Obstructive and Restrictive Lung Disease Flashcards
What are obstructive airway diseases?
- common
- categorised on pattern of spirometry
- quantitative, objective measurement of lung function
- repeatable
- monitor the course of disease
- measurements include FEV1.0 and FVC
What is spirometry?
a common test used to assess how well your lungs work by measurinf how much air you inhale; how much you exhale nad how quickly you exhale
What is the meaning of forced vital capacity?
- Forced = exhale as hard as possible
- Vital = total volume in the lungs minus the residual volume
- Capacity = sum of more than one volume
How happens the FVC ratio in restrictive lung diseases?
stays the same but everything is just decreased
What happens the ratio in obstructive lung diseases?
Ratio decreases
What is the FEV1.0/FVC ratio?
a measure if airflow obstruction
What is a normal FEV1.0/FVC ratio?
> 0.7
Draw a diagram of tbe FEV1.0/FVC ratio of:
- normal lungs
- restrictive diseases
- Obstructive diseases
What does hypoxia tend to result from?
V/Q mismatching
What are the most common obstructuve lung diseases?
- Asthma
- COPD
- Bronchiectasis
- Cystic fibrosis
What is asthma?
Clinical diagnosis based on history and examination
What would one or more of what symptoms indicate asthma?
- wheeze
- breathlessness
- chest tightness
- cough
- Especially if there is diurinal variation
- symptoms in response to allergen, exercise and cold air
What are the 3 components of asthma?
- airway narrowing/ obstruction
- airway hyperresponsiveness
- airway inflammation
eosinophils
What are the important mediators in asthma?
- leukotriene B4 and cystinyl-leukotrienes (C4 and D4)
- interleukins 4, 5 and 13
- tissue damaging eosinophil proteins
What can symptoms occur or worsen in the presence of?
- viral
- allergens
- cold
- food/nutrition
- chemicals - smoke
- exercise
What is the non-pharmacological treatment of asthma?
- normal healthy BMI
- breathing exercise programmes
- stop smoking
What are the characteristics of COPD?
- Chronic = symptoms for more than 3 months in 2 consecutive years
- Obstructive = predominant sign of wheeze (need spirometry for assessment)
- Affects both the airways and the lung
What is COPD?
- persistent airflow limitation
- progressive and assoiciated with an enhanced chronic inflammatory response in the airways
Epidemiology of COPD
- smoking
- indoor/outdoor pollution from biomass fuels
- host factrs effect progression of disease
- genetic abnoramlities (alpha-1 antitripysin deficiency)
- abnormal lung development
- age and gender
When should cannibas smoking be considered as a cause of COPD?
- COPD at younger age
- large bullae on x-ray
- hotboxing (TB)
- contaiminated joint (aspergillosis)
What should be considered with an early onset of COPD?
alpha1 antitripypsin deficiency
- enzyme produced in the liver - prevents the break down of lung tissue
- counter acts proteinases - reduces elastase activity
- autosomal co-dominance
Pathophysiology of COPD
- inflammation and fibrosis of the bronchial wall
- hypertrophy of mucosal glands and hypersecretion of mucus
- loss of elastic, parenchymal lung fibres (emphysema)
Clinical presentation of COPD
- insidious onset
- usually 50s or 60s
- chronic cough
- sputum production (worse in morning)
- SOB
- diminishing exercise tolerance
- history of exposure to risk factors
Describe pink puffer
- pink
- increased SOB but with little cough
- pursed lips
- barrel chest due to air trapping
- use of accessory muscles
- decreased breath sounds
Describe blue bloater
- blue = cyanosed
- Bloaters = signs of RHS heart failure
- expectorant cough (productive)
- crackles and wheezes
What are the 5 fundamentals of COPD care?
- support to stop smoking
- pneumococcal and flu vaccine
- pulmonary rehab
- co-develop a personalised self-management plan
- optimise co-morbidities
Name 4 restrictive lung diseases
- idiopathic pulmonary fribsosi
- hypersensitivity pneumonitis
- Sarcoidosis
- Connective tissue disease related ti lung disease
Symtpoms of restrictive lung disease
- dyspnoea
- dry cough
- malaise
examination finding of restrictive lung disease
- bilateral fine crackles
- finger clubbing
