medical respiratory conditions Flashcards
describe COPD and its characteristics
COPD= chronic obstructive pulmonary disease
-it is a common, preventable and treatable disease that is characters tided by persistent respiratory symptoms and airflow limitation
in relation to COPD, what does a limitation of airflow mean?
it means that is is difficult to exhale fully
-spirpmetry shows a reduced ratio of FEV1:FVC - key for diagnosis
what structural changes can chronic inflammation lead to?
narrowing of the small airways, decreased elastic recoil, parenchyma destruction (sites of exchange)
-this leads to a diminished ability of the lungs to stay open during expiration
what 2 conditions is COPD associated with?
1.chronic bronchitis - inflammation and narrowing of the airways and mucous production
2. emphysema - break down of the alveolar membranes
what are examples of factors that can influence the development and progression of COPD?
-smoking
-exposure to pollutants
-age
-sex - women tend to have more severe disease
-infections
-lung growth and development
what is an alpha antitrypsin deficiency (AATD)?
a deficiency that affects the production of alpha 1 antitrypsin - which plays a crucial role in protecting the lung from damage caused by enzymes released by WBC’s
-these enzymes can destroy alveolar walls if not properly regulated by AAT
what are the most common symptoms of COPD?
-shortness of breath
-cough - intermittent or chronic cough
-sputum prediction - not present in all patients
-wheezing and chest tightness
-fatigue, weight loss and muscle loss
what is hyperinflation in COPD?
refers to the abnormal increase in the volume of air remaining in the lungs at the end of normal exhalation - this occurs because people with COPD have narrowed or obstructed airways making it difficult to exhale
what are the 2 types of hyperinflation in COPD?
-static
-dynamic
define static hyperinflation
-refers to the increase in lung volume that remains constant over time - ie there is an abnormal increase in the amount of air left in the lungs after exhalation which doesnt change much with activity
define dynamic hyperinflation
the increase in lung volume that happens during physical activity eg exercise
- eg if a person with COPD exercises, their airways might become more obstructed, leading to more air being trapped in the lungs during each breath
what are morbidities?
morbidities refer to the presence of one of more diseases or health conditions in a person
what morbidities is COPD associated with?
- cardiovascular disease
- skeletal muscle dysfunction
-metabolic syndrome
-osteoporosis
-lung cancer
-depression and anxiety
what are COPD exacerbations?
-episodes where the symptoms of COPD worsen significantly compared to the usual state
- eg increased breathlessness, coughing, changes in sputum , wheezing etc
what important test is required to diagnose COPD?
lung spirometry - the presence of a FEV1/FVC less than 0.7 confirms the presence of airflow limitation
what is FVC?
the amount of air that can be forcibly exhaled from your lungs after taking the deepest breath possible, as measured by spirometry
what is FEV1?
forced expiratory volume in 1 second
-measures the volume of expired air over the first second of an FVC measure
-healthy lungs will exhale more than 80% of the FVC in the first second
describe GOLD stage 1, stage 2, stage 3 and stage 4 values in relation to FEV1/FVC values
-GOLD stage 1 (mild) - FEV1 will be less than 80%
-GOLD stage 2 (moderate) - FEV1 between 50 and 80% predicted
-GOLD stage 3 (severe)- FEV1 between 30-50% predicted
-GOLD stage 4 - very severe - FEV1 less than 30%
what is the modified MRC dyspnea scale?
it is a tool used to assess the level of breathlessness or dyspnea experienced by people, particularly those w/ chronic respiratory conditions eg COPD etc
what is the BORG breathlessness scale?
a subjetive tool used to measure the intensity of breathlessness experienced by people - using a scale range 0-10what
what is the ACBD tool?
a structured assessment tool to evaluate and manage patients with COPD- stands for A (assess exacerbation freq), C (comorbidities), B (breathlessness), D (daily functioning)
what does the pharmacological treatment of COPD involve?
