Doencas Pulmonares Obstrutivas

Question 1

Doenças incluídas neste grupo

Answer 1

• DPOC
• Asma
• FQ
• Bronquiectasias
• Doenças bronquiolares (pequenas vias)

Question 2

Sintomas que podem ser comuns

Answer 2

Sibilância, expectoração, inflamação crónica das vias aéreas, alterações estruturais e remodeling, exacerbações

Question 3

asma e DPOC

Answer 3

• DPOC: inflamação e estrutura das vias aéreas anormais em resposta a um irritante inalado (tipicamente fumo de tabaco)->limitação fluxo ar irreversível ou incompletamente reversível. Tipicamente PROGRESSIVA.
• Asma: hiperreactividade do músculo liso com limitação do fluxo aéreo REVERSÍVEL, curso clínico variável e associação frequente com atopia

Question 4

Sintomas típicos bronquiectasias (3)

Answer 4

Tosse crónica, expectoração purulenta, hemoptises

Question 5

O fluxo de ar que passa nas vias aéreas é directamente proporcional à ‘driving pressure’ é inversamente proporcional à resistência. Que processos estão alterados na asma e DPOC?

Answer 5

DPOC: - elastic recoil in expiration .: - driving pressure

Asma: + resistência pela contração do ML, inflamação e fibrose, colapso pequenas vias (por perda do tecido pulmonar circundante)

Produção de muco (+resistência) em todas as doenças obstrutivas

Question 6

Alterações espirométricas

Answer 6

RV e FRC aumentados
TLC =/aumentado
Capacidade vital reduzida
Capacidade inspiratoria reduzida

Question 7

Exame Dx útil para # asma de DPOC

Answer 7

FEV1/FVC pós broncodilatador

Melhora na asma

Question 8

DLCO na asma e na DPOC

Answer 8

Asma: normal ou aumentado

DPOC: diminuído

Question 9

Sintomas FQ

Answer 9

Sinusite, bronquiectasias, ileus meconial, má absorção, infertilidade (em homens, ausência congénita do canal deferente)

Question 10

Hx possível de outras doenças associadas a doenças bronquiolares

Answer 10

Doenças do tecido conjuntivo, DII, tx pulmonar ou de células estaminais hematopoiéticas

Question 11

Alterações Rx doenças bronquiolares

Answer 11

HRCT: Padrão mosaico, nódulos centrilobulares, ‘tree in bus’ opacities

Question 12

Microorganismos frequentes em doentes com FQ

Answer 12

Haemophilus Inf.
Pseudomonas
Micobactérias atípicas

Question 13

Exames Dx FQ

Answer 13

Conc. Cl aumentada no suor

Mutação gene CFTR (canal cloro)

potencial da mucosa nasal anormal

Gordura fecal aumentada

Question 14

Definition of COPD

Answer 14

Persistent airflow limitation that is usually progressive and ~ with enganches inflammatory response.

Note: emphysema and chronic bronchitis are not synonyms with COPD (they can occur with or without expiratory airflow limitation)

Pp 208, C16

Question 15

Definition of chronic bronchitis

Answer 15

Cough and sputum for at least 3 months in at least 2 consecutive years

Question 16

Factors associated with increasing prevalence of COPD

Answer 16

Age, lower sociodemographic status, smoking, men

Pp 208, C16

Question 17

Which position does COPD hold as a cause of death worldwide

Answer 17

4th

Pp 209, C16

Question 18

Only genetic disorder ~ COPD

Answer 18

Alfa1-antitrypsin deficiency (1-2% of COPD cases)

Note: there are familial clusters

Question 19

Average lung function decline in:

a) non-smoking men
b) smoking
c) susceptible smoker

(Decline in FEV1)

Answer 19

a) 35-40 ml
b) 45-60
c) 70-120

Question 20

Definition of emphysema

Answer 20

Permanent enlargement of the air spaces distal to the terminal bronchioles

Pp209, C16

Question 21

Classification of emphysema

Answer 21

Centrilobular (most common in emphysema related to smoking) and Panlobular (Alfa1-antitrypsin deficiency)

Question 22

main target for inactivation by antitrypsin

Answer 22

Neutrophil elastase

Question 23

Cigarette smoke contains a lot of oxidant molecules capable of oxidative stress. What are the effects of this?

Answer 23

Inactivation of antiproteases, acetylation of specific histones in the chromatin of lung cells (with the expression of pro-inflammatory genes)

Question 24

Where is antitrypsin produced?

Answer 24

Liver

Question 25

Therapies targeted at molecular pathways involved in emphysema pathogenesis have not been successful in disease progression except…

Answer 25

Antitrypsin replacement in patients with its deficiency (decreased loss of lung density)

Question 26

Predominant symptom in chronic bronchitis

Answer 26

Sputum production

Question 27

Symptoms and signs of COPD (clinical presentation)

Answer 27

Symptoms: Slowly progressive dyspnea, exercise intolerance, fatigue, weight loss, depression, anxiety, chronic cough (productive or dry).

Physical examination: may be normal initially. Hyperresonance, diminished breath sounds, ronchi or wheezes, barrel chest.
Later stages: increased work of breathing and weight loss.

Question 28

Pink buffer vs blue bloater phenotype

Answer 28

Pink buffer: able to retain normal O2 levels until very late.

Blue bloater: retain CO2 and diminish work of breathing resulting in chronic respiratory acidosis.

Question 29

Most important triggers of exacerbation sim COPD

Answer 29

Infections, air pollution, pulmonary embolism, cardiac failure

Pp 211, chap 16

Question 30

Comorbid conditions associated with COPD (4)

Answer 30

Atherosclerotic heart disease, lung cancer, osteoporosis, depression

Pp 211, chap 16

Question 31

Signs of cor pulmonale

Answer 31

S3, distended neck veins, hepatojugular reflux, leg edema

Pp211, chap16

Question 32

The severity of COPD depends on the FEV1. What are the 4 stages ?

Answer 32

GOLD 1: FEV1 >=80% predicted

GOLD 2: >=50% but less than 80%

GOLD 3: >=30% but less than 50%

GOLD 4: <30% predicted

Question 33

What scale is used for a better prediction of mortality in COPD?

Answer 33

BODE index

(BMI, FEV1, dyspnea score, exercise capacity in 6-minute walk)

Pp 212, chap 16

Question 34

Apart from FEV1, what other tests can be used in COPD?

Answer 34

Lung volume (increased RV, FRC and TLC), DLCO (decreases), Chest x ray (hyperinflation, hyperlucency, flattening of diaphragm, bullous changes in parenchyma), CT (Dx of emphysema in patients considered to operative interventions) HRCT (more sensitive for occult emphysema and emphysematous changes), ECG (RV strain), echocardiography (RV hypertrophy or dilation, pulmonary arterial pressure), high blood hemoglobin level