Common Respiratory Conditions Flashcards
Name 5 common respiratory conditions
- Cystic fibrosis (bronchiectasis)
- Pulmonary embolism
- COPD
- Asthma
- Pulmonary fibrosis
Describe the basic anatomy of the lungs
RHS - Superior, middle and inferior lobes with inferior being posterior
LHS - Superior with cardiac notch and inferior lobes with inferior being posterior
Describe oxygen and carbon dioxide levels of Type 1 respiratory failure
- pO₂ < 8kPa
- pCO₂ < 6kPa
Describe oxygen and carbon dioxide levels of Type 2 respiratory failure
- pO₂ < 8kPa
- pCO₂ > 6kPa
Describe the difference between treatment between Type 1 and Type 2 respiratory failure
- Type 1 treated with high flow oxygen to get oxygen levels up to satisfactory levels
- Type 2 treated with very controlled oxygen intake to get rid of hypoxia but not too much to cause more carbon dioxide to be retained
Name 4 respiratory conditions which can lead to Type 1 respiratory failure
- Acute asthma
- Pneumonia
- Pulmonary embolism
- Pulmonary oedema
Name 3 respiratory conditions which can lead to Type 2 respiratory failure
- Neuromuscular disorders
- COPD
- Chest wall deformities
Describe bronchiectasis
- Abnormal and permanent dilatation of the bronchi associated with chronic infection
- Congenital or acquired
- Cough and excess sputum production
Describe treatment of bronchiectasis
Sputum clearance techniques several times per day
What is thromboembolism?
Formation in a blood vessel of a clot that breaks loose and is carried by the blood stream to plug another vessel
Name 5 risk factors of pulmonary embolism
- Surgery / Obstetrics
- Lower limb problems
- Malignancy
- Reduced mobility - Fractures etc
- Thrombotic disorders
Name 3 thrombotic disorders which can lead to pulmonary embolism
- Factor V leiden
- Protein C and S deficiency
- Antithrombin III deficiency
Describe 5 treatment options for pulmonary embolism
- Thrombolysis
- Heparin
- Warfarin
- DOACs - Rivaroxaban, apixaban
- Embolectomy
What is the theory behind thrombolysis and heparin as treatments for pulmonary embolism?
Dissolving the clot
What is COPD?
Chronic obstructive pulmonary disease
What is the main symptom of COPD>
Breathlessness
Describe 3 components of the air flow obstruction in COPD
- Usually progressive
- Not fully reversible
- Does not change markedly over a few months
Define COPD with regards to FEV1 and FEV1 / FVC values
- FEV1 < 80%
- FEV1 / FVC < 0.7
Describe 4 features which may be seen on a chest x-ray from a patient suffering from COPD
- Lots of air in the chest
- Ribs almost horizontal
- Diaphragm flattened
- No focal lesions
What is FVC?
Forced vital capacity
What is FEV?
Forced expiratory volume
Describe 3 stages of severity of COPD with regards to FEV %
Mild - 50 to 80%
Moderate - 30 to 49%
Severe - Under 30%
What is the function of pharmacotherapy for COPD?
None of the medications modify long-term decline in lung function so aim is to decrease symptoms and / or complications
Describe 5 non-pharmacological therapies of COPD
- Smoking cessation (by far most important)
- Exercise
- Diet - Weight reduction
- Flu and pneumococcal vaccination (limited evidence)
- Pulmonary rehabilitation
Name 5 types of drug therapies used for COPD
- Bronchodilators
- Inhaled steroids
- Theophyllines
- Oral steroids
- Oxygen
Name 3 short acting bronchodilators
- Salbutamol
- Terbutaline
- Ipratropium bromide
Describe how salbutamol and terbutaline relieve symptoms of COPD
Increases airway diameter by action on smooth muscle
Describe how ipratropium bromide relieves symptoms of COPD
Block neural bronchoconstriction by anticholinergic effects
Name a long acting bronchodilators
Tiotropium bromide
Name 2 commonly used combined preparations of inhaled steroids for COPD
- Seretide (Fluticasone / Salmeterol)
2. Symbicort (Budesonide / Formoterol)
What is the indication for use of inhaled oral steroids?
Use in those with FEV1 < 60% and at least 2 exacerbations in the past year
What is a common side effects of inhaled steroids relevant to dentistry?
Oral candida
Describe theophyllines as a treatment for COPD
- Oral bronchodilators e.g uniphyllin
- Lots of interactions with other medications
- Difficult to tolerate
- Worth a trial with COPD patients
Name 4 components of pulmonary rehabilitation
- Physical exercise
- Dietetics assessment
- Disease education
- Physiological and social interventions
Describe steroid recommendations for COPD
- Oral steroids should be prescribed for all patients with exacerbations (unless major contra indications)
- 30mg / day for 7 to 14 days
- Do not discontinue inhaled steroids
What is asthma?
A chronic inflammatory disorder of the lungs characterised by variability in symptoms and lung function
Name 4 symptoms of asthma diagnosis
- Wheeze
- Cough
- Shortness of breath
- Chest tightness
Name 2 objective measures of asthma
- > 20% diurnal variation on at least 3 days in one week on PEFR chart
- > 15% increase in FEV after short acting bronchodilator or 30mg / day prednisolone for 2 weeks
Name 3 general treatments for asthma
- Allergen avoidance
- Environmental (smoking and air pollution)
- Alternative medicine (no evidence)
Name 3 ways severe asthma can be diagnosed
- Severe dyspnoea - Unable to complete sentences
- Tachypnoeic > 25 mins
- Tachycardic > 110 min
Describe treatment of severe asthma exacerbation
- Moderate exacerbation treatment
- Call ambulance
- Oxygen > 60% if available
What is pulmonary fibrosis?
Gradual replacement of normal lung parenchyma with fibrotic tissue
Describe why pulmonary fibrosis is termed a restrictive lung disease
Scar tissue cannot carry oxygen to the blood stream which leads to irreversible decrease in oxygen diffusion capacity and the lungs become stiff
Describe the usual FEV1 and FVC ratio of a patient suffering from pulmonary fibrosis
High ratio
Describe 5 components of the assessment of interstitial lung diseases
- History
- Bloods
- Examination
- Pulmonary function
- Radiology
Describe sarcoidosis
- Multisystem disorder with granulomatous inflammation
- Most commonly bilateral hilar lymphadenopathy with no ILD
- Affects upper zones of lungs
- Decreased FVC factors
- Usually steroid responsive
Describe extrinsic allergic alveolitis (EAA)
- Inflammation of the alveoli caused by hypersensitivity to organic dusts
- Occupational / hobby
- Acute symptoms of fever, cough and malaise
- Chronic symptoms of cough, dyspnoea, fatigue, weight loss
- Can use steroids to settle alveolitis
Name 3 connective tissue diseases
- Rheumatoid arthritis
- Scleroderma
- Dermatomyositis
Describe asbestosis
- Typically basal interstitial fibrosis developing 20 years after exposure
- Dose dependent
- Pleural plaques, restrictive lung function and basal crackles
- Increased risk for lung cancer