-bronchodilators
-antiinflammatories
-oxygen therapy
-mucolytics (meds to help break down mucous)
-corticosteroids
what does non-pharmacological treatment of COPD involve?
-pulmonary rehab
-smoking cessation
-nutrition
-airway clearance techniques
-surgery - lung volume reduction surgery, lung transplant etc
what are endobronchial valves?
they are one way valves that restrict airflow to a particular lung segment
what are the goals of management of COPD?
-relieve symptoms
-improve exercise tolerance
-improve health status
-prevent disease progression
-reduce mortality
what is the strongest predictor of mortality for people with COPD?
physical activity
-people with COPD who are more active experience fewer hospitalisations and exaceberations
what is asthma?
-asthma is usually characterised by chronic airflow limitation
-defined by the history of respiratory symptoms such as wheeze, SOB, chest tightness and cough
-both symptoms and airflow limitation vary over time and intensity and they can be triggered by exercise, allergens etc
compare COPD vs asthma
-COPD- onset in mid line, symptoms slow and progressive, long smoking history, largely irreversible airflow limitation
-asthma - early onset in life, symptoms vary from day to day, may have associated allergic disease, largely reversible airflow limitation
what is the treatment for asthma?
-inhaled corticosteroid inhaler
- preferred reliever - long active beta agonist
define bronchiectasis
the term used for the permanent dilation of 1 or more bronchi
what is non CF bronchiectasis?
refers to a broad set of conditions that give rise to airway injury that result in inflammation, increased mucus secretions and infections that produce airway dilatation
what are the key features if non CF bronchiectasis?
-bronchial dilation
-mucus accumulation
-recurrent infections
-chronic cough & sputum production
what are examples of some causes of non CF bronchiectasis?
-lung infection eg TB, pneumonia, whooping cough
-immunodeficiency
-local airway obstruction eg tumour, COPD, foreign body
-environmental exposures
what are the main symptoms of non CF bronchiectasis?
-sputum - sometimes blood stained
-chronic cough
-SOB
-fatigue
what does the pharmacological management of non CF bronchiectasis involve?
-mucolytic
-antibiotic
-corticosteroids
-bronchodilators
-oxygen therapy
what is cystic fibrosis?
a genetically inherited disease that primarily affects the lungs and digestive system
what is the genetic cause of CF?
-genetic mutation causes abnormalities in the production & function of a protein called the cystic fibrosis transmembrane conductance regulator
-CTFR acts as a chloride channel and a regulator of sodium chloride and bicarbonate transport
what does inactive or compromised functioning of CTFR lead to?
impaired chloride transport and increased sodium absorption across airway epithelial cells
-dehydrates the airway surfaces and more viscid mucus
-cilia become impaired due to very sticky mucus, resulting in a build up of secretions
how do you diagnose CF?
genetic testing
-sweat test - high conc of electrolytes in the sweat are a hallmark of CF - sweat chloride levels
how is CF managed pharmacologically ?
-antibiotics
-bronchodilators
-hydrator therapy
-mucolytics
-CFTR modulators
how is CF managed non pharmacologically?
-nutrition support
-airway clearance techniques - physio
-exercise
-surgery - lung transplant
what is interstitial lung disease?
it is an umbrella term for a large group of disorders that cause scarring of the lungs
-the scarring causes stiffness in the lungs which makes it difficult to breathe
what are examples of interstitial lung diseases?
-idiopathic pulmonary fibrosis
-hypersensitivity pneumonitis
what is idiopathic pulmonary fibrosis?
chronic and progressive lung disease characterized by the thickening and scarring (fibrosis) of the lung tissue
-cause is not known
what are the symptoms of IPF?
-SOB
-non productive cough
-fine crackles on auscultation
compare the pharmacological vs non pharmacological management of IPF
- pharma =. corticosteroids, immunosuppressive agents, o2 therapy, anti-fibrotic agents
- pulmonary rehab, surgery, management of breathlessness etc
