Obstructive airways disease Flashcards
What are examples of respiratory symptoms? (5 points)
- Cough
- Wheeze
- Stridor
- Dyspnoea
- Pain
What is a productive cough?
- Produces something (sputum, blood)
What is a dry cough?
- Doesn’t produce anything
What is a wheeze?
- Expiratory noise (noise you make when you breath out)
- Can’t fake a wheeze
What is a Stridor?
- Inspriatory noise
- Usually blockage in the airway and you are chocking
What is Dyspnoea?
- Distress on effort
- Distress when breathing as you know your breathing is not working well
Why might pain be a respiratory symptom?
- Could be general or inspiratory
- Pain when you breath in - because you have inflammatory changes in you r chest wall
What are examples of respiratory signs that you would want to check? (5 points)
- Chest movement with respiration (want to ensure its the same on each side)
- Rate of respiration (12-15/min)
- Air entry - symmetrical? reduced?
- Vocal resonance
- Percussion note - resonant (drum like), dull (solid)
What is vocal resonance?
- The sound of ordinary speck through a chest wall
- If stick your ear on someone’s chest and listen to someone speaking sounds odd if you have air in the lungs
- If you have fluid in the lungs and do this with a stethoscope and the person speaks then you can hear them pretty well
What are examples of respiratory investigations you can do? (5 points)
- Sputum examination
- CXR - chest radiograph
- Pulmonary function (lung function tests)
- Bronchoscopy
- VQ scan - ventilation/perfusion mismatch
When doing pulmonary function testing, what can you look for? (3 points)
- PERF - maximum flow rate
- FEV1 - forced expiratory volume
- FEV1/VC - measure of resp. function
What is a common example of a respiratory infection?
- Pneumonia
What are 3 examples of airflow obstruction (respiratory diseases)?
- Asthma
- Chronic Obstructive Pulmonary Disease
- Restrictive pulmonary change
What is a ‘gas exchange failure’ respiratory disease?
- Even when ventilate the lungs properly, don’t have the ability to get gas into the blood - reduced alveoli
- Loss of the space for blood and gas to meet so there isn’t enough space to get the oxygen into the blood
- This can be cased by a reduced surface area, fibrosis or fluid in the lungs
Can tumours cause respiratory diseases?
- Yes
What are 2 examples of diseases that cause chronic airflow obstruction?
- Asthma & COPD
What 3 things can make chronic airflow obstruction diseases worse (exacerbating factors)?
- Infections
- Exercise
- Cold air
Is asthma a reversible or irreversible airflow obstruction?
- Reversible
What percentage of children and adults have asthma?
- Children = 5-10%
- Adults = 2-5%
What is asthma known as?
- ‘bronchial hyper reactivity’
What happens to the airways in someone with asthma? (3 points)
- Contraction of smooth muscle
- Inflammation and swelling
- Excessive mucous production (thick mucous)
- All cause narrowing of the tube
What is the triad of mechanisms that cause asthma?
- Airway smooth muscle contraction
- Inflammation of the mucosa (swelling)
- Increased mucous secretion
What are 3 signs of asthma?
- Cough
- Wheeze
- Shortness of breath
What is ‘diurnal variation’ in asthma?
- Follows a pattern depending on the time of day
- Reguulated to some extent by circadian rhythms
- Worse early morning
What is peak expiratory flow rate?
- PEFR is the max flow rate generated during a forceful exhalation, starting from full lung inhalation
PEFR will vary at different times of the day. Why is this important when comparing PEFR?
- Have to compare like with like so have to compare at the same time every day
What are common triggers of asthma? (4 points)
- Infections
- Environmental stimuli (dust, smoke and chemicals at work)
- Cold air
- ‘Atopy’
What is atopy?
- A genetically determined state of hypersensitivity to environmental allergens
What is meant by asthma being a biphasic immune response and why is this important?
- You get an early response then seem to get better but about 6 hours later you will get worse again
- So, get initial problem then get late problem
- IMPORTANT - if you have someone who has a bad asthma attack early what will happen is you will treat them and make them better but if you don’t do something else about it the later response will kick in and it will get worse again
- Have to use beta2 agonist but unless you also use steroids as well then they will have the later response as well
What are the 5 stages if asthma treatment?
- Occasional beta-agonist only
- Low-dose inhaled steroid or sodium cromoglycate/nedocromil
- High-dose inhaled steroid
- Long-acting beta-agonist, theophyline, anti-muscarinic drugs
- Oral steroid
What are examples of respiratory drugs? (6 points)
- Beta-adrenergic agonists
- Anticholinergics
- Corticosteroids
- Leukotriene inhibitors
- Chromones
- Theophyllines
How can beta adrenergic agonists be administered? (4 points)
- By puffer, tablet, injection or nebuliser
What do beta-adrenergic agonists do? (4 points)
Relax bronchial smooth muscle:
- Reduce bronchoconstriction
- Redeuce resting bronchial tone
PROTECTIVE against stimuli
Are beta-adrenergic agonists long or short acting?
- Can be either
What do anticholinergic drugs act on?
- Muscarinic receptors
What do anticholinergic drugs do?
- Reduce BASAL tone only
- Good in COPD
- ‘neurogenic’ triggers
What severity of asthma are theophylline’s used for?
