Clinical Med Part 1 (Miller) Flashcards
What is asthma?
- A heterogeneous disease characterized by chronic airway inflammation and variable remodelling
Who does asthma affect more of?
- Boys more than girls in childhood
- Women more than men post puberty
What are some prenatal risk factors or triggers for asthma?
- Ethnicity
- Low SES
- Stress
- C-section
- Maternal tobacco smoking
- Prematurity causes four fold increase in risk
What are some postnatal risk factors for asthma?
- Levels of endotoxins and allergens within the home
- Viral and bacterial infections
- Air pollution
- Antibiotic use
- Acetaminophen exposure
- Obesity
What causes the airway inflammation in asthma?
- Type 2 hypersensitivity
- Sensitized by allergens like dust mites, pet dander, pollen, fungi
- Accompanying inflammatory infiltrate (eosinophils and mast cells)
- Defective resolution of process
What causes the airway remodeling in asthma?
- Increased airway smooth muscle
- Thickened subepithelial reticular lamina
- Increased mucous cells in new areas
- Increased mucous production
What is the clinical presentation of asthma?
- Cough, recurrent wheezing, chest tightness and SOB
What is asthma typically worse?
- At night, with exercise, viral infection, exposure to allergens, changes in weather, laughing or crying
How is asthma diagnosed?
- Combination of appropriate clinical symptoms in association with documented reversible airflow limitation and/or airway hyperresponsiveness
Does a normal spirometry exclude the diagnosis of asthma?
- No
What is the main goal for treatment of asthma?
- Provide the best quality of life through minimizing disease symptoms and abolishing disease exacerbations
What are some complications of asthma?
- Poor quality of life
- Pneumonia
- Pneumothorax
- Asthma exacerbation
- Respiratory failure
- Airway remodeling
What can cause an asthma exacerbation?
- Benign viral infections or allergens
What can be used to treat and asthma exacerbation
- Bronchodilators, systemic glucocorticoids, O2
What are some prevention methods that for asthma?
- Breastfeeding
- Avoidance of active and passive tobacco smoke exposure
- Interventions that target obesity
- Balanced diet comprising of adequate micronutrients
- Allergen avoidance
- Vaccinations
What is COPD?
- Persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airway and lungs
Who has a higher mortality with COPD?
- Men
- Older people
- People in poverty
What are some COPD risk factors?
- Smoking/exposure to tobacco smoke
- History of tuberculosis
- Outdoor air pollution??
What are the main pathological features of COPD?
- Obstructive bronchitis
- Emphysema
- Mucus hypersecretion
What are some other pathological features of COPD?
- Chronic inflammation
- Accelerated aging of lung parenchyma
- Oxidative stress
What does the oxidative stress in COPD lead to?
- Telomere shortening
- Cellular senescence
- DNA damage
- Mitochondrial dysfunction
- Decreased autophagy
- Stem cell exhaustion
- Decreased anti ageing molecules
What is the pathology of acute exacerbations in COPD?
- Episodes of symptom worsening that are usually associated with increased airway inflammation and systemic inflammatory effects
What are the symptoms of an acute exacerbation in COPD?
- Increased dyspnea
- Increased sputum purulence
- Increased cough
- Increased wheezing
- Beyond normal day-to-day variation
What does the clinical presentation look like for COPD?
- Decreased capacity to exercise with parallel decrease in activity
- Low muscle strength
- Low BMI
- Other comorbidities
