COPD, Bronchiectasis, CF And Asthma Flashcards
What is COPD?
A disease characterised by persistent respiratory symptoms and airflow limitation due to airway or alveolar abnormality caused by significant exposure to particles or gases
What pathophysiological pathways make up COPD?
Small airways disease (chronic bronchitis) Parenchymal destruction (emphysema)
What is the aetiology of COPD?
Smoking,
Biomass exposure,
Air pollution,
Genetic susceptibility (alpha one antitrypsin)
what are common COPD symptoms?
Persistent progressive shortness of breath,
Chronic cough with recurrent wheeze,
Clear sputum,
Recurrent lower respiratory tract infections.
What test is used to diagnose COPD?
Spirometry (Low FEV1, FVC and FEV1/FVC ratio
What are common signs of COPD?
Purse lip breathing, hyperinflation or barrel chest, wheeze.
In severe disease: cyanosis and cor pulmonale
What other investigations may be done for COPD? (Bar spirometry)
High resolution computer tomography (HRCT) - rule out bronchiectasis
Chest X ray - rule out malignancy
Pulmonary function tests
What test should be done in younger patients or a presentation of atypical lower lobe emphysema?
Alpha-1-antitrypsin blood test
What are exacerbations?
Acute worsening of respiratory symptoms that result in additional therapy
Who is at risk of an exacerbation?
Those with previous exacerbations, Severe disease with airflow obstruction, Gastro-oesophageal reflux disease, Pulmonary hypertension, Respiration failure.
What causative organisms often cause exacerbations?
Influenza,
Rhinoviruses,
Haemophilus influenza,
Streptococcus pneumoniae.
What treatments for COPD improve symptoms?
Bronchodilators (LABA or SABA, LAMA or SAMA), Mucolytics, Low dose opiates, Pulmonary rehabilitation, Inhaled corticosteroids, Long term macrolides.
What is the most important therapy for COPD?
Smoking cessation.
What is pulmonary rehabilitation?
6-8 week course with supervised and unsupervised sessions aimed to educate and provide exercise and maintenance therapy for those with COPD
How do Antimuscarinics improve COPD?
Inhibit bronchoconstriction effect of acetylcholine at M3 muscarinic receptors on smooth muscle. Non selective agents also block M1 and M2 receptors.
What is the mechanism of action of Beta2 agonists
Directly activate B2 receptors in bronchioles, leading to increase in cAMP and relaxation of the smooth muscle, causing bronchodilation.
Who are inhaled corticosteroids targeted towards?
COPD patients with a high eosinophil count, targets T2 inflammatory pathway.
Who is long term oxygen therapy suitable for?
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.
After hospitalisation, what is the course of treatment for COPD?
Nebuliser bronchodilators,
Oral corticosteroids- prednisolone for 5 days,
Controlled oxygen at target 88-92%,
Antibiotics if indicated,
Post exacerbation pulmonary rehabilitation.
What is bronchiectasis?
Dilated, damaged airways with paradoxical narrowing due to sputum build up and inflammation
What are common symptoms of bronchiectasis?
Breathlessness, Recurrent infections, Haemoptysis, Weight loss, fatigue. Productive cough with purulent sputum.
What are the causes of bronchiectasis?
CF,
Post infectious - TB, pneumonia, whooping cough,
COPD, ABPA,
IBD, RA.
What sign on CT indicate bronchiectasis?
Signet ring sign - airways larger than blood vessels.
What treatment is used for bronchiectasis?
Mucolytics, Low dose macrolides, Inhaled corticosteroids, Bronchodilators, Physiotherapy.
What organisms chronically colonise those with bronchiectasis?
Pseudomonas Aeruginosa,
Non-Tuberculous Mycobacteria.
What is cystic fibrosis?
Abnormal function of CFTR chloride ion channel, leading to thick and sticky mucous secretions.
Which gene mutation is the most common cause of CF?
Phe508del
How is CF diagnosed?
Screening as a newborn - heel prick test.
Sweat test - >60mmol/L sweat chloride concentration.
What sign on X-ray indicates CF?
Tram track sign - represents thick walled bronchi
Signet sign - bronchiectasis (common in CF)
What are the main clinical presentations of CF?
Meconium ileus - blockage of the bowel by sticky secretions.
Intestinal malabsorption due to blockage of exocrine pancreas glands.
Recurrent chest infection
How does atypical CF present?
Recurrent idiopathic pancreatitis, recurrent sinusitis and lung infections, infertility.
What are pulmonary complications of CF?
Bronchiectasis, Pneumothorax, ABPA, Haemoptysis, Respiratory failure.
What is the only respiratory cure of CF?
Lung transplant
Why are people with CF usually isolated from each other?
Often chronically infected with pseudomonas aeruginosa that is multi drug resistant, and as such cannot risk spreading this to one another
What lifestyle advice are CF patients given?
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.
How is CF managed?
Chest physical therapy and postural drainage, mucolytics, infection management, maintain optimal nutritional status.
How does the drug Orkambi treat cystic fibrosis?
Works for Phe508del mutation - allows transport of CFTR into cells and increases the function of the protein at the cell membrane.
What is asthma?
A chronic inflammatory airway disease characterised by intermittent airway obstruction and hyper-reactivity
Which part of ventilation do asthmatics struggle with
Expiration - audible wheeze as turbulent flow
Who does asthma often present in?
Young boys
Often found in women at later ages
Atopy - those predisposed to allergic conditions
How do allergens lead to bronchoconstriction in asthma?
Allergen - dendritic cell - Th2 cell - B lymphocyte - IgE antibodies - Mast cell - release of leukotrienes - bronchoconstriction
What happens to the bronchi in asthma?
Wall inflamed and thickened chronically.
Acutely, smooth muscle tightens, trapping air in the alveoli.
How does asthma present?
Dry, nocturnal cough,
Wheeze on expiration,
Breathlessness,
Chest tightness.
What is atopy? What other conditions are often found alongside asthma?
Genetic predisposition to allergic conditions.
Asthma found alongside hayfever and eczema.
What may trigger asthma?
Dust, Cigarette smoke, Aerosols, Infection, Excercise, Cold weather, Allergens eg pollen and pets
What signs are associated with asthma?
Increased respiratory rate, increased pulse rate, decreased O2 sats
How is asthma diagnosed?
Peak expiratory flow testing - low FEV1, FVC and FEV1/FVC ratio
What are the differences between asthma and COPD?
Asthma - dry cough COPD - productive cough Age groups, History of smoking vs Atopy Good reversibility in asthma vs poor in COPD
How is asthma managed?
Secondary prevention - remove triggers if possible
- Short acting beta 2 agonists
- Inhaled corticosteroids
- Combination inhaler
- Increased doses or addition of leukotriene receptor antagonist
- Specialist care referral
What are the signs of severe acute asthma?
Difficulty speaking due to breathlessness, Wheeze, Reduced PEFR to 33-50%, O2 >92% Pulse >110
What are the signs of life threatening asthma?
Silent chest, Drowsy or altered consciousness, Cyanosis, PEFR <33% RR drops Heart rate unpredictable
How is asthma managed in hospital?
Salbutamol nebuliser, Steroids, Consider ventilation, GP follow up after discharge. Consider CXR to rule out pneumothorax.
