CVPR Week 5: Obstructive Airway Disease Flashcards
Objectives
Common obstructive lung diseases
5 listed
- Asthma
- Emphysema (COPD)
- Chronic bronchitis (COPD)
- Bronchiectasis
- Cystic fibrosis
Asthma type of lung disease
Obstructive lung disease with reversible airflow obstruction
Asthma types
different phenotypes
Asthma inflammation
Inflammation is prominent
Emphysema lung disease type
Obstructive “COPD” permanent enlargement/destruction of the respiratory bronchioles
Chronic bronchitis lung disease type
“COPD” Sputum production 3 months/year for 2 years
The less common obstructive lung diseases
2 listed
- Bronchiectasis
- Cystic fibrosis
Bronchiectasis description
Enlarged airways and tortuous blood vessels (bronchial arteries) resulting from chronic infection
Cystic fibrosis description
3 listed
- Hereditary disease
- multiple gene mutations
- bronchiectasis with chronic respiratory infections with a failure to thrive
The most common obstructive lung diseases
3 listed
- Asthma
- Emphysema (COPD)
- Chronic Bronchitis (COPD)
Bronchiectasis clinical course
3 listed
- Abnormal dilation of the bronchial tree
- Causes scarring 7 obstructions & mucus accumulation distally
- May eventually lead to right ventricular failure/respiratory failure
Congenital causes of Bronchiectasis
2 listed
- When due to Kartagener’s presents as GI situs inversus and chronic sinusitis
- Ciliary dyskinesia disorders
Acquired causes of Bronchiectasis
3 listed
- often 2o to severe LRTI in childhood
- Linked to pertussis & measles
- Can occur post TB infection
Types of bronchiectasis
3 listed
What kind of bronchiectasis is this?
cylindrical bronchiectasis
What kind of bronchiectasis is this?
cystic bronchiectasis
What kind of bronchiectasis is this?
This is actually normal
What kind of bronchiectasis is this?
Varicose bronchiectasis
What is this?
bronchiectasis
Obstructive ventilatory defect definition
essentially means that Forced Expiratory volume is decreased compared to the Forced vital capacity
The earliest changes associated with airflow obstruction are in?
The small airways
Changes on the flow-volume curve associated with airflow obstruction
COPD classification by severity
COPD is classified as
FEV1/FVC = < 0.7
Asthma Definition
A common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction [fully/completely reversible], bronchial hyperresponsiveness, and underlying inflammation
Asthma diagnosis
3 listed
- Diagnosis by history and to confirm, spirometry is used however may be normal if the asthma is under control at the time
- However, a lack of bronchodilator response does not rule out asthma
Asthma clinical features
5 listed
- Wheezing
- SOB
- Cough
- Chest tightness
- Variable Peak Expiratory Flow Rates (PEFR)
Asthma epidemiology
4 things listed
- 40 million individuals died from asthma in 2015 a decrease of 26% from 1990
- Asthma is the most common respiratory disease worldwide affecting 358 million in 2015
- The U.S. Prevalence = 8.3%
- The estimated annual cost of asthma in 2013 was 81.9 billion
Asthma pathophysiology between phenotypes
- Distinct phenotypes of asthma exist however the pattern of airway inflammation does not vary significantly depending upon disease severity, persistence and duration
- The cellular profile and the response of the structural cells in asthma are quite consistent
Asthma phenotypes
5 listed
- Intermittent
- persistent
- exercise-associated
- aspirin-sensitive
- severe asthma
Asthma pathophysiology: Cells involved
6 listed
- T lymphocytes (Th2)
- Mast cells
- Eosinophils
- Macrophages
- Neutrophils
- Epithelial Cells
Asthma pathophysiology: T lymphocyte involvement
produce cytokines IL-4, IL-5, IL-13
Asthma pathophysiology: Mast cell involvement
- mediators of bronchoconstriction (histamine, cysteinyl-leukotrienes, prostaglandin D2)
Asthma pathophysiology: Eosinophil involvement
3 listed
- increased numbers of eosinophils exist in the airway of most but not all asthmatics
- contain inflammatory enzymes, generate leukotrienes and express a wide variety of pro-inflammatory cytokines
- may not be the only primary effector cell in asthma, it likely has a distinct role in different phases of the disease
Asthma pathophysiology: Macrophages involvement
2 listed
- most numerous cells in the airways
- can be activated by allergens to release inflammatory mediators and cytokines that amplify the inflammatory response
Asthma pathophysiology: Neutrophil involvement
- pathophysiological role remains uncertain
Asthma pathophysiology: Epithelial cell involvement
they produce more inflammatory mediators
Asthma pathophysiology diagram
Asthma pathophysiology diagram 2
Asthma pathophysiology diagram 3
Asthma pathophysiology main components of pathology
2 listed
- smooth muscle dysfunction
- airway inflammation
Asthma Smooth muscle dysfunction leads to?
