Investigation and Treatment of Resp diseases Flashcards
What are the 2 ways that bronchodilation can be achieved?
Block the cholinergic system (parasympathetic)
Stimulation of the adrenergic system (to achieve bronchodilation)
What is FEV1?
Forced Expiratory volume: Volume of air expired in 1 second
What is FVC?
Forced vital capacity: maximal volume of air that can be expired from lungs
What type of respiratory disease causes the greatest decrease in FEV1 AND FVC?
Obstructive disease
How is asthma described?
Recurrent, reversible airflow obstruction
How is asthma different to COPD in terms of symptoms
Asthma is triggered by something so the symptoms are variable. Whereas in COPD, there are the same symptoms everyday
What are the 2 phases of asthma?
Bronchospasm of smooth muscle
Inflammation
BRIEFLY describe the pathophysiology of asthma
allergen binds to Antigen Presenting Cell and is taken up by it. It is presented to T lymphocyte which proliferates along one of two pathways:
TH1
TH2
In asthmatics, the THC 2 pathway is used more than normal people. T lymphocytes interact with B cells and they produce IgE antibodies. IgE antibodies want on mast cells to form a complex and stimulate the release fo histamine. They also act on eosinophils to produce an inflammatory response.
Interleukins 4, 5, 13 are also involved in amplifying the response.
What drugs are used for asthma treatment?
Bronchodilators
Anti-inflammatory drugs
List the four bronchodilator drugs involved in asthma treatment?
Leukotrienes antagonists
Xanthines
Beta 2 receptor AGONISTS
Anti-cholinergic agents
What are the two types of Beta 2 agonists and give one example of each
SABA: salbutamol
LABA: Salmeterol
What is the function of Beta 2 agonists
Bronchodilate, stabilise mast cells, monocytes and cilia function
What is the side effect of Beta 2 agonists
tremors
What des LAMA stand for and what type of drug is it?
Long acting muscarinic antagonist
It is an anti-cholinergic agent
what type of drugs are Montelukast and Zafirlukast?
Leukotriene antagonists
What are the disadvantages of Xanthines?
very narrow therapeutic window: small difference in the amount needed to treat someone and making them unwell
Many side effects
Many drug interaction
GIVE two examples of Anti-inflammatory Agents in asthma treatment
Anti-IgE antibodies
Glucocorticoids (synthetic)
What is the major side effect of glucocorticoids?
MANY side effects (e.g. moon face, thin arms and legs, increased abdominal fat, cataracts, thinning of skin, easily bruised, poor wound healing)
What are some of the new non-pharmacological approaches to asthma treatment?
Bronchial thermoplasty - involves burning the smooth muscle in the bronchi
targeted lung denervation: Burn through the nerves
How is COPD described?
Irreversible airflow obstruction
Does drug therapy help COPD?
It does not help disease progression but it can be used to relieve symptoms and reduce exacerbations
What 3 tests do respiratory investigations largely come under?
Imaging
Sampling
Function tests
How do investigations help in diagnostic process?
Confirm diagnosis
Establish Severity/extent of disease
Assess fitness of patient for treatment
What factors influence the choice of investigation method?
Risk/complications Cost Time Ease Reliability and repeatability Specificity of test Anxiety Pain/discomfort
What type of drugs are Ipratropium and Tiotropium ?
Anti-cholinergic agents
What type of drugs are aminophlyline and theophylline?
Xanthines
What type of drugs are Beclomethasone, Budesonide and Fluticasone?
Glucocorticoids
What type of drugs are prednisolone and hydrocortisone?
Glucocorticoids
What is spirometry?
Measure of lung function by assessing amount and/or speed of air that can be inhaled or exhaled.
What is Forced Expiratory Manoeuvre
patient takes a maximum inspiration and then expires for as long as possible
what should a normal FEV/FVC be?
70%
What is a peak flow test also known as and what is it?
PEF (Peak Expiratory Volume)
maximum speed of expiration
What factors affect the volumes and flow measured by spirometry?
Age
Height
Gender
Ethnicity
What test is used to check if airflow improves with medication?
Bronchodilator Reversibility Testing
In those with airflow limitation, how does FEV/FVC ration and Peak flow compare?
They are both reduced and low
In spirograms what do the bottom semi-circle and top semi-circle show?
Bottom: Deep inspiration
Top: forced expiration
What things make a spirogram unacceptable?
cough glottis closure early termination/cut off Effort not maximal enough leak obstructive mouthpiece
