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Yr 2 - Respiratory System > COPD, Asthma, Lung Cancer > Flashcards

COPD, Asthma, Lung Cancer Flashcards

1
Q

What is COPD?

A

Name for a group of chronic, progressive lung diseases that causes obstructed air flow and cannot be reversed.

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2
Q

What is COPD predominantly caused by?

A

Smoking

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3
Q

Why are many people with COPD undiagnosed?

A

Significant airflow obstruction may occur before the individual is aware of it

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4
Q

What are the symptoms of COPD?

A
  • Breathlessness
  • Persistent chesty cough with phlegm (may be dismissed as smokers cough)
  • Frequent chest infections
  • Wheezing (normally polyphonic)
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5
Q

How can genetics cause COPD?

A

Alpha-1-antitrypsin deficiency

  • Chromosome 14
  • Autosomal recessive
  • Basal emphysema
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6
Q

How does alpha-1 antitrypsin protect your lungs?

A

Is a glycoprotein which is largely produced in the liver. It is a protease inhibitor which balances out the action of neutrophil elastase which increases in response to inflammation, infection and smoking

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7
Q

How does smokers cough and COPD differ?

A

Symptoms improve in smokers cough in 90% if stop smoking, unlike COPD

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8
Q

What is FEV1?

A

Forced expiratory volume in 1 second –> the volume of air that can be expelled from maximum inspiration in the first second

Time dependent and reflects airway quality

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9
Q

What is FCV?

A

Forced vital capacity of the lung –> the volume of air that can be forcibly expelled from the lung from the maximum inspiration to the maximum expiration

Volume dependent and reflects lung volume not quality

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10
Q

What are FEV1, FVC and peak flow like in COPD?

A

Fairly similar FVC
Far lower FEV1
Little variability in peak flow

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11
Q

What is the peak flow test?

A

Simple measurement of how quickly you can blow air out of your lungs

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12
Q

What is the FEV1:FVC ratio in obstructive disease?

A

Reduced ratio. Has to be less than 0.7 (70%)

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13
Q

What is a ‘pack year’?

A

20 cigarettes a day for one year

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14
Q

What is asthma?

A

A chronic inflammatory disorder of the airways involving airway hyper responsiveness. Recurrent episodes of wheezing and breathlessness

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15
Q

Is asthma obstructive or restrictive?

A

Obstructive

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16
Q

Explain airway hyper-responsiveness in asthma

A

Exaggerated response of the airways to nonspecific stimuli (such as histamine) which results in airway obstruction –> hyper-reactive smooth muscle

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17
Q

What is vascular tone?

A

The degree of constriction experienced by a blood vessel relative to its maximally dilated state

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18
Q

How can asthma affect basal tone?

A

Increased basal tone

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19
Q

Define atopy

A

The genetic tendency to develop allergic diseases

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20
Q

How do COPD and asthma differ?

A

Asthma is reversible, COPD is irreversible

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21
Q

What are the clinical features differentiating COPD and asthma?:

  1. Smoker or ex-smoker
  2. Chronic productive cough
  3. Symptoms under 35
  4. Breathlessness
  5. Night-time waking with breathlessness and/or wheeze
  6. Significant diurnal or day-to-day variability of symptoms
A

COPD;

  1. Nearly all
  2. Common
  3. Rare
  4. Persistent and progressive breathlessness
  5. Uncommon
  6. Uncommon

Asthma;

  1. Possibly
  2. Uncommon
  3. Often
  4. Variable breathlessness
  5. Common
  6. Common
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22
Q

What is peak expiratory flow (PEF)?

A

Person’s maximum speed of expiration, measured with a peak flow meter (handheld device that monitor’s ability to breathe out)

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23
Q

How can B2 Adrenoceptor agonist be used to treat asthma?

A

Stimulates airway B2 adrenoceptors which causes relaxation of bronchial smooth muscle

–> may lead to tachycardia

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24
Q

How can antimuscarinic be used to treat asthma?

A

Inhibits muscarinic receptors on smooth muscle causing relaxation of bronchial smooth muscle

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25
Q

How can glucocorticoids prevent asthma?

