Obstructive and Restrictive Lung Disease

Question 1

What are the main obstructive lung diseases?

Answer 1

• Asthma
• COPD
• Bronchiectasis
• Cystic fibrosis

Question 2

What is the difference between restrictive and obstructive lung diseases?

Answer 2

• Reduction in airflow (obstructive) vs a reduction in lung volume (restrictive)

Question 3

What is the ratio of FEV1/ FVC in obstructive diseases?

Answer 3

<0.7

Question 4

What is the ratio of FEV1/ FVC in restrictive diseases?

Answer 4

Ratio maintained (both figures decreased)

Question 5

What does FVC stand for?

Answer 5

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

Question 6

What immune cells are usually present in Asthma?

Answer 6

Eosinophils

Question 7

What immune cells are usually present in COPD?

Answer 7

Neutrophils

Question 8

What condition responds well to corticosteroids?

Answer 8

Asthma

Question 9

What condition has a poor bronchodilator response?

Answer 9

COPD

Question 10

What are the 3 main components of asthma?

Answer 10

• Airway narrowing/obstruction (reversable)
• Airway hyper-responsiveness
• Airway inflammation (eosinophils)

Question 11

What are 3 non pharamcological treatments for asthma?

Answer 11

• Achieve and maintain normal BMI if overweight
• Breathing exercise programmes
• Stop smoking (patient +/- household members)

Question 12

What can diagnose a patient with acute severe asthma?`

Answer 12

• PEF 33-50% best or predicted
• RR >_ 25/min
• HR >_ 110/min
• Inability to complete sentences in one breath

Question 13

What can be a sign of life-threatening asthma?

Answer 13

• 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)

Question 14

What can near fatal asthma show?

Answer 14

Raised PaCO2 and/or requires ventilation/NIV

Question 15

How is acute asthma immediately managed?

Answer 15

• 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

Question 16

If patient is still not improving consider after immeadiate treatment for acute sever asthma what should you consider?

Answer 16

• IV magnesium sulphate (bronchodilates, anti-inflammatory)

- Switch from nebulised to IV salbutamol or IV methylxanthine (aminophylline)

Question 17

At what time of year is COPD worse?

Answer 17

Winter

Question 18

What is COPD?

Answer 18

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

Question 19

What sex has an increased risk of COPD?

Answer 19

Females

Question 20

What fungus can people contract as a result of smoking a contaminated joint?

Answer 20

Aspergillosis

Question 21

What enzyme deficiency causes an increased risk of COPD (especially before the age of 45)

Answer 21

alpha1 antitrypsin deficiency

Question 22

What enzyme does alpha1 antitrypsin inhibit?

Answer 22

Elastase

Question 23

When does COPD usually present?

Answer 23

50s or 60s

Question 24

What is the pathophysiology of COPD?

Answer 24

• Inflammation and fibrosis of the bronchial wall
• Hypertrophy of the submucosal glands and hypersecretion of mucous
• Loss of elastic, parenchymal lung fibres (emphysema)

Question 25

What are the 5 fundamentals of COPD care?

Answer 25

• Support to stop smoking
• Pneumococcal and flu vaccination
• Pulmonary rehab
• Co-develop a personalised self-management plan
• Optimise co morbidities

Question 26

What are some of the main restrictive lung diseases?

Answer 26

• Idiopathic pulmonary fibrosis
• Hypersensitivity pneumonitis
• Sarcoidosis
• Connective tissue disease related lung disease

Question 27

What are the features of a restrictive lung disease?

Answer 27

• 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

Question 28

When can domiciliary oxygen therapy be given?

Answer 28

• Patients with a PaO2 <7.3 - 8 kPa
• Must have stopped smoking
• Must be breathed for >15 hrs a day to improve mortality

Question 29

What are the factors which contribute towards a diagnosis of COPD?

Answer 29

• 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

Question 30

What are the two categories of COPD?

Answer 30

Pink puffers and blue bloaters

Question 31

What are the features of a pink puffer?

Answer 31

• 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

Question 32

What are the features of a blue bloater?

Answer 32

• Blue - cyanosed
• bloater - signs of Right heart failure
• Expectorant cough
• Wheezes and crackles

Question 33

When would inhaled steroids be used in COPD?

Answer 33

If the individual also has asthma