COD respiratory diseases Flashcards

Question

Describe Atopic asthma

Answer 1

``` Allergic Extrinsic (triggered by environment) Most common Begins in childhood Elevated IgE - antibodies produced by the immune system More favourable Family history ```

Answer 2

``` Non-allergic Intrinsic (no recognisable allergen) Non common Late onset Normal IgE -antibodies produced by the immune system More severe ```

Answer 3

``` Airway hyperresponsiveness to a range of stimuli / triggers Airway inflammation and structural remodelling -> obstruction Thickened airway wall Smooth muscle spasm Mucus hypersecretion Goblet cell hyperplasia Immune cells infiltration (inflammation) ```

Answer 4

Affects both large and small airways Triggered by epithelial cells Recruitment & prolonged activation of immune cells Th2, dendritic cells, macrophages Increased smooth muscle cell mass & contractility, increased deposition of extracellular matrix -> structural airway remodelling (thickening, fibrosis)-> obstruction Activated fibroblasts & smooth muscle cells Increased number of Goblet cells -> mucus production -> obstruction

Answer 5

Characteristic pattern of respiratory symptoms Variable airflow limitation Variability in lung function -> peak expiratory flow measurement Bronchial provocation test (e.g. inhaled methacholine/histamine or exercise stress challenge -> measures how the airways respond to triggers, assesses airway hyperresponsiveness) Allergy test (presence of atopy increases probability for asthma)

Answer 6

``` Reliever inhalers = bronchodilator eg salbutamol Dilate the airways Used occasionally During attack for immediate relief of symptoms ``` Preventer inhalers = anti-inflammatory Used regularly eg daily For prevention of symptoms Reduces airway swelling Severe asthma: monoclonal antibodies (e.g. IgE, IL-5, IL-4 receptor)

Answer 7

Different classes & mechanism, but all open (dilate) the airways ▪ Short-acting or long-acting

Answer 8

Affects mostly older people (>50 years), more common in males 5000 people diagnosed every year in the UK 30,000 living with IPF in the UK (2016) Median survival: 2-4 years Disease involving parenchymal remodelling and progressive ‘scarring’ of the lung Difficulty breathing and getting oxygen into bloodstream

Answer 9

Unknown cause

Answer 10

Difficult as symptoms resemble other respiratory diseases & there are many types of interstitial lung diseases (ILDs) Multidisciplinary team of experts diagnose Exclusion of other known causes Spirometry to look for restrictive pattern DLCO measurement (Lung ability to transfer gas from inhaled air into bloodstream (indicates extend of damage))

Answer 11

High-resolution chest CT scan -> Usual Interstitial Pneumonia pattern Subpleural reticulation Honeycombing Collagen accumulation Histology: Fibroblastic foci Lung biopsy (if HRCT not clear)

Answer 12

No cure 2 drugs approved in 2014 (side effects) Pirfenidone Nintedanib Oxygen therapy and pulmonary rehabilitation

Answer 13

Urgent need for sensitive ILD biomarkers -> early & accurate diagnosis (potential for disease reversal) -> identification of rapid progressors Need for better & curative treatments -> identification of disease drivers & novel regulators -> discovery of new drugs without side effects & suitable for severe disease Need for better disease education (patients & doctors) -> earlier diagnosis & better management

Answer 14

Affects people of all ages, but the most dangerous for elderly and vulnerable (associated chronic diseases) 123 million people have been infected worldwide (end of 2020) 2.7 Million deaths so far Caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)

Answer 15

ACE2 & TMPRSS2 expression: nose, oral mucosa, lung (heart, kidney, pancreas, eye, brain, testes) -> potential (but not proof) for infection

Answer 16

Expression of ACE2 and TMPRSS2 in nasal and bronchial airways relative to age and diseases status children: lower expression than adults increased expression in smokers, COPD, asthma and hypertension May explain differences in disease severity & susceptibility

Answer 17

Excessive scarring in the lung | occurring due to aberrant repair

Answer 18

Higher expression of receptors in the nose -> increased infectivity of the virus viral transmissibility dependent on the spatial distribution of receptor accessibility along the respiratory tract Presence of receptors may explain patients symptoms eg > gastrointestinal tract (small intestines): diarrhoea, viral sheading respiratory tract: cough, pneumonia, acute respiratory distress syndrome > brain: neurological symptoms: confusion, agitation, memory loss, psychosis, brain inflammation and swelling, stroke)

Answer 19

children: lower expression than adults increased expression in smokers, COPD, asthma and hypertension

Answer 20

``` SARS coronaviruses are fibrogenic exacerbates pulmonary fibrosis Fibrotic changes observed in patients who recovered from COVID-19 Fibrotic changes visible on CT scans eg micro-honeycombing ```