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JL Respiratory > Obstructive Airway Overview > Flashcards

Obstructive Airway Overview Flashcards

1
Q

What general class of disease involves the lungs?

A

Restrictive disease

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2
Q

Name three obstructive airway syndromes

A

Asthma
Chronic bronchitis
Emphysema

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3
Q

What is the asthma triad?

A

Reversible airflow obstruction
Airway inflammation
Airway hyperresponsiveness

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4
Q

Dynamic evolution of asthma: What does bronchoconstriction lead to?

A

Brief symptoms

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5
Q

Dynamic evolution of asthma: What does chronic airway inflammation lead to?

A

Exacerbations of airway hyperresponsivness

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6
Q

Dynamic evolution of asthma: what does airway remodelling lead to?

A

Fixed airway obstruction

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7
Q

In relation to the hallmarks of remodelling in asthma, what happens to the basement membrane, submucosa and smooth muscle?

A

Basement membrane - thickening
Submucosa - collagen deposition
Smooth muscle - hypertrophy

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8
Q

Describe the stages in the inflammatory cascade.

A
  1. Genetic predisposition + trigger factor (viral, allergen, chemical)
  2. Airway inflammation
  3. Mediators/TH2 Cytoklines (e.g. histamine, leukotriene)
  4. Twitchy smooth muscle (hyper-reactivity)
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9
Q

What can be used to manage airway inflammation in the inflammatory cascade?

A

Anti-inflammatory corticosteroid

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10
Q

What can be used to control the mediators in the inflammatory cascade?

A

Anti-leukotriene
Anti-IgE
Anti-IL4/5/13

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11
Q

What can be used to manage twichy smooth muscle (hyper-reactivity) in the inflammatory cascade?

A

Bronchodilators (beta-2-agonists)

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12
Q

What happens to asthma symptoms when the patient is related to drugs (NSAIDs, B-blockers), chemicals, cold, smoke, viral infection and exercise?

A

Symptoms worsen

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13
Q

What can be said about the timing of asthma symptoms?

A

Episodic and dirurinal variability (nocturnal/early morning)

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14
Q

What type of cough is present in asthma, and what symptoms alongside it?

A

Non-productive cough and wheeze

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15
Q

Name three associated atopy with asthma

A

Rhinitis
Conjunctivitis
Eczema

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16
Q

What is the wheezing due to in asthma?

A

Turbulent airflow

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17
Q

What would a diurinal variation of peak flow rate indicate about the diagnosis of asthma?

A

Confirm it

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18
Q

What would the forced expiratory ratio be like in an asthmatic?

A

Reduced

FEV1/FVC

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19
Q

What two methods can be used for provocation testing for bronchospasm in suspected asthma patients?

A

Exercise

Histamine/allergen inhalation

20
Q

In COPD, what leads to mucociliary dysfunction, inflammation and tissue damage?

A

Noxious particles or gases e.g. smoking

21
Q

In COPD, what do mucociliary dysfunction, inflammation and tissue damage all lead to?

A

Development of obstruction and ongoing disease progression

22
Q

What are two characteristics of COPD?

A

Exacerbations

Reduced lung function

23
Q

In COPD, what is the subtype called where there are disrupted alveolar attachments?

A

Emphysema

24
Q

What is the subtype of COPD, where mucosal and peribronchial inflammation and fibrosis occur?

A

Bronchiolitis

25
Q

In COPD, when cigarette smoke encounters alveolar macrophages, what 4 things do the cells release?

A

Neutrophil chemotatic factors
Cytokines (IL-8)
Mediators (LTB4)
Oxygen radicals

26
Q

In COPD, what do proteases lead to?

A 
Alveolar wall destruction (emphysema)
Mucus hypersecretion (chronic bronchitis)
27
Q

What type of COPD has chronic neutrophilic inflammation, mucus hypersecretion, smooth muscle spasm and hypertrophy and is partially reversible?

A

Chronic bronchitis

28
Q

What type of COPD has alveolar destruction, imparied gas exchange, loss of bronchial support and is irreversible?

A

Emphysema

29
Q

What sort of imbalance is present in emphysema?

A

Protease imbalance

30
Q

What 3 things must you assess in the assessment of COPD?

A
  1. Assess symptoms
  2. Assess degree of airflow limitation using spirometry
  3. Assess risk of exacerbations
31
Q

Relating to exacerbations and spirometry, what features are indicators of high risk COPD?

A

Two exacerbations or more within the last year

FEV1

32
Q

What can be said about the timing of symptoms in COPD?

A

Chronic symptoms not episodic

33
Q

Is COPD atopic?

A

No

34
Q

What is the cough like in COPD?

A

Daily and productive

35
Q

Is the breathlessness reversible or progressive in COPD?

A

Progressive

36
Q

What occurs frequently in COPD patients?

A

Infective exacerbations

37
Q

Which subtype of COPD is characterised by wheezing?

A

Chronic bronchitis

38
Q

Which subtype of COPD is characterised by reduced breath sounds?

A

Emphysema

39
Q

What are the 5 steps of the chronic cascade in COPD, before death?

A
  1. Progressive fixed airflow obstruction
  2. Impaired alveolar gas exchange
  3. Respiratory failure: decreased PaO2, increased PaCO2
  4. Pulmonary hypertension
  5. Right ventricular hypertrophy/failure (i.e. Cor Pulmonale)
40
Q

What are 6 non-pharmacological management measures of COPD?

A
  1. Smoking cessation
  2. Immunisation- infleunza/pneumococcal
  3. Physical activity
  4. Oxygen - domiciliary
  5. Venesection
  6. Lung volume reduction surgery
41
Q

Name the 4 pharmacological gold standard COPD managements

A
  1. LAMA: Tiotropium/Aclinidium
  2. LABA: Salmeterol/Formoterol
  3. LAMA-LABA combo: Alinidium/Formoterol
  4. LABA-ICS combo: Beclometasone-Formoterol
42
Q

What are the 3 other pharmacological managements of COPD?

A

PDE4I - Roflumilast
Mucolytic - Carbocisteine
Antibiotics - Azithromycin

43
Q

What is the difference between inflammation in asthma and COPD?

A

Asthma - eosinophilic

COPD - Neutrophilic

44
Q

What is the difference between FVC and TLCO in asthma and COPD?

A

Asthma - preserved FVC and TLCO

COPD - reduced FVC and TLCO

45
Q

What general class of disease involves the airways?

A

Obstructive disease

46
Q

What produces IL-13, IL-4 and IL-5?

A

TH2 cells

JL Respiratory (27 decks)

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