obstructive airways disease Flashcards
1
Q
what are some respiratory symptoms
A
- cough
- wheeze
- stridor
- pain
2
Q
what is a cough
A
- can be productive = produces stuff, such as sputum (green, white, red), or blood
- or can be non-productive = dry cough
3
Q
what is a wheeze
A
- expiratory noise
- each airway makes a different noise = will have a different noise depending on which airway is blocked
- means something bad is happening
- can’t fake a wheeze
4
Q
what is a stridor
A
- inspiratory noise
- blockage in big airway = choking
5
Q
what is dyspnoea
A
- distress on effort
- patient knows breathing is not right and is uncomfortable when they breathe
6
Q
what pain is experienced
A
- can be general or inspiratory
- if a patient has been coughing for a few days they will have rib pain
- if patient has chest wall problems they will have pain
7
Q
what are respiratory signs
A
- chest movement with respiration
- rate of respiration
- air entry
- vocal resonance
- percussion note
8
Q
what does chest movement show
A
- want to check expansion is the same on both sides
- place thumb at ribs and hands round patients back to check and thumbs should move at same time
9
Q
what does rate of respiration show
A
- should be 12-15/min
- good to know
- in asthma, patient will have a higher rate as they can’t ventilate properly so compensate by increasing rate
10
Q
what does air entry show
A
- is it symmetrical?
- is it reduced?
11
Q
what does vocal resonance show
A
- someone with healthy lungs should have lots of air in them and when you press your ear to their chest you wont be able to hear what they say
- if someone has liquid in their liquids in their lungs you ca hear what they say with ear to chest
12
Q
what does percussion note show
A
- resonance, dull
- tap to see if it makes hollow or solid noise
13
Q
what are some respiratory examinations
A
- sputum examination
- CXR chest radiograph
- pulmonary function
- bronchoscopy
- VQ scan
14
Q
what is tested for in pulmonary function
A
- PEFR = maximum flow rate
- FEV1 = forced expiratory volume in 1 second
- FEV1/VQ = measure of respiratory function
15
Q
how is a bronchoscopy done
A
- flexible tube placed down throat
16
Q
what is a VQ scan
A
- ventilation/perfusion mismatch
- shows difference between oxygenation and ventilation
- looks t blood flow and gas flow to lungs and see if they match
17
Q
what are some respiratory disease
A
- infections = pneumonia
- airflow obstruction = problem getting gas in and out of lungs, changes ability of lungs to stretch
- gas exchange failure = reduces surface area, fibrosis, fluid, don’t have ability to get gas from alveoli to blood
- tumours
18
Q
what are examples of airflow obstruction
A
- asthma
- COPD
- restrictive pulmonary change
19
Q
what is chronic airflow obstruction
A
- reversible airway obstruction
- asthma is reversible if it lasts 10 mins to a week but over 40 years it will cause damage to lungs
- COPD is always obstructive, there is always an element from which you can’t recover
20
Q
what can make chronic airflow obstructions worse
A
- infections
- exercise
- cold air
21
Q
how common is asthma
A
- 5-10% children = is thought to be an overreaction to mild stimulants, children should go outside and okay to keep immune system active
- 2-5% adults
- bronchial hyper-reactivity
22
Q
what happens in asthma
A
- get an inflammation of airways
- inflammation of lining which narrows the tube
- mucus glands go into hyper secretion secreting slimy ‘goo’ which makes airways even narrower
23
Q
what will patients notice in asthma
A
- a wheeze and a cough
- wheeze from narrow airway
- cough due to mucus
24
Q
what is the mechanisms of asthma
A
- triad of = airway smooth muscle constriction, inflammation of mucosa (swelling), increased mucus secretion
- cough, wheeze, shortness of breath
- diurnal variation = worst in the morning and at night
25
what is the peak expiratory flow rate
- changes as airways narrowed
- morning are all the same and nights are all the same
- varies at different times of the day
26
what are some triggers of asthma
- infections
- environmental stimuli = dust, smoke, chemicals at work
