LUNGS- respiratory diseases Flashcards by lara monaghan

What are the symptoms shown by a patient with respiratory problems?

Cough- can be Dry or productive (sputum or blood)
Wheeze- making a noise breathing out
Stridor- making a noise breathing in
Dyspnoea- trouble breathing
pain (in general or from inspiration)

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What do we look for when examining a patient with respiratory problems?

Is their respiratory rate 12-15 per minute
Is their chest moving?
Is air entering the lungs symetrically (or is entry reduced?)
Percussion- can you hear noise? (yes, if lungs are filled with fluid)

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What investigations can we undertake for someone with a respiratory problem?

Chest radiograph

Sputum examinations

Measure pulmonary function (PEFR, FEV1, FEV1/VC)

Bronchoscopy

Check for ventillation perfusion mismatch.

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What is FEV₁

Forced expiratory volume

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What is PEFR?

Peak expiratory flow rate- can be used to measure how fast you can get air out of your lungs.

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What is asthma?

Asthma is a reversible airflow obstruction caused by bronchial hyper-reactivity.

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Describe the mechanism of asthma

Contraction of smooth muscles due to mast cell granulation.

Production of thicker mucous

Inflammation and swelling of the airway

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Explain what is meant by the byphasic immune response of asthma?

If you survive the early asthma response you will get better.

But then you get worse again because the late asthmatic response.

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How is asthma treated?

Depending on the severity:

Least severe: short acting beta 2 agonist
beta 2 agonist + low dose corticosteroid
High dose corticosteroid
Long acting beta 2 agonist
steroid tablet

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What are Chronic obstructive pulmonary diseases?

A mix of chronic airway obstruction and a destructive lung disease e.g emphysema and asthma

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What is emphysema?

When some alveoli are destroyed, and the others become inflamed to fill the space.

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Describe the effect of COPD on the pulmonary system?

Restricted airways- the airways have inflamed walls and are filled with mucous.

Abnormal alveoli (some damaged so others are enlarged sacks to fill the space)

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How do we manage COPD?

Smoking cessation to stop it getting worse
Using bronchiodilators to improve ventillation
Inhaled steroids
Systemic steroids
Oxygen support
Pulmonary rehabilitation therapy.
*

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Why can we not use the medication a patient is taking to assess the severity of their COPD?

The medication is not given based on severity, it is based on reversibility.

Someone with COPD due to inflamed airways has a better chance of succesful treatment than someone who has alveoli problems.

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How does COPD lead to respiratory failure?

Due to the combination of reduced gas exchange (due to thickened alveolar mucosal barrier)

Poor ventillation (narrowed airways)

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Compare type 1 and type 2 respiratory failure

Type 1 is oxygenation failure. Type 2 is ventillation failure.

Type 1 causes Hypoxaemia (decreased partial pressure of O₂) due to failure of diffusion through the thickened alveolar barrier.

Type 2 causes Hypercapnia (increased CO₂) due to the body struggling to get rid of CO₂

Partial pressure of O₂ <8 kPa. Partial pressure of CO₂> 6.7 kPa

What causes type 1 respiratory failure?

Poor alveolar respiration

abnormal diffusion

Mismatching between ventillation and perfusion.

What causes type 2 respiratory failure?

Airway blockage/ narrowing

Muscle dysfunction

Reduced compliance (ability to expand)

Infections that cause a sudden deteroration from chronic to acute.

How is breathing controlled in a normal individual?

You breathe due to high CO₂ levels in the blood.

How is breathing different in an individual suffering from COPD?

Individuals suffering from COPD are tolerant to CO₂ as a result, the receptors are less sensitive to the CO₂ build up and so the individual is less likely to breathe.

It is Hypoxia- the low O₂ levels in the tissues that causes the patient to breathe.

Discuss the oral health issue with inhaled steroids?

Patients who take corticosteroid inhalations are at greater risk of developing candida. The steroid causes immune supression which allows the fungal infection to occur.

We prevent this by rinsing your mouth after taking the inhalation and using a spacer device to deliver the inhaled steroid.

What is cystic fibrosis?

This is when there is excessive sticky mucous produced on any surface where mucous is secreted (affected by the lungs and pancreas)

How do we diagnose cystic fibrosis?

Heel prick at birth- blood tests

Sweat test- as there would be increased salt levels in a patient with CF

What are some of the symptoms of cystic fibrosis?

Troublesome cough to try and get rid of mucous

repeated chest infections

Prolonged diarrhoea

poor weight gain

Liver dysfunction

diabetes symptoms

reduced fertility

Prone to osteoporosis

How is cystic fibrosis treated?

Physiotherapy- to remove the mucous from the airways Excercise- to keep the lung function optimal Transplantation (for end stage lung disease) bronchiodilators- open up the airways and make it easier to get mucous out Antibiotics- to reduce the risk of chest infection Dnase- to break down mucous Pancreatic enzyme replacement for the digestive system.

What are symptoms of lung tumours?

Coughing Blood stained sputum (haemophytsis) Pneumonia Dysphagia Superior vena cava obstruction Hoarseness (due to recurrent laryngeal nerve palsy)

How do we treat lung tumours?

In the majority of cases, the tumour is found too late (once the cancer has spread) so we make the patient comfortable until they die

How do we prevent lung tumours?

Don't smoke

What is Obstructive sleep apnoea?

This is when the patient's airway closes, and the tongue flops against the soft palate. This prevents the patient from breathing while they are asleep. Chronic hypoxia occurs while asleep. This wakes the patient up every few minutes to move and breathe.

What is central sleep apnoea?

When the body doesn't ask the patient to breathe.

What are the symptoms of sleep apnoea?

Drowsiness during the day (because they have been constantly woken up at night) Snoring Sounding like they are being strangled when they sleep

How do we treat sleep apnoea?

**Continuous Positive Airway Pressure** - This blows air into your upper airway to preventing the airways from closing **Mandibular advancement device**- a gumshield which keeps the mandible further forward to keep the mouth open and the tongue away from the back of the mouth.

What is a sign a patient is about to have an asthma or COPD attack?

The patient is unable to form sentences.

How do we treat COPD using oxygen, and why?

In acute COPD- we use all the oxygen In chronic COPD- we used a fixed rate of oxygen. As the patient relies on being hypoxic to breathe. Giving the patient 15L of O₂ will remove the drive to breathe. They will stop ventilating & become hypercapnic (type 2 COPD )