Obstructive Airway Disease Flashcards
Overview of Obstructive Airway Disease
Disease of the airways (bronchi and larger bronchioles) causing the trapping of air within the lungs
Usually associated with inflamed, and easily collapsible airways
Includes: asthma, COPD (chronic bronchitis and emphysema), and bronchiectasis
Definition of Asthma
Chronic inflammatory condition concerning the airways which is associated with acute reversible exacerbations which in turn are characterised by smooth muscle spasm in the bronchi and bronchioles
These exacerbations are usually triggered by something
Asthma Triggers
Exercise, cold air, pollutants (Ozone, sulphur dioxide, cigarette smoke), drugs (NSAIDs, Beta blockers), emotion, allergens (dust mites, grass pollen, pets)
Occupational triggers come in 2 flavours: low molecular weight (colophony fumes, wood dust) which react with epithelium and are non-IgE related, and high molecular weight (latex, antibiotics) which involve specific IgE
Prevalence of Asthma
Thought to affect 15% of the global population
Rates are higher in developed countries (Western Europe) with rates far lower in Far Eastern countries (China, Malaysia) and Eastern Europe
Interleukin-4 and Asthma
Release of IL-4 from Th2 cells stimulates the production of IgE ntibodies which in turn coats mast cells, triggering the release granules containing histamines, leukotrienes and prostaglandins
The release of IgE makes this a type 1 hypersensitivity reaction
Interleukin-5 and Asthma
Release of IL-5 (& IL-13) from Th2 cells activates eosinophils which in turn release cytokines and leukotrines
Th2 Cells and Asthma
Dendritic cells phagocytose allergens in airways and present these to CD4 T cells, these T cells differentiate into Th2 cells which lead the allergic response
Histology/pathophysiology of Asthma
Bronchial inflammation characterised by T lymphocytes, mast cells, eosinophils +associated plasma exudation, oedema, smooth muscle hypertrophy, matrix deposition, mucus plugging, and epithelial damage
Atopy
Defined as the genetic tendency to develop allergic diseases (hay fever, asthma) in response to common allergens
Runs in families
Characterised by wheeling skin reactions to allergen
Found to have circulating allergen specific IgE
Results of Chronic Airway Inflammation in Asthma
The exacerbations of airway hyper-responsiveness (broncho constriction) increase in severity and occurrence with each trigger
Airway remodelling may occur in sever cases, characterised by smooth muscle hypertrophy, collagen deposition, and basement membrane thickening, resulting in a fixed airway obstruction
Chronic activation of epithelium leads to loss of cilla and makes patients more susceptible to common infections (exhaled NO can be measured to detect inflammation)
Bronchial Challenge Test
Patients inhale increasing methacholine and histamine whilst measuring FEV1
In asthmatic patients, this will cause transient airway obstruction (decrease of about 20% in FEV1 is the standard measure)
Record at what conc. standard obstruction occurs
Obstruction may occur at HIGH doses in patients with seasonal wheeze (pollen season), allergic rhinitis, very low grade asthma, and patients with no reported respiratory symptoms
Blood tests for me
Stool culture = neg.
C diff. = neg
H.pylori = neg
Peak Inspiratory Flow Rate in Asthma
A measure of the peak rate of flow on forceful expiration
Reduced in asthmatic patients (~25%-60% less than predicted value)
Spirometry in Asthma
Obstructive pattern will be present
Characterised by a preserved FVC, decreased FEV1 (0.8 of predicted), FEV1/FVC is less than 0.7
CXR in Asthma
Usually normal, but may exhibit hyperinflation
Presentation of Asthma
Intermittent shortness of breath, intermittent wheeze, dry or productive cough
Any associated triggers?
Nocturnal cough (children)/night wakening with SOB
Recent changes?
Impact upon life?
Management of Acute Asthma Attack
Oxygen Salbutamol Hydrocortisone IV acces + Ipratropium Theophylline Magnesium sulphate Escalate care
Evaluating an Acute Asthma Attack
Life threatening = 33 (PEFR value is less than that percent of predicted), 92 (oxygen salts are less than), C(yanosis), H(ypotension), E(xhaustion), S(ilent chest), the T(achycardia)
Severe = PEFR<50%, cant complete sentences, RR>24, PR>110
Moderate = PEFR<75%
Mild>75%