- Used in SEVERE asthma due to potential adverse effects
What are theophylline’s?
- Adenosine inhibitors
- CNS stimulation, diuresis, arrhythmia
What is the most effective asthma treatment?
- Corticosteroids
- If someone asks how do you treat asthma the answer is steroids
What types of cells do corticosteroids have actions on? (2 points)
- Immune cells and epithelial cells
When would you give someone with asthma corticosteroids?
- If they use beta2 agonists more than 3 times a week
Can the admission of corticosteroids cause adrenal suppression or oestoeporosis?
- No evidence if daily dose <1500ug
- Children <800ug
When is a spacer advised when giving someone corticosteroids?
- If daily dose exceeds 800ug in an adult
recommended if using 400 micrograms a day
What are 3 terms for COPD?
- Chronic obstructive pulmonary disease
- Chronic obstructive airways disease
- Chronic bronchitis and emphysema
What is COPD?
- MIXED airway reversible obstruction and destructive lung disease
= Asthma and emphysema
What is emphysema?
- Destruction of alveoli
- Dilation of others to ‘fill space’
What is the gold classification of COPD?
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What can COPD progress to respiratory failure fro m? (2 points)
- Reduced surface area for gas exchange
- Thickening of alveolar mucosal barrier
What causes poor ventilation in COPD? (2 points)
- Airway narrowing
- Restrictive lung defects
What are common causes of COPD? (3 points)
- Smoking (most common)
- Environmental lung damage (occupational lung disease e.g. coal, asbestos etc)
- Hereditary - Emphysema
Occupational lung disease can lead to respiratory failure. What are 2 common ways of this?
- Fibrosis (dust related - coal, silicon, beryllium, asbestos)
- Tumours (asbestos - mesothelioma) (tumour of the pleural lining)
How can you manage COPD? (6 points)
- Smoking Cessation
- Long acting bronchodilator
- Inhaled steroids (<50% FEV)
- (systemic steroids)
- Oxygen support
- Pulmonary rehabilitation therapy
COPD can result in type 1 or type 2 respiratory failure. What happens in type 1 respiratory failure? (2 points)
- Hypoxaemia (low oxygen)
- Thickening of the alveolar barrier
COPD can result in type 1 or type 2 respiratory failure. What happens in type 2 respiratory failure? (2 points)
- Hypercapnia (too much CO2)
- Ventilation failure
What happens as a result of type 2 respiratory failure? (3 points)
- Airway blockage or narrowing
- Ventilation problems - muscles
- Acute or chronic - infections
What are the treatment options for COPD going from less to more severe? (5 points)
- Stop smoking, occasional inhaled bronchodilator
- Regular inhaled bronchodilator, for example anticholinergic +/- beta agonist
- Trial of oral/inhaled corticosteroids - if positive consider regular inhaled corticosteroids
- Oral methylxanthines
- Consider:
- Home nebuliser
- Cylinder oxygen for short ‘burst’ treatment
- long-term domiciliary oxygen therapy
- pulmonary rehabilitation
- Surgery for bullae
- Lung transplantation
What causes respiratory failure? (2 points)
- Failure to oxygenate
- Failure of ventilation
When can you consider lungs to have a failure in oxygenation? (3 points)
- When PaO2 <8.0kPa on air
- Surrogate - SaO2 <90% on air
- You are HYPOXIC - sue to poor ventilation of the alveoli or diffusion abnormality of the alveoli of diffusion/ventilation mismatch
What can cause a failure of oxygenation? (3 points)
- Poor alveolar ventilation
- Diffusion abnormality
- Ventilation perfusion mismatch
What can be considered as failure of ventilation?
- When PaCO2 >6.7kPa
In which type of respiratory failure do you get failure of ventilation? (2 points)
- Only in ACUTE respiratory failure
- 20% reduction in ventilation needed
When does CHRONIC ventilation failure occur?
- As renal compensation for acidosis
What can contribute to CHRONIC ventilation failure? (3 points)
- Reduced compliance
- Airway obstruction
- Muscle dysfunction
What controls breathing in NORMAL breathing? (2 points)
- CO2 drive controls ventilation
- Oxygen saturation usually OK
What controls breathing in people with COPD? (2 points)
- CO2 tolerance
- HYPOXIA drives ventilation
In acute stages of COPD what treatment would you give to someone? (2 points)
- Use O2 until medical help arises
- Watch: respiratory rate, SaO2 (if these are starting to get lower then there is a problem and you will need to turn off the O2)
In the CHRONIC stage of COPD what treatment would you give someone?
- Use O2 with care - fixed percentage delivery
Sometimes people are on home O2 therapy. What 2 ways can this be done?
- Oxygen cylinder or oxygen concentrator
- Oxygen concentrator takes room air in and removes the nitrogen from it making the oxygen more concentrated
If someone is on home oxygen therapy, when should they be given oxygen?
- If someone is going to get O2 supplementation they have to have it 24 hours a day
Why is knowing that people have an airflow obstruction important in dentistry?
- Ability to attend for treatment - home oxygen is inflammable
- Use of inhaled steroids - there is a candida risk
- Smokers - oral cancer risk
If someone is using an inhaled steroid there is a risk of candida. What should you advise the patient to do? (2 points)
- Rinse mouth after use
- Use a spacer device
