L17 - Flashcards
Bronchiectasis
- permanent dilation of bronchi
- happens from untreated lung disease
Clinical Features/Symptoms
- chronic cough & significant mucus production
- SoB, coughing up blood
- wheezing & constant infections
- excessive inflammatory response
Caused by: cystic fibrosis (50%)
Diagnosis & Treatment of Bronchiectasis
Diagnosis: high-resolution computed tomography HRCT scan performed, showing persistent airway dilation
Treatment Brensocatib 24weeks
lifestyle - avoid smoking, get exercise, good nutrition
Antibiotics: macrolides & Vaccinations
Pneumonia Mechanism for Infection
- caused by: bacteria, virus, fungi
- infections reach the alveoli and cause inflammatory response.
- alveoli fill with fluid, WBC ,proteins & RBC
symptoms: dyspnoea, cough, fever & chest pain
Treatment for Pneumonia
Mild/Moderate
- treat infection with antibiotics
Severe
- oxygen therapy
Cystic Fibrosis
- genetic susceptibility
Autosomal Recessive Genetic Disease
- caused by mutation in the gene that encodes the (CFTR)
Normal Lung: Cl- ions pass out of cell with Na+ + H2O
CF Lung : CFTR is blocked & Cl- ions cant leave the cell
Treatment
- Dornase-a
Management of Cystic Fibrosis
Treatment
- anti-inflammatory if >6 (prednisolone, ibuprofen)
- Ivacaftor (keeps Cl- ion channel open
- Oral/IV antibiotics (mild/severe)
Symptom Management
- SABA
Interstitial Lung Disease
- Pathophysiology
- “ground glass” appearance
Treatment
- oral corticosteroid Prednisolone
- (IV methylprednisolone for exacerbations)
- Rutiximab + methotrexate
Allergic Broncho Pulmonary Aspergillosis
- ABPA
- inhaled pathogen causing many infections and pulmonary disease
allergy to the aspergillosis mould
- fungal hyphae colonise mucus plugs in airways
- increased IgE antibody levels leads to inflammatory response when mast cell activated
- local and systemic eosinophilia, and probable local neutrophilia.
- Increase of helper T cell subset 2 (TH2) CD4+ cells
Chronic Pulmonary Aspergillosis
- CPA
- long-term lung infection
- Lung Structural Changes from other diseases (COPD) provide environment for fungal cell growth
- IgG levels increase
- chronic inflammation , also weight loss, dyspnoea
Invasive Pulmonary Aspergillus
- IPA
- Aspergillosis hyphae invades the lungs arterioles leading to ischemic necrosis
- affects immunocompromised patients
IPA Treatments
1- Azole (voriconazole)
- targets ergosterol precursors to selectively inhibit ergosterol. stops fungal growth
Drug Resistance
- fungi eventually efflux azole out of cell (resistance)
- fungal cell may change mechanism of ergosterol biosynthesis so that Azole can’t inhibit its growth
S/E - sight issues, rash, hepatitis
- AMB - broad-spec antifungal
- binds to ergosterol directly causing cell lysis by leakage
Aspergillosis Treatment
1- Liposomal Amphotericin B
2- Echinocandins (caspofungin)
- AMB - broad-spec antifungal
- binds to ergosterol directly causing cell lysis by leakage - Caspofungin
- interferes with fungal cell wall biosynthesis by non-competitive inhibition of B(1,3)-D-glucan
Cough Phases
- Inspiratory Phase
- compression
- expiratory
- inhalation , generating the necessary volume for effective cough
- compression - pharynx closes while chest muscle contracts the diaphragm resulting in higher intrathoracic pressure
- Expiratory - Glottis opens causing high expiratory flow
- large airway compression happens
- high airflow dislodges mucus
Cough Types & Their Treatments
Above Larynx
- Demulcents used to coat the tissue
Below Larynx
- steam inhalation
- menthol can block TRPV1 channels
Far Below Larynx
- C-Fibres not stimulated by mechanical respiration
- SAR - controls respiration reflex
Muco-Active Drugs for Cough
- viscous mucus cant be cleared by cilia , needs to be made thicker
N-acetylcysteine + Carbocystiene
- break di-sulphide bonds in mucins to decrease viscosity and make it easier to clear mucus
Guaifenesin (expectorant)
- stimulates mucus secretion to encourage productive cough
