Obstructive Airway Disease

Question 1

List the symptoms of respiratory disease.

Answer 1

Cough: dry or sputum producing. (Can sometimes contain blood)

Wheeze - expiratory noise
Stridor - inspiratory noise

Dyspnoea - distress when breathing

Pain - general or on inspiration

Question 2

List the sign of reparatory disease.

Answer 2

Respiratory rate: > 12-15 ppm.

Chest movement: Should have bilateral expansion

Percussion

Vocal resonance:
Ask patient to speak whilst listening to their chest.
If voice is clear = abnormality
If voice is muffled = healthy

Question 3

List some respiratory investigations.

Answer 3

Sputum examination.

Radiographs

FEV1

FEV1/VC

Peak expiratory flow rate

Question 4

What test is used to diagnose and monitor asthma?

Describe how this is carried out.

Answer 4

peak flow test/PEFR (peak expiratory flow rate):
Breathe in as much as you can and force out as much air as you can in 1 second.

3 readings are recorded and an average is taken.

This is carried out before treatment and after treatment using b2 agonists.

Question 5

List the possible respiratory diseases.

Answer 5

Infection e.g. pneumonia

Tumour

Airflow obstruction e.g. COPD - asthma, emphysema. Restrictive pulmonary change.

Gas exchange failure e.g. fibrosis (scar tissue) , fluid in the lungs.

Question 6

Is asthma reversible?

Answer 6

yes - reversible obstructive airway disease

Question 7

What causes asthma?

Answer 7

Hyper reactivity to minor stimuli

Question 8

Describe the mechanisms of asthma.

Answer 8

Contraction of smooth muscle
Excessive mucous secretion
Mucosal oedema from inflammation

Question 9

What causes the wheeze in asthma?

Answer 9

The narrowing of airways

Question 10

What causes the cough in asthma?

Answer 10

The excess mucous secretion

Question 11

What will the patient complain of when presenting asthma?

Answer 11

Cough, wheeze and shortness of breath.

Question 12

What is a strong indictor of asthma?

Answer 12

Diurnal variation - worse at night (and in the morning)

Question 13

List the triggers for asthma.

Answer 13

Infection
Dust
Smoke
Cold air (common in children) 
atopy - heightened immune response

Question 14

What is asthma usually associated with?

Answer 14

other autoimmune disease i.e. eczema

Question 15

What are the signs of an asthma attack?

Answer 15

wheezing
Increased respiratory rate
Increased heart rate

Severe attack:
Inability to talk
Confusion

Question 16

Describe the responses in an asthma attack.

Answer 16

Biphasic

Early response and a late response

Question 17

How would you determine severe asthma?

Answer 17

If oral steroids have been taken more than once a year.

Colour of inhaler (i.e pink/orange inhalers)

If the patient has had to be admitted to hospital more than once per year.

If they attend a specialist

Question 18

What is the most useful medication used to treat asthma?

Answer 18

Steroids

Question 19

What is COPD?

Answer 19

A combination of reversible obstruction and destructive lung disease.

Question 20

Give an example of COPD.

Answer 20

Asthma, emphysema and chronic bronchitis

Question 21

What is emphysema?

Answer 21

Where some alveoli are destroyed therefore other alveoli enlarge and become inflamed to compensate.

Question 22

How do you classify severity of COPD?

Answer 22

Using Gold Classification

Question 23

Describe the Gold classification of COPD.

Answer 23

1/2 = mild : cough and little/no breathlessness

3 = severe : Cough with sputum and breathlessness on exertion.

4 = very severe : cough and wheeze, breathlessness on mild exertion, lung over inflation, cyanosis and peripheral oedema.

Question 24

What causes COPD?

Answer 24

Smoking
Hereditary
Environmental factors e.g. smoke, chemicals, occupational exposure.

OE:
Dust = fibrosis
Asbestos = tumours

Question 25

How is COPD managed?

Answer 25

Anticholinergic drugs e.g. ipratropium
Oxygen support
Smoking cessation
Inhaled steroids e.g. beclamethasone 
Long acting bronchodilators e.g. salmeterol

Question 26

What does treatment success reflect?

Answer 26

Reversibility of the disease.

Question 27

What can COPD progress to?

Answer 27

Respiratory failure

Question 28

Describe type 1 respiratory failure.

Answer 28

Alveolar diffusion fails : thickening of the alveoli means that diffusion of oxygen cannot occur.

= hypoxia
< 8pKa partial pressure of arterial oxygen

Question 29

Describe type 2 respiratory failure.

Answer 29

Ventilation fails : can’t breathe out CO2

= Hypercapnia
> 6.7 pKa partial pressure CO2 in arterial blood.

Question 30

What are the causes of type 2 reparatory failure?

Answer 30

Airway blockage/narrowing

Problems with muscles - cant ventilate

Question 31

What occurs in chronic respiratory failure?

Answer 31

Renal compensation for acidosis.

Question 32

What controls normal breathing?

Answer 32

CO2 controls ventilation

Question 33

What controls breathing in COPD?

Answer 33

Hypoxia controls ventilation

Question 34

Why must you be cautious when giving a patient with COPD high concentrations of oxygen?

Answer 34

COPD patients rely on hypoxia to control breathing.
If you force oxygen into the system it removes their drive to breath on their own.
Results in type 2 reparatory failure (failure of ventilation)
Type 2 failure = Acidosis of the lungs