Investigation and Treatment of Resp diseases

Question 1

What are the 2 ways that bronchodilation can be achieved?

Answer 1

Block the cholinergic system (parasympathetic)

Stimulation of the adrenergic system (to achieve bronchodilation)

Question 2

What is FEV1?

Answer 2

Forced Expiratory volume: Volume of air expired in 1 second

Question 3

What is FVC?

Answer 3

Forced vital capacity: maximal volume of air that can be expired from lungs

Question 4

What type of respiratory disease causes the greatest decrease in FEV1 AND FVC?

Answer 4

Obstructive disease

Question 5

How is asthma described?

Answer 5

Recurrent, reversible airflow obstruction

Question 6

How is asthma different to COPD in terms of symptoms

Answer 6

Asthma is triggered by something so the symptoms are variable. Whereas in COPD, there are the same symptoms everyday

Question 7

What are the 2 phases of asthma?

Answer 7

Bronchospasm of smooth muscle

Inflammation

Question 8

BRIEFLY describe the pathophysiology of asthma

Answer 8

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.

Question 9

What drugs are used for asthma treatment?

Answer 9

Bronchodilators

Anti-inflammatory drugs

Question 10

List the four bronchodilator drugs involved in asthma treatment?

Answer 10

Leukotrienes antagonists
Xanthines
Beta 2 receptor AGONISTS
Anti-cholinergic agents

Question 11

What are the two types of Beta 2 agonists and give one example of each

Answer 11

SABA: salbutamol
LABA: Salmeterol

Question 12

What is the function of Beta 2 agonists

Answer 12

Bronchodilate, stabilise mast cells, monocytes and cilia function

Question 13

What is the side effect of Beta 2 agonists

Answer 13

tremors

Question 14

What des LAMA stand for and what type of drug is it?

Answer 14

Long acting muscarinic antagonist

It is an anti-cholinergic agent

Question 15

what type of drugs are Montelukast and Zafirlukast?

Answer 15

Leukotriene antagonists

Question 16

What are the disadvantages of Xanthines?

Answer 16

very narrow therapeutic window: small difference in the amount needed to treat someone and making them unwell
Many side effects
Many drug interaction

Question 17

GIVE two examples of Anti-inflammatory Agents in asthma treatment

Answer 17

Anti-IgE antibodies

Glucocorticoids (synthetic)

Question 18

What is the major side effect of glucocorticoids?

Answer 18

MANY side effects (e.g. moon face, thin arms and legs, increased abdominal fat, cataracts, thinning of skin, easily bruised, poor wound healing)

Question 19

What are some of the new non-pharmacological approaches to asthma treatment?

Answer 19

Bronchial thermoplasty - involves burning the smooth muscle in the bronchi
targeted lung denervation: Burn through the nerves

Question 20

How is COPD described?

Answer 20

Irreversible airflow obstruction

Question 21

Does drug therapy help COPD?

Answer 21

It does not help disease progression but it can be used to relieve symptoms and reduce exacerbations

Question 22

What 3 tests do respiratory investigations largely come under?

Answer 22

Imaging
Sampling
Function tests

Question 23

How do investigations help in diagnostic process?

Answer 23

Confirm diagnosis
Establish Severity/extent of disease
Assess fitness of patient for treatment

Question 24

What factors influence the choice of investigation method?

Answer 24

Risk/complications
Cost
Time
Ease
Reliability and repeatability
Specificity of test
Anxiety
Pain/discomfort

Question 25

What type of drugs are Ipratropium and Tiotropium ?

Answer 25

Anti-cholinergic agents

Question 26

What type of drugs are aminophlyline and theophylline?

Answer 26

Xanthines

Question 27

What type of drugs are Beclomethasone, Budesonide and Fluticasone?

Answer 27

Glucocorticoids

Question 28

What type of drugs are prednisolone and hydrocortisone?

Answer 28

Glucocorticoids

Question 29

What is spirometry?

Answer 29

Measure of lung function by assessing amount and/or speed of air that can be inhaled or exhaled.

Question 30

What is Forced Expiratory Manoeuvre

Answer 30

patient takes a maximum inspiration and then expires for as long as possible

Question 31

what should a normal FEV/FVC be?

Answer 31

70%

Question 32

What is a peak flow test also known as and what is it?

Answer 32

PEF (Peak Expiratory Volume)

maximum speed of expiration

Question 33

What factors affect the volumes and flow measured by spirometry?

Answer 33

Age
Height
Gender
Ethnicity

Question 34

What test is used to check if airflow improves with medication?

Answer 34

Bronchodilator Reversibility Testing

Question 35

In those with airflow limitation, how does FEV/FVC ration and Peak flow compare?

Answer 35

They are both reduced and low

Question 36

In spirograms what do the bottom semi-circle and top semi-circle show?

Answer 36

Bottom: Deep inspiration
Top: forced expiration

Question 37

What things make a spirogram unacceptable?

Answer 37

cough
glottis closure
early termination/cut off
Effort not maximal enough 
leak
obstructive mouthpiece