LUNGS- respiratory diseases

Question 1

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

Answer 1

• 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)

Question 2

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

Answer 2

• 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)

Question 3

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

Answer 3

Chest radiograph

Sputum examinations

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

Bronchoscopy

Check for ventillation perfusion mismatch.

Question 4

What is FEV₁

Answer 4

Forced expiratory volume

Question 5

What is PEFR?

Answer 5

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

Question 6

What is asthma?

Answer 6

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

Question 7

Describe the mechanism of asthma

Answer 7

Contraction of smooth muscles due to mast cell granulation.

Production of thicker mucous

Inflammation and swelling of the airway

Question 8

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

Answer 8

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

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

Question 9

How is asthma treated?

Answer 9

Depending on the severity:

1. Least severe: short acting beta 2 agonist
2. beta 2 agonist + low dose corticosteroid
3. High dose corticosteroid
4. Long acting beta 2 agonist
5. steroid tablet

Question 10

What are Chronic obstructive pulmonary diseases?

Answer 10

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

Question 11

What is emphysema?

Answer 11

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

Question 12

Describe the effect of COPD on the pulmonary system?

Answer 12

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)

Question 13

How do we manage COPD?

Answer 13

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

Question 14

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

Answer 14

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.

Question 15

How does COPD lead to respiratory failure?

Answer 15

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

Poor ventillation (narrowed airways)

Question 16

Compare type 1 and type 2 respiratory failure

Answer 16

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

Question 17

What causes type 1 respiratory failure?

Answer 17

Poor alveolar respiration

abnormal diffusion

Mismatching between ventillation and perfusion.

Question 18

What causes type 2 respiratory failure?

Answer 18

Airway blockage/ narrowing

Muscle dysfunction

Reduced compliance (ability to expand)

Infections that cause a sudden deteroration from chronic to acute.

Question 19

How is breathing controlled in a normal individual?

Answer 19

You breathe due to high CO₂ levels in the blood.

Question 20

How is breathing different in an individual suffering from COPD?

Answer 20

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.

Question 21

Discuss the oral health issue with inhaled steroids?

Answer 21

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.

Question 22

What is cystic fibrosis?

Answer 22

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

Question 23

How do we diagnose cystic fibrosis?

Answer 23

Heel prick at birth- blood tests

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

Question 24

What are some of the symptoms of cystic fibrosis?

Answer 24

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

Question 25

How is cystic fibrosis treated?

Answer 25

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.

Question 26

What are symptoms of lung tumours?

Answer 26

Coughing

Blood stained sputum (haemophytsis)

Pneumonia

Dysphagia

Superior vena cava obstruction

Hoarseness (due to recurrent laryngeal nerve palsy)

Question 27

How do we treat lung tumours?

Answer 27

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

Question 28

How do we prevent lung tumours?

Answer 28

Don’t smoke

Question 29

What is Obstructive sleep apnoea?

Answer 29

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.

Question 30

What is central sleep apnoea?

Answer 30

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

Question 31

What are the symptoms of sleep apnoea?

Answer 31

Drowsiness during the day (because they have been constantly woken up at night)

Snoring

Sounding like they are being strangled when they sleep

Question 32

How do we treat sleep apnoea?

Answer 32

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.

Question 33

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

Answer 33

The patient is unable to form sentences.

Question 34

How do we treat COPD using oxygen, and why?

Answer 34

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 )