- cold air = more of an issue for children
- atopy = when the general response of the immune system is a problem
27
what is a skin prick test for asthma
- good but it only tests the skin, doesn't test lungs as could be different
- narrows down possibilities however
28
what type of immune response is asthma
- biphasic immune response
- early response is a wheeze etc
- if you survive this then 6 hours later you will get the late response with increased bronchial hyper-responsiveness
29
how long can it take for someone to die from asthma
- 20 minutes
30
how is asthma treated
- need to give patient initial treatment after early response to get them better but also need to give more to prevent late response
- need to give beta agonist and steroids to prevent late phase
31
what is the treatment for asthma based on severity
- very strategic
- 1-5 (1 OK, 5 bad)
- 1 = occasional beta agonist
- 2 = low dose inhaled steroid or sodium cromoglycate
- 3 = high dose inhaled steroid
- 4 = long acting beta agonist, theophylline, antimuscuranic drugs
- 5 = oral steroid
32
what do the different colours of puffer mean
- brown/blue = mild asthma
- purple/pink = moderate asthma
- take steroid tablets = severe
33
how do you treat mild asthma
- treat with blue puffer and send home
34
how do you treat severe asthma
- you're not going to fix them, only make it slightly better
- need to go to hospital soon
35
what are some respiratory drugs
- beta-adrenergic agonists
- anticholinergic
- corticosteroids
- leukotriene inhibitors = good for delayed phase
- chromones
- theophyllines
36
what are beta adrenergic agonists
- given by puffer or nebuliser
- relax bronchial smooth muscle = reduce bronchoconstriction, reduce resting bronchial tone
- protective against stimuli
- short and long acting
- but = do nothing for mucosal oedema, only quick fixes, don't address fundamental issues of asthma
37
what are anticholinergic
- act on muscarinic receptors = good for muscles
- reduce basal tone only = good in COPD, not so much asthma
- neurogenic triggers
38
what are theophylline
- used in severe asthma due to potential adverse effects
- adenosine inhibition = CNS stimulation, diuresis, arrhythmias
- immunomodulatory
39
what are corticosteroids
- most effective treatment for asthma = 'fix' asthma
- why you are to take brown puffer everyday, takes a few days to kick in so wont work in emergencies however
- don't get mucosal oedema, secretion or bronchoconstriction
- immune cell and epithelial cell actions
- use if beta2 agonist > 3 times a week
- to prevent late phase need to give by injection
40
what are the problems with corticosteroids
- can cause adrenal suppression and osteoporosis
- no evidence of this if daily dose <1500 micrograms however or <800micrograms in children
- spacer is recommended if daily dose exceeds 800 micrograms in the adult
41
what are other names for COPD
- chronic obstructive pulmonary disorder
- chronic obstructive airways disease
- chronic bronchitis and emphysema = most descriptive
42
what is COPD
- destruction of alveoli and cartilaginous airways
- airways are inflamed and narrowed
- restricted airways caused by chronic bronchitis, with inflames walls and lined with mucus
- get abnormal alveoli with enlarged sacs, compared with normal alveoli = gas exchange compromised by fewer alveoli and ventilation compromised by obstructed airways
- get big holes where alveoli used to be= still lined by gas exchange tissue
43
what is emphysema
- destruction of alveoli
| - dilation of others to 'fill space'
44
what are the GOLD classifications of COPD
```
- GOLD 1 or 2
= mild to moderate disease state
= lung function - FEV1 50-80%
= clinical state - cough, little or no breathlessness
- GOLD 3
= severe disease state
= lung function - FEV1 30-50%
= clinical state - cough and sputum, breathlessness on exertion
- GOLD 4
= very severe disease state
= lung function - FEV1 30%
= clinical state - wheeze and cough, breathlessness on mild exertion, over inflated lungs, cyanosis and peripheral oedema in some
```
45
how can COPD progress to respiratory failure
