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Respiratory System > COPD, Bronchiectasis, CF And Asthma > Flashcards

COPD, Bronchiectasis, CF And Asthma Flashcards

1
Q

What is COPD?

A

A disease characterised by persistent respiratory symptoms and airflow limitation due to airway or alveolar abnormality caused by significant exposure to particles or gases

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2
Q

What pathophysiological pathways make up COPD?

A 
Small airways disease (chronic bronchitis)
Parenchymal destruction (emphysema)
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3
Q

What is the aetiology of COPD?

A

Smoking,
Biomass exposure,
Air pollution,
Genetic susceptibility (alpha one antitrypsin)

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4
Q

what are common COPD symptoms?

A

Persistent progressive shortness of breath,
Chronic cough with recurrent wheeze,
Clear sputum,
Recurrent lower respiratory tract infections.

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5
Q

What test is used to diagnose COPD?

A

Spirometry (Low FEV1, FVC and FEV1/FVC ratio

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6
Q

What are common signs of COPD?

A

Purse lip breathing, hyperinflation or barrel chest, wheeze.

In severe disease: cyanosis and cor pulmonale

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7
Q

What other investigations may be done for COPD? (Bar spirometry)

A

High resolution computer tomography (HRCT) - rule out bronchiectasis
Chest X ray - rule out malignancy
Pulmonary function tests

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8
Q

What test should be done in younger patients or a presentation of atypical lower lobe emphysema?

A

Alpha-1-antitrypsin blood test

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9
Q

What are exacerbations?

A

Acute worsening of respiratory symptoms that result in additional therapy

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10
Q

Who is at risk of an exacerbation?

A 
Those with previous exacerbations,
Severe disease with airflow obstruction,
Gastro-oesophageal reflux disease,
Pulmonary hypertension,
Respiration failure.
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11
Q

What causative organisms often cause exacerbations?

A

Influenza,
Rhinoviruses,
Haemophilus influenza,
Streptococcus pneumoniae.

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12
Q

What treatments for COPD improve symptoms?

A 
Bronchodilators (LABA or SABA, LAMA or SAMA),
Mucolytics,
Low dose opiates,
Pulmonary rehabilitation,
Inhaled corticosteroids,
Long term macrolides.
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13
Q

What is the most important therapy for COPD?

A

Smoking cessation.

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14
Q

What is pulmonary rehabilitation?

A

6-8 week course with supervised and unsupervised sessions aimed to educate and provide exercise and maintenance therapy for those with COPD

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15
Q

How do Antimuscarinics improve COPD?

A

Inhibit bronchoconstriction effect of acetylcholine at M3 muscarinic receptors on smooth muscle. Non selective agents also block M1 and M2 receptors.

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16
Q

What is the mechanism of action of Beta2 agonists

A

Directly activate B2 receptors in bronchioles, leading to increase in cAMP and relaxation of the smooth muscle, causing bronchodilation.

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17
Q

Who are inhaled corticosteroids targeted towards?

A

COPD patients with a high eosinophil count, targets T2 inflammatory pathway.

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18
Q

Who is long term oxygen therapy suitable for?

A

Non smokers,
Those who do not retain CO2,
Fire risk assessments must be completed and therapy must be used for minimum 16 hours per day.

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19
Q

After hospitalisation, what is the course of treatment for COPD?

A

Nebuliser bronchodilators,
Oral corticosteroids- prednisolone for 5 days,
Controlled oxygen at target 88-92%,
Antibiotics if indicated,
Post exacerbation pulmonary rehabilitation.

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20
Q

What is bronchiectasis?

A

Dilated, damaged airways with paradoxical narrowing due to sputum build up and inflammation

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21
Q

What are common symptoms of bronchiectasis?

A 
Breathlessness,
Recurrent infections,
Haemoptysis,
Weight loss, fatigue.
Productive cough with purulent sputum.
22
Q

What are the causes of bronchiectasis?

A

CF,
Post infectious - TB, pneumonia, whooping cough,
COPD, ABPA,
IBD, RA.

23
Q

What sign on CT indicate bronchiectasis?

A

Signet ring sign - airways larger than blood vessels.

24
Q

What treatment is used for bronchiectasis?

A 
Mucolytics,
Low dose macrolides,
Inhaled corticosteroids,
Bronchodilators,
Physiotherapy.
25
Q

What organisms chronically colonise those with bronchiectasis?

A

Pseudomonas Aeruginosa,

Non-Tuberculous Mycobacteria.

