Obstructive Airway Disease

Question 1

Airways lead to obstructive or restrictive disease

Answer 1

obstructive

Question 2

lungs = restrictive or obstructive

Answer 2

restrictive

Question 3

list common obstructive airway syndromes

Answer 3

asthma
chronic bronchitis
emphysema
ACOS asthma/COPD overlap syndrome (COPD = reversibility / eosinophilia = steroid response)

Question 4

name the conducting zones

Answer 4

trachea - bronchi - bronchioles

Question 5

name the acinar zones

Answer 5

terminal bronchioles alveolar ducts/sacs

Question 6

conducting zones are used for

Answer 6

gas transport

Question 7

acinar zones are used for

Answer 7

gas exchange

Question 8

list the large airways

Answer 8

trachea bronchi

Question 9

list the small airways

Answer 9

bronchioles terminal bronchioles alveolar ducts/sacs

Question 10

large airway size

Answer 10

> 2mm

Question 11

small airway size

Answer 11

<2mm

Question 12

Name the 3 features of the asthma triad

Answer 12

Reversible airflow obstruction
Airway inflammation
Airway hyper-responsiveness

Question 13

Describe the hallmarks of asthma remodelling

Answer 13

Basement membrane = thickening
submucosa = collaged deposition
smooth muscle = hypertrophy

Question 14

Inflammatory Cascade in asthma

Answer 14

Inherited or acquired factors

• genetic predisposition
• viral, allergen, or chemical

eosinophilic inflammation

mediators/ Th2 cytokines

twitchy smooth muscle (hyperactivity)

Question 15

How to treat inflammatory cascade in asthma

Inherited or acquired factors

• genetic predisposition
• viral, allergen, or chemical

Answer 15

Avoidance of percipitant

Question 16

How to treat inflammatory cascade in asthma

eosinophilic inflammation

Answer 16

anti-inflammatory medication

• coticosteroids
• cromones
• theophylline

Question 17

How to treat inflammatory cascade in asthma

mediators/ Th2 cytokines

Answer 17

antileukotrienes or antihistamines
monoclonal antibodies
-anti IgE/ anti-interleukin 5

Question 18

Asthma triggers

Answer 18

Allergens

• animal disorder
• dust mites
• pollens
• fungi

Others

• exercise
• viral infection
• smoke
• cold
• chemicals
• drugs (NSAIDs, B blockers)

Question 19

Asthma clinical setting

Answer 19

episodic symptoms + signs
diurnal variability - nocturnal/early morning
non productive cough/wheeze
triggers
associated atopy increase IgE (rhinitis, conjunctivitis, eczema)
Blood eosinophilia >4%
Responsiveness to steroids or beta agonists
Family history of asthma
Wheezing fue to turbulent airflow

Question 20

Diagnosis of asthma

Answer 20

History + examination
Diurnal variation of peak flow rate
Reduced forced expiratory ratio (FEV1/FVC <75%)
Reversibility to inh. salbutamol >15%
Provocation testing = bronchospasm
-exercise
-histamine/methacholine/mannitol

Question 21

List the 3 factors in the development of obstruction + ongoing disease progression

Answer 21

mucocilliary dysfunction
inflammation
tissue damage

Question 22

list the characteristics of COPD development

Answer 22

Exacerbations

Reduced lung function

Question 23

list the symptomsof COPD development

Answer 23

breathless

worsening quality of life

Question 24

COPD disease process

Answer 24

cigarette smoke
inflammation of lungs
COPD = normal protective +/or repair mechanisms overwhelmed/defective
Activate macrophages + airway epithelial cells
release neutrophil chemotatic factors incl. IL 8 and B4
Release proteases
Breakdown connective tissue
Mucus hyper-secretion
Proteases = counteracted by portease inhibitors (a1-antirypson, secretory leukoprotease inhibitor + tissue inhibitors of matrix metalloproteinases)

Question 25

Characteristics of chronic bronchitis

Answer 25

``` chronic neutrophilic inflammation mucus hypersecretion mucociliary dysfunction altered lung dysfunction smooth muscle spasm and hypertrophy partially reversible ```

Question 26

emphysema characteristics

Answer 26

alveolar destruction impaired gas exchange loss of bronchial support irreversible

Question 27

assessment of COPD

Answer 27

assess symptoms assess degree of airflow limitation using spirometry assess risk of exacerbation assess comorbidites (IHD/HF)

Question 28

high risk COPD indicataors

Answer 28

2 exacerbations or more within the past year | FEV1<50%

Question 29

COPD = clinical

Answer 29

``` chronic symptoms - not episodic smoking non-atopic daily productive cough progressive breathlessness frequent infective exacerbations chronic bronchitis - wheezing emphysema - reduced breath sounds ```

Question 30

chronic cascase in COPD

Answer 30

progressive fixed airflow obstruction impaired alveolar gas exchange resp failure (decrease PaO2 increased PaCO2) pulmonary hypertension right ventricular hypertrophy (cor pulmonale) death

Question 31

effect of stopping smoking

Answer 31

arrests further decline in lung volume

Question 32

features of asthma COPD overlap syndrome

Answer 32

COPD blood eosinophils >4% responds better to ICS wrt exacerbations reductions more reversible = salbutamol difficult to distinguish from asthmatic smokers = airway remodelling

Question 33

non pharmacological COPD managemnt

Answer 33

smoking cessation +/- nicotine/bupropion/verecicline immunisation - influenza/ pneumococcal physical activity oxygen-domiciliary

Question 34

pharmacological COPD managemnt

Answer 34

LAMA/LABA momo LABA/LAMA combo ICS/LABA combo ICS/LABA/LAMA combo

Question 35

Asthma key features

Answer 35

``` non smoker allergic early/late onset intermittent symptoms non productive cough non progressive eosinophilic inflammation diurnal variability good corticosteroid response good bronchodilator response preserved FVC and TLCO normal gas exchange ```

Question 36

COPD key features

Answer 36

``` smokers non allergic late onset chronic symptoms productive cough progressive decline neutrophilic inflammation (not ACOS) no diurnal variability poor corticosteroid response (not ACOS) poor bronchodilator response reduced FVC and TLCO impaired gas exchange ```