Lecture 20 - Asthma and Chronic Obstructive Pulmonary Disease Flashcards
Cells producing inflammatory mediators in asthma and COPD
Mast cells, alveolar macrophages
Airway cell transformation
Formation of goblet cells in epithelial layer.
Increase in airway smooth muscle (rarely seen in normal airways)
Epithelial collagen thickening.
Effect of obstructive lung disease on FEV1 and FVC
Decrease in FEV1.
FVC only decreased in severe obstructive disease
Infectious diseases that particularly affect asthmatics
Viral
How can symptom presentation rule out asthma?
If symptoms are persistent (asthmatics typically are healthy in between attacks)
Diagnostic test for asthma and COPD
Spirometry.
Diagnostic criteria for asthma.
1)
2)
1) FEV:FVC ratio under 0.7 is diagnostic.
2) Look for improvement in forced expiratory ratio with exposure to a bronchodilator
Way to test for exercise-induced asthma
Bronchoprovocation (hyperventilation, inhalation of methocholine).
A greater than 20% drop in FEV1 is diagnostic of asthma
Appearance of FEV1 with asthma
‘Scalloped’ tail of graph.
Corticosteroid reserved for most-severe asthmatics
Prednisolone
Are large doses of corticosteroids needed?
No
At what dose of corticosteroids does oral candiasis present?
Over 1000ug/day
What is COPD?
A heterogeneous group of phenotypes resulting in obstructive lung disease.
Fixed, non-improving airway obstruction.
Two types of COPD
1) Emphysema (destruction of lung parenchyma)
2) Chronic bronchitis (inflammation, sputum production)
Proportion of the time that COPD is associated with smoking in the developed world.
~95% of the time