- reduced surface area for gas exchange
- thickening of alveolar mucosal barrier
- can't oxygenate enough to get sufficient amount to tissues
46
what are the causes of COPD
- smoking = mainly
- environmental lung damage = coal, silica, beryllium, asbestos, occupational lung diseases
- hereditary = emphysema
47
what is occupational lung disease
- can lead to respiratory failure
- fibrosis = dust related (coal, silica, beryllium, asbestos)
- tumours = from asbestos (mesothelioma), tumour of pleural lining, lungs lining most affected
- asbestos is only a problem when you try and remove it
- more smoking you do, worse lung volume you have
48
how is COPD managed
- smoking cessation = 1st thing
- long acting bronchodilator = improve ventilation (as can't improve gas exchange as can't replace alveoli) so need to keep remaining healthy
- inhaled steroids = if <50% FEV
- oxygen support
- pulmonary rehabilitation therapy
49
what is the problem with management of COPD
- there is no rule of thumb
- patient tries both bronchodilators and steroids to see which works
- treatment doesn't reflect the extent of the disease
- cannot asses severity of disease by medication alone
50
what is type 1 respiratory failure COPD
- hypoxaemia = low oxygen
- caused by hypoxia
- thickening of alveolar barrier = more difficult for alveolar infusion of oxygen
51
what is type 2 respiratory failure COPD
- hypercapnia = problem with CO2
- ventilation failure = CO2 moves easily in and out of alveoli but problem is ventilating O2 going in to alveoli
- airway blockage or narrowing = oedema of mucosal lining or tumour
- ventilation problems = muscles, if you have a neuromuscular disease it will gradually get worse as you can't breath properly
- acute or chronic infections = most common reason, most patients have chronic COPD then get infections, cause fluid and swelling of airways causing sudden deterioration
52
what is failure of oxygenation in respiratory failure
- when PaO2<8.0kPa on air in arteries when breathing
- surrogate - SaO2<90% on air
- key thing is patient is hypoxic due to = poor alveolar ventilation, diffusion abnormality, ventilation perfusion mismatch
- blood is going to one part of the lungs but ventilation is occurring elsewhere
53
what is failure of ventilation in respiratory failure
- PaCO2>6.7kPa
- can get in acute or chronic respiratory failure
- 20% reduction in ventilation needed
- CHRONIC ventilation failure = renal compensation for acidosis
- contributions from = reduced compliance, airway obstruction, muscle dysfunction
54
what is normal breathing control
- brain only works with sugar and O2
- CO2 drives controls for ventilation
- driver for taking a breath is hypercapnia = when you hold your breath CO2 amount increases
- O2 saturation usually OK
- CO2 slowly increases therefore sensitivity of cO2 receptors becomes less and less
55
what is COPD type 2 breathing control
- CO2 tolerance = don't have same need to breathe as CO2 threshold higher
- hypoxia drives ventilation
- when you give them O2 they can stop breathing = it will stop the hypoxia but then also stop their desire to breathe
- need to give small amounts of O2 and count respiratory rate as you do
56
what is the oxygen use in COPD
- in the acute stage use O2 until medical help arrives
- give patient O2 and watch respiratory rate and oxygen saturation = if these get lower then need to take off O2
- in chronic stage, sue O2 with care = fixed % delivery
57
what is home O2 therapy
- if you get to the point whee you can't maintain O2 at room air you need O2 daily
- is good but only if patient uses it properly
- chronic hypoxia increases risk of cardiac events
58
what home O2 therapy is used
- in cylinder with a mask
| - an O2 concentrator = saves patient having a cylinder, takes in room air and removes nitrogen
59
how does airflow obstruction impact dentistry
- can patient attend appointment
- use of inhaled steroids = candida risk, can land inside mouth and cause local immune suppression and fungal infection so need to rinse mouth and use spacer device
- smokers = 2 times more likely of getting oral cancer
