Obstructive Airway Disease Flashcards

1
Q

List the symptoms of respiratory disease.

A

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

Wheeze - expiratory noise
Stridor - inspiratory noise

Dyspnoea - distress when breathing

Pain - general or on inspiration

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2
Q

List the sign of reparatory disease.

A

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

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3
Q

List some respiratory investigations.

A

Sputum examination.

Radiographs

FEV1

FEV1/VC

Peak expiratory flow rate

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4
Q

What test is used to diagnose and monitor asthma?

Describe how this is carried out.

A

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.

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5
Q

List the possible respiratory diseases.

A

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.

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6
Q

Is asthma reversible?

A

yes - reversible obstructive airway disease

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7
Q

What causes asthma?

A

Hyper reactivity to minor stimuli

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8
Q

Describe the mechanisms of asthma.

A

Contraction of smooth muscle
Excessive mucous secretion
Mucosal oedema from inflammation

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9
Q

What causes the wheeze in asthma?

A

The narrowing of airways

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10
Q

What causes the cough in asthma?

A

The excess mucous secretion

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11
Q

What will the patient complain of when presenting asthma?

A

Cough, wheeze and shortness of breath.

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12
Q

What is a strong indictor of asthma?

A

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

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13
Q

List the triggers for asthma.

A
Infection
Dust
Smoke
Cold air (common in children) 
atopy - heightened immune response
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14
Q

What is asthma usually associated with?

A

other autoimmune disease i.e. eczema

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15
Q

What are the signs of an asthma attack?

A

wheezing
Increased respiratory rate
Increased heart rate

Severe attack:
Inability to talk
Confusion

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16
Q

Describe the responses in an asthma attack.

A

Biphasic

Early response and a late response

17
Q

How would you determine severe asthma?

A

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

18
Q

What is the most useful medication used to treat asthma?

19
Q

What is COPD?

A

A combination of reversible obstruction and destructive lung disease.

20
Q

Give an example of COPD.

A

Asthma, emphysema and chronic bronchitis

21
Q

What is emphysema?

A

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

22
Q

How do you classify severity of COPD?

A

Using Gold Classification

23
Q

Describe the Gold classification of COPD.

A

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.

24
Q

What causes COPD?

A

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

OE:
Dust = fibrosis
Asbestos = tumours

25
How is COPD managed?
``` Anticholinergic drugs e.g. ipratropium Oxygen support Smoking cessation Inhaled steroids e.g. beclamethasone Long acting bronchodilators e.g. salmeterol ```
26
What does treatment success reflect?
Reversibility of the disease.
27
What can COPD progress to?
Respiratory failure
28
Describe type 1 respiratory failure.
Alveolar diffusion fails : thickening of the alveoli means that diffusion of oxygen cannot occur. = hypoxia < 8pKa partial pressure of arterial oxygen
29
Describe type 2 respiratory failure.
Ventilation fails : can't breathe out CO2 = Hypercapnia > 6.7 pKa partial pressure CO2 in arterial blood.
30
What are the causes of type 2 reparatory failure?
Airway blockage/narrowing | Problems with muscles - cant ventilate
31
What occurs in chronic respiratory failure?
Renal compensation for acidosis.
32
What controls normal breathing?
CO2 controls ventilation
33
What controls breathing in COPD?
Hypoxia controls ventilation
34
Why must you be cautious when giving a patient with COPD high concentrations of oxygen?
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