L10: Airway Disease

Question 1

What is the basic lung function test to asses airways

Answer 1

Spirometry

Question 2

In obstructive airway diseases how does the spirometry trace present

Answer 2

Low FEV1/FVC ratio

Question 3

In a restrictive lung condition what does the spirometry show

Answer 3

Normal or high FEV1/FVC but lower FVC lower

Question 4

What is FEV1/FVC

Answer 4

The rate of expiration

Question 5

Name examples of obstructive airway diseases

Answer 5

Asthma
COPD
Bronchiestasis

Question 6

Name restrictive lung disease

Answer 6

Pulmonary fibrosis

Question 7

In airflow obstruction what does the flow volume loop look like

Answer 7

Collapse of flow volume loop

Question 8

What does the flow volume loop in restriction look like

Answer 8

Similar shape but smaller volume

Question 9

What is asthma

Answer 9

Chronic inflammatory disorder of the airways that leads to airflow obstruction

Question 10

What is the diagnostic criteria for asthma in spirometry

Answer 10

FEV1 will improve by 12% and 200ml after giving a bronchodilator

Question 11

What is the diagnostic criteria for asthma for peak expiratory flow rate

Answer 11

Diurnal variability is less than 20%

Question 12

Wha is asthma commonly associated with

Answer 12

Allergies

Question 13

Describe the mechanism of asthma

Answer 13

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

Question 14

What happens to the lumen of the airways in asthma

Answer 14

Becomes narrow

Question 15

What happens to the smooth muscle in asthma

Answer 15

Contract

Question 16

What are the symptoms of asthma

Answer 16

Coughing
Wheezing
Chest tightness
Shortness of breath

Question 17

Does wheezing occur during inspiration or expiration

Answer 17

Expiration

Question 18

What happens during an asthma attack

Answer 18

More contraction of smooth muscle
Swelling of epithelium
Increase in mucus production

Question 19

What is good asthma control

Answer 19

No daytime symptoms 
No night time awakening
No need for reliever
No exacerbation 
No limitation of physical activity
Normal lung function (FEV1) above 80%

Question 20

What are the asthma triggers as allergens

Answer 20

Moulds 
Dust mites
Animal dander
Pollens 
Food

Question 21

What are the other asthma triggers apart from allergens

Answer 21

Irritants 
Viral infections 
Changes in weather
Exercise
Endocrine factors such as mentrual period or pregnancy

Question 22

What are irritants

Answer 22

Second hand smoke
Aerosols
Ozone
Particulate matter

Question 23

What can cause occupation asthma

Answer 23

Paint
Soldering
Cleaners
Bakers

Question 24

How do we manage asthma

Answer 24

Identify the trigger
Medication
Peak flow monitoring
Emergency plan

Question 25

What are the inhaled asthma medications

Answer 25

Beta agonist | Steroids

Question 26

What do beta2 agonist do

Answer 26

Target beta2 receptors on smooth muscle for bronchodilation

Question 27

Name beta 2 agonist drugs

Answer 27

Salbutamol | Salmeterol

Question 28

What is the role of steroids

Answer 28

Target inflammation

Question 29

What does the stepwise approach to asthma medication involve

Answer 29

Steps that increase the intensity of the medication

Question 30

Describe step 1 in asthma medication

Answer 30

Short acting beta agonist

Question 31

Describe step 2 in asthma medication

Answer 31

Add inhaled steroid

Question 32

Describe step 3 in asthma medication

Answer 32

Add long acting beta agonist

Question 33

Describe step 4 in asthma medication

Answer 33

Increase the steroid dosage

Question 34

Describe step 5 (last step) in asthma medication

Answer 34

Use steroid tablets

Question 35

Name a medication that is anti IgE

Answer 35

Omaluzimab

Question 36

What does COPD stand for

Answer 36

Chronic obstructive pulmonary disease

Question 37

What is COPD

Answer 37

Airflow obstruction that is not reversible

Question 38

What causes COPD

Answer 38

Smoking

Question 39

What is the mechanism of smoking for COPD

Answer 39

Smoking stimulate proteases and oxidants | This leads to parenchymal damage and mucus hypersecretion

Question 40

What changes do you get in the lungs with COPD

Answer 40

``` Mucocillary dysfunction Airflow limitation Breakdown of alveoli Osteoporosis Loss of muscle mass ```

Question 41

What would the FEV1/FVC ratio be in COPD

Answer 41

Less than 0.7

Question 42

How do we differentiate between asthma and COPD

Answer 42

COPD: Smoker Chronic productive cough Persistent breathless Asthma: Night time waking with breathlessness or wheeze Signification diurnal variability of symptoms

Question 43

What is the management of COPD

Answer 43

``` Short acting beta agonist Then Long acting muscarinic antagonist Then Add steroid in patients with elevated inflammation ```