Obstructive and Restrictive Lung Disease Flashcards
What are the main obstructive lung diseases?
- Asthma
- COPD
- Bronchiectasis
- Cystic fibrosis
What is the difference between restrictive and obstructive lung diseases?
- Reduction in airflow (obstructive) vs a reduction in lung volume (restrictive)
What is the ratio of FEV1/ FVC in obstructive diseases?
<0.7
What is the ratio of FEV1/ FVC in restrictive diseases?
Ratio maintained (both figures decreased)
What does FVC stand for?
Forced Vital Capacity
- F - Exhales as hard as long as possible
- V - Total volume in the lungs minus residual volume
- Capacity - Sum of more than one volume
What immune cells are usually present in Asthma?
Eosinophils
What immune cells are usually present in COPD?
Neutrophils
What condition responds well to corticosteroids?
Asthma
What condition has a poor bronchodilator response?
COPD
What are the 3 main components of asthma?
- Airway narrowing/obstruction (reversable)
- Airway hyper-responsiveness
- Airway inflammation (eosinophils)
What are 3 non pharamcological treatments for asthma?
- Achieve and maintain normal BMI if overweight
- Breathing exercise programmes
- Stop smoking (patient +/- household members)
What can diagnose a patient with acute severe asthma?`
- PEF 33-50% best or predicted
- RR >_ 25/min
- HR >_ 110/min
- Inability to complete sentences in one breath
What can be a sign of life-threatening asthma?
- Altered consciousness
- Exhaustion
- Arrythmia
- Hypertension
- Cyanosis
- Silent chest
- Poor respiratory effort
- PEF < 33% best/predicted
- SpO2 < 92%
- PaO2 < 8 kPa
- “Normal” PaCO2 (4.6-6kPa)
What can near fatal asthma show?
Raised PaCO2 and/or requires ventilation/NIV
How is acute asthma immediately managed?
- Oxygen (to maintain SpO2 at 94-98%)
- SABA (salbutamol or terbutaline) via nebuliser
- IV Steroid = hydrocortisone … switch to oral steroid = prednisolone
- or - antibiotics
- or - musc antagonist inhaled
If patient is still not improving consider after immeadiate treatment for acute sever asthma what should you consider?
- IV magnesium sulphate (bronchodilates, anti-inflammatory)
- Switch from nebulised to IV salbutamol or IV methylxanthine (aminophylline)
At what time of year is COPD worse?
Winter
What is COPD?
Characterised by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases
What sex has an increased risk of COPD?
Females
What fungus can people contract as a result of smoking a contaminated joint?
Aspergillosis
What enzyme deficiency causes an increased risk of COPD (especially before the age of 45)
alpha1 antitrypsin deficiency
What enzyme does alpha1 antitrypsin inhibit?
Elastase
When does COPD usually present?
50s or 60s
What is the pathophysiology of COPD?
- Inflammation and fibrosis of the bronchial wall
- Hypertrophy of the submucosal glands and hypersecretion of mucous
- Loss of elastic, parenchymal lung fibres (emphysema)
What are the 5 fundamentals of COPD care?
- Support to stop smoking
- Pneumococcal and flu vaccination
- Pulmonary rehab
- Co-develop a personalised self-management plan
- Optimise co morbidities
What are some of the main restrictive lung diseases?
- Idiopathic pulmonary fibrosis
- Hypersensitivity pneumonitis
- Sarcoidosis
- Connective tissue disease related lung disease
What are the features of a restrictive lung disease?
- Overall lungs are smaller
- Dyspnoaea
- Dry cough
- Malaise
- Bilateral fine crackles (finger clubbing)
- Decreased VC and decreased FEV1 but ratio maintained
- 6 min walk test
- Often palliative
- > 200 different pathologies
When can domiciliary oxygen therapy be given?
- Patients with a PaO2 <7.3 - 8 kPa
- Must have stopped smoking
- Must be breathed for >15 hrs a day to improve mortality
What are the factors which contribute towards a diagnosis of COPD?
- Insidious onset
- Usually 50s or 60s
- Chronic cough
- Sputum production (worse in morning typically)
- Increasing dyspnoea over time
- Diminishing exercise tolerance
- History of exposure to risk factors
What are the two categories of COPD?
Pink puffers and blue bloaters
What are the features of a pink puffer?
- pink
- increased SOB but little cough
- Pursed lips (alveoli tend to collapse)
- Barrel chest due to air trapping
- Use of accessory muscles
- Decreased breath sounds
What are the features of a blue bloater?
- Blue - cyanosed
- bloater - signs of Right heart failure
- Expectorant cough
- Wheezes and crackles
When would inhaled steroids be used in COPD?
If the individual also has asthma
