Lung Flashcards
What proportion of pregnant women have asthma?
8%
Most severe asthma in which weeks of pregnancy?
24, 25 and 26
What is poorly controlled asthma in pregnancy linked with?
Pre-eclampsia Pre-term birth IUGR Perinatal death Congenital malformations
How many women experience dyspnoea in pregnancy?
60%
What can you use to monitor asthma in asthmatic pregnant women?
FEV1 (doesn’t change in pregnancy even though resp minute volume increases)
How many women experience improvement/no change/worsening of their asthma in pregnancy?
Improvement: 34%
Unchanged: 26%
Worsen: 36%
What improvement in FEV1 is expected after salbutamol therapy?
12% improvement or more
What are the differential diagnoses for breathlessness in pregnancy?
Dyspnoea of pregnancy PE Amniotic fluid embolism Bronchitis/pneumonia Post nasal drip (rhinitis) Congestive heart failure/cardiomyopathy GORD Vocal cord dysfunction Dysfunctional breathing
Management of asthma in pregnancy
Smoking cessation Vaccination Body weight Folate Routine monitoring Eduction about SE and adherence Control of environmental triggers Inhaler techniques Management of existing conditions
What asthma treatments cannot/should not be used in pregnancy?
Leukotriene receptor antagonists
Anticholinergics
Immunotherapy
What is the advice for oral corticosteroids?
Not teratogenic
Small risk of cleft lip
Associated with low birth weight and pre-eclmapsia but possible confounding variable is severity of asthma
Benefits outweigh risks of uncontrolled asthma!
Is there any genetic link to maternal asthma?
ADAM33 gene is induced in allergic maternal asthma
Advice of how to avoid allergens?
Remove pets from home
Encase pillow and mattress with impermeable covers
Wash sheet and blankets weekly in hot water
Any advice for labour with maternal asthma?
Avoid carboprost, ergonovine and indomethacin
Instead use prostaglandin, MgSO4 or terbutaline
What other diseases are included in the COPD diagnosis?
Chronic bronchitis, emphysema and asthma
Spirometry diagnosis of COPD?
FEV1/FVC ratio less than 0.7
No reversibility with B2 agonists
What is LTOT?
Long term oxygen therapy
Increases survival for those with chronic respiratory failure
Lowers cardiac risk and improves cognition (not as hypocapnic)
What are the arguments for smoking cessation in COPD?
Improves mortality and health quality Makes oxygen less risky Inhalers work better Less exacerbations Improves mental and cardiovascular health
Treatment of COPD?
Inhaled antimuscarinics + LABAs + steroids
Stand by oral steroids and antibiotics
Mucolytics
What can be offered for repeated infective exacerbations of COPD?
Long term macrolide antibiotics
eg clarithromycin
What is interstitial lung disease?
Any disease that affects the space between alveolar epithelium and capillary endothelium
Inflammation, fibrosis and remodelling
Name 3 exposure related ILD causes
Occupational (asbestosis)
Environmental (dust mite hypersensitivity)
Medication (bleomycin)
CT disease
Name the major idiopathic pulmonary fibroses
Idiopathic pulmonary fibrosis
Idiopathic non specific interstitial pneumonia
Respiratory bronchiolitis interstitial lung disease
What is the most frequent ILD?
Idiopathic pulmonary fibrosis
Incidence is increasing
Median survival 3 yrs
Risk factors for idiopathic pulmonary fibrosis
Genetics (MUC58, TOLLIP, Telomerase) Cigarette smoking > 20 pack years Metal and woods dusts, farming, raising birds, stone cutting Herpes viruses, EBV, CMV, Hep C GORD
Presentation of idiopathic pulmonary fibrosis
Increases with age, males more than females Exertional dyspnoea Dry cough Digital clubbing Diffuse inspiratory crackles
Diagnosis of idiopathic pulmonary fibrosis relies on:
Exclusion of other ILDs (CT diseases, environmental exposures, medications)
Presence of ‘Usual Interstitial Pneumonia’ (UIP) pattern on chest High Res Chest CT/surgical lung biopsy
What does the ‘usual interstitial pneumonia’ pattern if disease involve?
Bilateral patchy fibrosis Basal/peripheral predominance Reticular line and fibroblast foci Honeycombing Traction bronchiectasis Architectural distortion
When is a lung biopsy taken?
In ILD if HR CT is nor diagnostic
Mortality is 1-3%
Can have serious complications (pneumothorax, pneumonia, empyema, haemothorax)
What factors are involved in the pathogenesis of ILD?
Myofibroblast accumulation and angiogeneis
TGFBeta, CTGF, ET-1, PDGF, VEGF
Excessive ECM and collagen
Treatment of ILD?
Pulmonary rehab O2 therapy Symptom control Lung transplantation Pirfenidone (anti TGF beta) Nintedanib (anti PDGF, VEGF, FGF)
What pattern of disease is seen in TB?
Apical lung cavitation
Casseous necrosis
Presentation of TB
Night sweats
Cough
Weight loss
(for 6 months?)
How is the diagnosis of TB made?
Sputum Ziehl-Nielsen stain
Induced sputum (culture takes weeks)
Bronchoscopy
Describe how a TB culture is done?
Induced sputum culture
Decontamination of specimens to avoid bacterial overgrowth
Solid media
Bactec 460 radiometric culture detects CO2 production so only takes 1-3 weeks
Treatment of TB
Rifampicin Isoniazid Pyrazinamide Ethambutol (for 6 months minimum) Nutritional support Steroids?
Why is drug resistance a threat?
Can take 18months of treatment if multiple drug resistant
Totally drug resistant strain found in India in 2012
Why are cavities and extracellular matrix destruction key to the success of TB?
Spread of organism
Cavities permit immune evasion
Other mycobacteria and fungi can colonise cavities
Aerosol super-spreaders
What are MMAs?
Matrix metalloproteinases
Can degrade fibrillar collagens at neutral pH
Are needed for cavity formation and transmission
Doxycycline suppresses MMP secretion and TB growth
What is the role of MMAs in treatment?
Doxycycline suppresses MMP secretion and TB growth
Decreases cavitation and spread
