L10: Airway Disease Flashcards
What is the basic lung function test to asses airways
Spirometry
In obstructive airway diseases how does the spirometry trace present
Low FEV1/FVC ratio
In a restrictive lung condition what does the spirometry show
Normal or high FEV1/FVC but lower FVC lower
What is FEV1/FVC
The rate of expiration
Name examples of obstructive airway diseases
Asthma
COPD
Bronchiestasis
Name restrictive lung disease
Pulmonary fibrosis
In airflow obstruction what does the flow volume loop look like
Collapse of flow volume loop
What does the flow volume loop in restriction look like
Similar shape but smaller volume
What is asthma
Chronic inflammatory disorder of the airways that leads to airflow obstruction
What is the diagnostic criteria for asthma in spirometry
FEV1 will improve by 12% and 200ml after giving a bronchodilator
What is the diagnostic criteria for asthma for peak expiratory flow rate
Diurnal variability is less than 20%
Wha is asthma commonly associated with
Allergies
Describe the mechanism of asthma
1) allergens interact with dendritic cells
2) th2 responce is triggered
3) th2 causes the release of IgE from B cells, leukotriene from eosinophil and mast cells
What happens to the lumen of the airways in asthma
Becomes narrow
What happens to the smooth muscle in asthma
Contract
What are the symptoms of asthma
Coughing
Wheezing
Chest tightness
Shortness of breath
Does wheezing occur during inspiration or expiration
Expiration
What happens during an asthma attack
More contraction of smooth muscle
Swelling of epithelium
Increase in mucus production
What is good asthma control
No daytime symptoms No night time awakening No need for reliever No exacerbation No limitation of physical activity Normal lung function (FEV1) above 80%
What are the asthma triggers as allergens
Moulds Dust mites Animal dander Pollens Food
What are the other asthma triggers apart from allergens
Irritants Viral infections Changes in weather Exercise Endocrine factors such as mentrual period or pregnancy
What are irritants
Second hand smoke
Aerosols
Ozone
Particulate matter
What can cause occupation asthma
Paint
Soldering
Cleaners
Bakers
How do we manage asthma
Identify the trigger
Medication
Peak flow monitoring
Emergency plan
What are the inhaled asthma medications
Beta agonist
Steroids
What do beta2 agonist do
Target beta2 receptors on smooth muscle for bronchodilation
Name beta 2 agonist drugs
Salbutamol
Salmeterol
What is the role of steroids
Target inflammation
What does the stepwise approach to asthma medication involve
Steps that increase the intensity of the medication
Describe step 1 in asthma medication
Short acting beta agonist
Describe step 2 in asthma medication
Add inhaled steroid
Describe step 3 in asthma medication
Add long acting beta agonist
Describe step 4 in asthma medication
Increase the steroid dosage
Describe step 5 (last step) in asthma medication
Use steroid tablets
Name a medication that is anti IgE
Omaluzimab
What does COPD stand for
Chronic obstructive pulmonary disease
What is COPD
Airflow obstruction that is not reversible
What causes COPD
Smoking
What is the mechanism of smoking for COPD
Smoking stimulate proteases and oxidants
This leads to parenchymal damage and mucus hypersecretion
What changes do you get in the lungs with COPD
Mucocillary dysfunction Airflow limitation Breakdown of alveoli Osteoporosis Loss of muscle mass
What would the FEV1/FVC ratio be in COPD
Less than 0.7
How do we differentiate between asthma and COPD
COPD:
Smoker
Chronic productive cough
Persistent breathless
Asthma:
Night time waking with breathlessness or wheeze
Signification diurnal variability of symptoms
What is the management of COPD
Short acting beta agonist Then Long acting muscarinic antagonist Then Add steroid in patients with elevated inflammation
