Lecture 19 - Chronic Airflow limitation

Question 1

what is asthma?

Answer 1

Chronic infalmmatory disorder of the airways

often associated with atopy

SymptomsL recurrent episodes of wheezing, breathlessness, chest tightness and coughing

Widespread, variable, usually reversible airfow limitations

Question 2

The allergen can stimilate which two cells in asthama pathophysiology?

Answer 2

mast cell (usually) or macrophage cell

causes mucos production and vasodilation and angiogenesis

Question 3

What happens to the subepitheliual collagen layer in asthmatics?

Answer 3

Remodelling causes it to thicken

in addition, the infiltration of inflammatory cells causes an increase in mucosal vascularity

Question 4

What happens to smooth muscle volume in asthamatic remodelling?

Answer 4

increases a lot. - augments the airway hyperresponsiveness

Question 5

The narrower a luminal diameter..

Answer 5

the high the airflow resistance (der)

Question 6

FEV1 is affected ___ than FVC in patients with obstructive lung disease

Answer 6

more - FVC can be fully preserved in cases

Question 7

Why do patients feel breathless with obstructed airways?

Answer 7

here is a change in the “work of breathing” - change in the load

Breathlessness is a recognition of an inappropriate degree of respiratory work for body workload

Question 8

What are the factors that exacerbate asthma?

Answer 8

Allergens
resp. infections
pollutants
Exercise and hyperventilation
weather changes
food, additives, drugs
emotion

Question 9

How do you make a diagnosis of asthma?

Answer 9

appropriate clinical setting

need to demonstrate reversible airflow obstruction (peak flow, spirometry - reduced FEV1)

Bronchoprovocation test - measures hyper-reactivity

Question 10

Targetting the inflammation that causes airway hyperresponsiveness is due using…

Answer 10

anti-inflammatory steroids (usually)

sometimes monoclonal antibodies

Question 11

Remember asthma treatment is more than just …

Answer 11

pharmacotherapy (although its important)

Question 12

Asthma medication tries to minimise the underlying pathophysiology - what are all the medication options?

Answer 12

beta 2 agonists

inhaled corticosteroids (preventer)

oral corticosteroids - only for severe asthmatics

combination inhalers

leukotriene receptor antagonists

anti-IgE

Question 13

clinical effect for corticosteroids is at what dosage?

Answer 13

a very modest amount - point of difference with COPD which needs higher doses

Question 14

What is COPD

Answer 14

group of disorders characterised by airway inflammation and airflow limitation that is not fully reversible

A progressive condition associated with an abnormal inflammatory response to noxious stimuli (almost always cigarettes)

fully reversible asthma is not COPD

Question 15

What are the two broad categories of COPD?

Answer 15

Emphysema - loss of airway tissue

Chronic bronchitis - inflammation and speutum production

Question 16

What are the COPD stats in Australia

Answer 16

3rd leading cause of disease burden in Australia

Fourth leading cause of death in Australian men & 6th in women

nearly 500,000 people in Aus with moderate to severe COPD

mortality of COPD 10-times higher in indigenous Australians

Among principal causes of death, only COPD continues to have a growing death rate

Question 17

COPD is currently what (in terms of diagnosis)

Answer 17

under-diagnosed
under-recognised
under-treated

COPD is preventable and treatable but largely unknown to health care professionals

Question 18

smoking is responsible for __ -__% of COPD cases

Answer 18

smoking is responsible for 80-90% of COPD cases

Question 19

Up to ___% of long-term smokers develop COPD

Answer 19

50%

15-20% develop severe airflow limitation

Question 20

Inflammation , caused by noxious agents acts in two parts of the lungs, what are they?

Answer 20

Small airway disease - Airway inflammation, airway remodelling

Parenchymal destruction - loss of alveolar attachments, loss of elastic recoil

Question 21

What are the inflammation damages from COPD?

Answer 21

Mucociliary dysfunction
strutural changes
Airway inflammation
systemic component

Question 22

Around one thurd of pateints with COPD grow _____from respiratory specimen during stable state

Answer 22

bacteria

Question 23

Bong hits are bad because?

Answer 23

Temperature of air is much hotter and there are fungi in the (pure) form

Question 24

There is alot of shared genetic predispositions between COPD and ___ ___

Answer 24

lung cancer - comorbid

Question 25

What are the non-pharm. and pharm. smoking cessation strategies?

Answer 25

non-pharmacologic:

will power
doctor's advice
self-help material
councelling
courses

Pharmacologic:

Nicotine replacement therapy
bupropion (partial agonists of nicotine receptor)
varenicline (partial agonists of nicotine receptor)

Question 26

true or False

b2 agonists (long-acting) are standard treatment

Answer 26

true

Question 27

Long-acting anticholinergics are demonstrated to achieve

Answer 27

less dyspnoea
better exercise tolerance
less exacerbations
less mortaility

Question 28

The only patients that will benefit from inhaled corticosteriods is…

Answer 28

those with frequent exacerbations

higher doses needed than in athsma

risk of pneumonia is increased

Question 29

Other are other treatment options for COPD?

Answer 29

Theophylline

long erm antibiotics

pulmonary rehabilitation

vaccinations (particularly influenza)

oxygen (only for those with significant resting hypoxia)