A

Bind to cytosolic receptors and affect gene transcription/translation. Results in potent anti-inflammatory agents and reduces airway hyper-responsiveness

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26
Q

What are the symptoms of lung cancer?

A
  • Persistent cough
  • Coughing up blood
  • Weight loss
  • Fatigue
  • Clubbing
  • Tachypnoea
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27
Q

What are the 2 main types of lung cancer?

A

Small cell and non-small cell lung cancers (NSCLC)

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28
Q

How common is lung cancer?

A
  • Most common cause of cancer mortality worldwide for both men and women – 1.2 million deaths/year
  • Commonest cancer in men >65
  • Uncommon under 45
29
Q

What is Horner’s syndrome?

A

Interruption of sympathetic nerve supply to the eye –> constricted pupil (miosis)

30
Q

What is results of bronchoscopy in lung cancer?

A

70% of tumours arise in large bronchi and 70% of tumours can be seen/biopsied on brochoscopy

31
Q

What are structural abnormalities of COPD?

A
  • Narrowing of airways
  • Enlargement of air spaces distal to the terminal bronchioles with destruction of their walls (emphysema)
  • Expansion of chest
32
Q

Physiological abnormalities of COPD?

A
  • Reduces rate at which air can flow to and from air sacs which limits effectiveness of lungs
  • Dynamic hyperinflation
33
Q

When does greatest reduction in air flow in COPD occur?

A

During expiration as the pressure in the chest tends to compress rather than expand the airway

34
Q

What is dynamic hyperinflation?

A

A little of the air of the previous breath remains within the lungs when the next breath is started. When this happens, there is an increase in the volume of air in the lungs.

35
Q

What are causes of COPD?

A
  • Smoking
  • Repeated chest infections
  • Family history
  • Exposure to dust in workplace or air pollution
36
Q

Symptoms of COPD?

A
  • Dyspnoea: (Breathlessness– may not be able to completely finish breathing out before need to take another breath, commonly during exercise when breathing has to be faster.)
  • Wheeze (heard by patient often after exercise)
  • Phlegm (may be clear normally or coloured when infected)
  • Cough (experienced by patient and family)
37
Q

Clinical signs of COPD?

A
  • Tachypnoea (rapid breathing often seen at rest and low exercise)
  • Hyper-inflated chest (increased diameter front to back)
  • Wheeze heard with stethoscope on chest)
  • Breath sounds decreased in intensity
  • Prolonged expiration
38
Q

CO2 levels and O2 levels in COPD?

A
  • Hypoxia (low blood O2 level)

* Hypercapnoea (raised blood CO2 level)

39
Q

Chest x-ray of COPD?

A

• Chest X-ray (hyperinflated lungs)

40
Q

FEV1 result of COPD?

A

• Reduced FEV1 (Forced Expiratory Flow in 1 second not fully reversible and most
often progressive)

41
Q

Treatment for COPD?

A

• Antibiotics for episodes of infective bronchitis
• Beta-2 receptor agonists bronchodilator therapy
• Anticholinergic bronchodilator therapy
• Long acting beta 2 agonists (eg salmeterol)
• Inhaled steroids (e.g. budesonide)
• Oral steroid (prednisolone) anti-inflammation therapy (for particularly bad
episodes of wheezing)
• Oxygen therapy (low flow)

42
Q

2ary prevention for COPD

A
  • Stop smoking

- O2 supplement

43
Q

Structural abnormalities present in asthma?

A

Reversible airflow obstruction and bronchospasm

44
Q

Physiological abnormalities present in asthma?

A

• Inflammatory disorder of airways which reduces the rate at which air can flow to and from the alveoli.
• Limits the effectiveness of the lungs
- Dynamic hyperinflation

45
Q

When does greatest reduction in air flow occur in asthma?

A

Occurs when breathing out (during expiration) because the pressure in the chest tends to compress rather
than expand the airway

46
Q

Prior events to asthma?

A
  • Exposure to allergens (e.g. hay, pollen, house dust)
    • Exposure to irritants (e.g. smoke, pollution)
    • Exercise or cold induced
    • Prior eczema or hay fever
    • Family history of asthma
47
Q

Symptoms of asthma?

