expiratory volume in one second
FEV1/VC - measure of respiratory function
what is ventilation/perfusion mismatch
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
what is the normal respiratory rate
12-15
what are respiratory diseases
infections
airflow obstruction
gas exchange failure
tumors
what are examples of respiratory infections
pneumonia
what are examples of airflow obstructive diseases
asthma
chronic obstructive pulmonary disease
restrictive pulmonary change
what can gas exchange failure be due to
reduced surface area, fibrosis, fluid
what are common triggers for exacerbations for chronic airflow obstruction
infections
exercise
cold air
what is asthma
reversible airflow obstruction
what us asthma due to
bronchial hypersensitivtiy
what is bronchial hypersensitivity
it is the immune system’s overreaction to minor stimulation. Something happens and triggers a disproportionate immune response
describe the immune response in asthma
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
what are the 3 things that contribute to an asthma attack
Muscle constriction, mucosal secretion & oedema are what mainly contribute to the asthma attack.
what produces a wheeze in asthma
narrowing of the airway causing airflow differences.
what is the function of the cough in asthma
try and bring up the mucous
what does asthma experience
diurnal variation - worse int early morning
what is the peak expiratory flow rate
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
what are asthma atriggers
infection
environmental stimuli
cold air
atopy
what are environmental stimuli that can cause asthma
o Dust
o Smoke
o Chemicals at work
how does cold air effect asthma
more of an issue for children, causes a wheeze due to the change in temperature of gas
what is atopy
atopy’ – people with asthma often have other conditions related to the immune system. Atopy refers to the genetic tendency to develop allergic diseases
why is a skin prick test done for asthmatics
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
what type of immune response does asthma show
biphasic
describe the biphasic pattern of asthma
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.
what is required for asthma
You need the initial treatment, beta2 agonists but if you do not use steroids then you will not tackle the second phase
describe the immunology for asthma
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
describe asthma treatment
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.
what is treatment for mild asthma
usually a blue puffer and a brown inhaled steroid to be used every day
what is Tx for severe asthma
More severe may take a high dose inhaled steroid, long acting beta agonists and oral steroids
who is classed as a severe asthmatic
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
what are the respiratory drugs
beta-adrenergic agonists anticholinergic corticosteroids leukotriene inhibitors chromones theophyllines
what to beta adrenergic agonists do
o Relax bronchial smooth muscle
Reduce bronchoconstriction
Reduce bronchial tone
what are the different types of beta adrenergic agonists
short and long acting
protective against stimuli
what do anticholinergic drugs to
act on muscarinic receptors
reduce basal tone only
good in COPD
what are corticosteroids
o Has immune cell and epithelial cell action
o They help prevent mucosal oedema/mucosal secretion/bronchial constriction
when should you use a corticosteroid
o Use if beta2 agonist is used more than 3 times a week
how should steroid be given in a severe attack
injection
what is the problem if the corticosteroids are taken everyday
possible adrenal serpression/osteoporosis
when is a spacer recommended for corticosteroids
if dose exceeds 800 ug in adults
what are theophyllines
good for helping ventilation
used in severe asthma due to potential adverse effects
what are the different layers to the pyramid of asthma risk assessment
red others LA B2 agonist LD inhaled steroid SA B2 agonist
what is COPD
MIXED airway reversible obstruction and destructive lung disease
what happens in COPD
Airways are inflamed causing them to narrow
Abnormal alveoli means that there is a reduction of surface area for gas exchange and lung function
what is emphysema
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.
what are the classifications of COPD
gold 1 or 2 (mild/moderate) gold 3 (severe) gold 4 (very severe)
what will a gold 4 COPD patient experience
wheeze and cough
breathless on mild exertion
over inflated lungs
cyanosis
how can COPD progress to respiratory failure
from:
reduced surface area for gas exchange
thickening of alveolar mucosal barrier
what can poor ventilation occur due to
airway narrowing
restrictive lung defects
what are the causes of COPD
smoking
environmental lung damage
hereditary
what is environmental lung damage
these are occupational lung diseases (coal, silica, beryllium, asbestos). Also causes the fibrosis of the lungs not just the tumour
what in COPD is hereditary
emphysema
some lack the enzymes required to maintain the integrity of the alveoli
what are the two types of occupational lung disease
fibrosis
tumors
how does fibrosis from occupation lung disease occur
from coal, silicon, beryllium, asbestos
what can asbestos also lead to other than fibrosis
mesothelioma
tumor of the pleural lining
describe management of COPD
smoking cessation long acting bronchodilator inhaled steroids systemic steroids oxygen support pulmonary rehabiliation therapy
what is type 1 respiratory failure
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
what is type 2 respiratory failure
hypercapnia
happens in ventilation
what can type 2 respiratory failure be due to
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
what is failure of ventilation defined as
When PaCO2 > 6.7kPa
It occurs only in acute respiratory failure (type 2)
There is a 20% reduction in ventilation needed.
What happens due to chronic ventilation failure
renal compensation for acidosis
what are contributions to chronic ventilation failure
- Reduced compliance
- Airway obstruction
- Muscle dysfunction
what is normal breathing control
In normal breathing CO2 drive controls ventilation.
Oxygen saturation is usually okay
what is breathing control in COPD
In COPD there is a CO2 tolerance and hypoxia drives ventilation.
why can giving oxygen in patients with COPD be detrimental
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
when is oxygen used in COPD
in the acute stages use oxygen until medical help arises
what should you watch in those that use oxygen in COPD
their respiratory rate and SaO2
how should oxygen be used in the chronic state of COPD
with care
fixed percentage delivery
what are the two ways home oxygen therapy can occur
via cylinder
via oxygen concentrator
why should oxygen support be used 24/7
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
what is COPD relations to dentistry
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