4 listed
- Bronchoconstriction
- bronchial hyperreactivity
- hypertrophy/hyperplasia
- inflammatory mediator release
Asthma airway inflammation leads to?
Asthma smooth muscle dysfunction and airway inflammation leads to?
symptoms/exacerbations and disease progression
Asthma pathophysiology Acute response
4 listed
- Bronchoconstriction
- Edema
- Secretions
- Cough
Asthma pathophysiology: Chronic inflammation
3 listed
- Cell recruitment
- epithelial damage
- early structural changes
Asthma pathophysiology: Airway remodeling
3 listed
- cellular proliferation
- extracellular matrix increase
- structural changes
Epithelial damage in asthma
Intrinsic factors affecting disease expression of Asthma
- genetics of disease
- Duration of asthma
- severity of childhood asthma
- Gender
- Response to therapy
Extrinsic factors affecting disease expression of Asthma
9 listed
- Viral infections
- Allergen exposure
- \Airway irritants
- Exercise
- Compliance
- Season
- Time of day
- Occupational (10-15% of adult asthma)
- Western lifestyle i.e. obesity
Asthma comorbidities that worsen the asthma
4 listed
- GERD-association with asthma 15 - 40 % prevalence
- Sinusitis/Allergic Rhinitis
- Illicit drug use – cocaine
- Non-compliance
Risk factors for death from asthma
- prior severe exacerbations (such as intubation or ICU admission)
- >= 2 hospital admits or >=3 ED visits past year
- admit ED visit with the last month
- Use of >2 canisters/month of β-agonist MDI
- difficulty perceiving symptoms or severity
- illicit drug use
- low socioeconomic status or inner-city residence
- lack of a written action plan
- sensitivity to Alternaria
Pharmacology in asthma goals of therapy
2 listed
Reducing impairment
Reducing risk
Reducing impairment in Asthma
4 listed
- Prevent chronic and troublesome symptoms
- maintain (near) normal pulmonary function
- Maintain normal activity levels
- Meet pts expectations for asthma care
Reducing risk in asthma
3 listed
- Prevent recurrent exacerbations
- Prevent progressive loss of lung function
- Avoid adverse medication side-effects
Medication types for asthma
7 listed
- short-acting β2 agonists
- long-acting β2 agonists
- Inhaled steroids
- Leukotriene modifiers
- Theophylline
- Oral steroids for exacerbations
- Omalizumab
Short-acting β2 agonists
2 listed
- Albuterol
- Levalbuterol
Long-acting β2 agonists
2 listed
- Salmeterol
- Formoterol
Inhaled steroids for asthma
4 listed
- Fluticasone
- budesonide
- Ciclesonide
- Mometasone
Leukotriene modifiers
3 listed
- Montelukast
- Zafilukast
- Zileutin
Theophylline for asthma
?
Oral steroids for asthma
for exacerbations
Omalizumab for asthma
Xolair injections every 2-4 weeks
Rescue medications for asthma
4 listed
- β2 agonists: Albuterol
- Used as needed with symptoms or flares or before exercise
- opens the airway quickly
- if you use this more than 2 times a week you may need a controller medicine