Obstructive Airways Disease

Question 1

What is obstructive lung disease?

Answer 1

Obstruction in the airways. Slide 5

Question 2

What is restrictive lung disease?

Answer 2

Restriction of the lungs. Slide 5

Question 3

What are the 3 obstructive airway syndromes?

Answer 3

Asthma
Chronic bronchitis
Emphysema. Slide 5

Question 4

What is ACOS?

Answer 4

Asthma/COPD overlap syndrome.

Smokers often with features of both asthma and COPD. Slide 5

Question 5

What makes up the asthma triad?

Answer 5

Reversible airway obstruction, airway inflammation and airway hyper-responsiveness. Slide 11

Question 6

What are the 3 dynamic steps of evolution of asthma?

Answer 6

Broncho-constriction, chronic airway inflammation and airway remodeling. Slide 12

Question 7

What are the hallmarks of remodeling in asthma?

Answer 7

Thickening of basement
Collagen deposition in the submucosa
Hypertrophy of smooth muscle. Slide 13

Question 8

What is the inflammatory cascade of reasons for asthma and how to target them?

Answer 8

Inherited or acquired factors e.g. avoidance
Eosinophilic inflammation e.g. corticosteroids
Mediators and TH2 cytokines e.g. Antihistamines and anti-IgE
Twitchy smooth muscle e.g. bronchodilators. Slide 15

Question 9

What are the clinical syndromes of asthma?

Answer 9

Non-productive cough
Wheeze due to turbulent airflow
Triggers
Associated atopy
Blood eosinophillia>3%
Responsive to steroids
Family history of asthma
Diurinal variability (early morning). Slide 22

Question 10

What is the diagnosis of asthma?

Answer 10

History and examination
Reduced forced expiratory ratio
Reversibility to inh. salbutamol
Provocation testing (bronchospasm). Slide 23

Question 11

What is COPD?

Answer 11

Chronic obstructive pulmonary disorder.

It is a multicomponent disease process causing mucociliary dysfunction, inflammation and tissue damage. Slide 25

Question 12

What does cigarette smoke do to the airways?

Answer 12

Cause inflammation and activates macrophages and airway cells release neutrophil chemotactic factors. These all release proteases and cause tissue damage. Slide 27

Question 13

What lung diseases does COPD include?

Answer 13

Chronic Bronchitis and Emphysema. Slide 28

Question 14

What is chronic bronchitis?

Answer 14

Chronis neutrophilic inflammation
Muscus hypersecretion 
Mucociliary dysfunction 
Altered lung microbiome to a Gm negative biome
Partially reversible. Slide 28

Question 15

What is emphysema?

Answer 15

Alveolar destruction
Impaired gas exchange
Loss of bronchial support
Irreversible. Slide 28

Question 16

What is entailed in the assessment of COPD?

Answer 16

Assess:
Symptoms
Degree of airflow limitation using spirometry
Risk of exacerbations
Comorbidities e.g. IHD/HF.
Slide 30

Question 17

What are high risk indicators of COPD?

Answer 17

Two or more exacerbations within the past year
FEV1 < 50%
Slide 30

Question 18

What would be the outcome of high exacerbation history and low symptoms when using the ABCD assessment tool?

Answer 18

C. Slide 31

Question 19

What is the clinical syndrome of COPD?

Answer 19

Smoking
Non atopic
Daily productive cough
Progressive breathlessness
Chronic bronchitis - wheezing
Emphysema - reduced breath sounds. Slide 32

Question 20

What is the non pharmacological COPD management?

Answer 20

Smoking terminated
Immunisation
Physical activity
Oxygen. Slide 35