A
  • Wheezing
  • Coughing
  • Chest tightness
  • Shortness of breath
48
Q

Clinical signs of asthma?

A

• Wheeze heard with stethoscope on chest
• Use of accessory muscles of respiration
• May be a paradoxical pulse (a pulse that is weaker during inhalation
and stronger during exhalation)
• Over-inflation of the chest

49
Q

FEV1 results in asthma?

A

Reduced FEV1 (Forced Expiratory Flow in 1 second) that is reversible

50
Q

Chest X-ray result in asthma?

A

Hyper extension of chest

51
Q

Medical treatment for asthma?

A
  • Inhaled short acting beta-2 agonist (e.g. salbutamol)
  • Inhaled corticosteroid (e.g. beclomethasone)
  • Long acting beta-2 agonist (e.g. salmeterol)
  • Oral prednisolone (corticosteroid)
52
Q

2ary prevention of asthma?

A
  • Symptoms can be prevented by avoiding triggers, such as allergens, irritants and certain medications such as aspirin, already talked about steroids above.
  • Leukotriene antagonists
53
Q

Structural abnormalities in lung cancer?

A
  • Blockage of bronchi due to intra-luminal growth or extra-luminal compression
    • Accumulation of pleural fluid compressing lung
54
Q

Physiological abnormalities in lung cancer?

A

Limits effectiveness of lungs (poor gas exchange, poor protection against infection)

55
Q

What are paraneoplastic syndromes?

A

Group of rare disorders that are triggered by an abnormal immune system response to a cancerous tumor known as a “neoplasm.” (normal cells attacked)

56
Q

Para-neoplastic syndromes associated with lung cancer?

A
  • Lambert-Eaton myasthenic syndrome (muscle weakness due to auto- antibodies)
  • Hypercalcaemia
  • Syndrome of inappropriate antidiuretic hormone production (SIADH)

Tumours in the top (apex) of the lung, known as Pancoast tumours, may invade the local part of the sympathetic nervous system, leading to changed sweating patterns and eye muscle problems (a combination known as Horner’s syndrome) as well as muscle weakness in the hands due to invasion of the brachial plexus.

57
Q

Common prior events to lung cancer?

A
  • Genetics
  • Smoking
  • Asbestos exposure
58
Q

Symptoms of lung cancer?

A
  • Dyspnoea (shortness of breath)
  • Haemoptysis (coughing up blood)
  • Chronic coughing (or change in regular coughing pattern)
  • Wheezing
  • Chest pain
  • Weight loss
59
Q

Clinical signs of lung cancer?

A
  • Cachexia (weight loss), fatigue, and loss of appetite
  • Dysphonia (hoarse voice)
  • Clubbing of the fingernails
  • Dysphagia (difficulty swallowing)
60
Q

Chest X-ray in lung cancer?

A

Shadow or collapse of lung

61
Q

CT scan in lung cancer?

A

Bronchial or other mass, lymphadenopathy (enlarged lymph nodes, metastasis within other lung or other organs)

62
Q

Bronchoscopy in lung cancer?

A

Visualised tumour obstructing bronchus

63
Q

PET scan in lung cancer?

A

Showing metabolic activity

64
Q

Endobronchial ultrasound (EBUS) in lung cancer?

A

Lymph node tissue

65
Q

Biopsy in lung cancer?

A

E.g. shows evidence of malignancy and type of abnormal cells (histology)
which is important when planning treatment

66
Q

Medical treatment for lung cancer?

A
  • Lobectomy, Pneumonectomy (Surgical removal of tumour)
  • Chemotherapy (use of strong drugs that kill cancer cells)
  • Radiotherapy (use of ionizing radiation to kill cancer cells)
67
Q

When is lung cancer typically found?

A
  • In many patients, the cancer has already spread beyond the original site by the time they have symptoms and seek medical attention
  • About 10% of people with lung cancer do not have symptoms at diagnosis; these cancers are incidentally found on routine chest X-ray.
68
Q

Common sites of metastasis in lung cancer?

A

Include the brain, bone, adrenal glands, contra- lateral (opposite) lung, liver, pericardium, and kidneys

Yr 2 - Respiratory System (22 decks)

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