26
Q

What is cystic fibrosis?

A

Abnormal function of CFTR chloride ion channel, leading to thick and sticky mucous secretions.

27
Q

Which gene mutation is the most common cause of CF?

A

Phe508del

28
Q

How is CF diagnosed?

A

Screening as a newborn - heel prick test.

Sweat test - >60mmol/L sweat chloride concentration.

29
Q

What sign on X-ray indicates CF?

A

Tram track sign - represents thick walled bronchi

Signet sign - bronchiectasis (common in CF)

30
Q

What are the main clinical presentations of CF?

A

Meconium ileus - blockage of the bowel by sticky secretions.
Intestinal malabsorption due to blockage of exocrine pancreas glands.
Recurrent chest infection

31
Q

How does atypical CF present?

A

Recurrent idiopathic pancreatitis, recurrent sinusitis and lung infections, infertility.

32
Q

What are pulmonary complications of CF?

A 
Bronchiectasis,
Pneumothorax,
ABPA,
Haemoptysis,
Respiratory failure.
33
Q

What is the only respiratory cure of CF?

A

Lung transplant

34
Q

Why are people with CF usually isolated from each other?

A

Often chronically infected with pseudomonas aeruginosa that is multi drug resistant, and as such cannot risk spreading this to one another

35
Q

What lifestyle advice are CF patients given?

A 
Avoid other CF patients,
Avoid people with respiratory infections,
Avoid jacuzzis (pseudomonas),
Avoid stables and rotting vegetation (aspergillus),
Sodium tablets in hot weathr due to loss via sweating.
36
Q

How is CF managed?

A

Chest physical therapy and postural drainage, mucolytics, infection management, maintain optimal nutritional status.

37
Q

How does the drug Orkambi treat cystic fibrosis?

A

Works for Phe508del mutation - allows transport of CFTR into cells and increases the function of the protein at the cell membrane.

38
Q

What is asthma?

A

A chronic inflammatory airway disease characterised by intermittent airway obstruction and hyper-reactivity

39
Q

Which part of ventilation do asthmatics struggle with

A

Expiration - audible wheeze as turbulent flow

40
Q

Who does asthma often present in?

A

Young boys
Often found in women at later ages
Atopy - those predisposed to allergic conditions

41
Q

How do allergens lead to bronchoconstriction in asthma?

A

Allergen - dendritic cell - Th2 cell - B lymphocyte - IgE antibodies - Mast cell - release of leukotrienes - bronchoconstriction

42
Q

What happens to the bronchi in asthma?

A

Wall inflamed and thickened chronically.

Acutely, smooth muscle tightens, trapping air in the alveoli.

43
Q

How does asthma present?

A

Dry, nocturnal cough,
Wheeze on expiration,
Breathlessness,
Chest tightness.

44
Q

What is atopy? What other conditions are often found alongside asthma?

A

Genetic predisposition to allergic conditions.

Asthma found alongside hayfever and eczema.

45
Q

What may trigger asthma?

A 
Dust,
Cigarette smoke,
Aerosols,
Infection,
Excercise,
Cold weather,
Allergens eg pollen and pets
46
Q

What signs are associated with asthma?

A

Increased respiratory rate, increased pulse rate, decreased O2 sats

47
Q

How is asthma diagnosed?

A

Peak expiratory flow testing - low FEV1, FVC and FEV1/FVC ratio

48
Q

What are the differences between asthma and COPD?

A 
Asthma - dry cough
COPD - productive cough
Age groups,
History of smoking vs Atopy
Good reversibility in asthma vs poor in COPD
49
Q

How is asthma managed?

A

Secondary prevention - remove triggers if possible

  1. Short acting beta 2 agonists
  2. Inhaled corticosteroids
  3. Combination inhaler
  4. Increased doses or addition of leukotriene receptor antagonist
  5. Specialist care referral
50
Q

What are the signs of severe acute asthma?

A 
Difficulty speaking due to breathlessness,
Wheeze,
Reduced PEFR to 33-50%,
O2 >92%
Pulse >110
51
Q

What are the signs of life threatening asthma?

A 
Silent chest,
Drowsy or altered consciousness,
Cyanosis,
PEFR <33%
RR drops
Heart rate unpredictable
52
Q

How is asthma managed in hospital?

A 
Salbutamol nebuliser,
Steroids,
Consider ventilation,
GP follow up after discharge.
Consider CXR to rule out pneumothorax.

Respiratory System (12 decks)

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