obstructive disease overview

Question 1

what is the asthma triad?

Answer 1

airway hyper-responsiveness, airway inflammation and reversible bronchospasm

Question 2

what is the progression of uncontrolled asthma?

Answer 2

airway hyper-responsiveness (bronchospasms) –> chronic airway inflammation –> irreversible airway remodelling

Question 3

describe the inflammatory cascade

Answer 3

genetic predisposition & trigger factor –> airway inflammation –> mediators/TH2 cytokines –> airway hyper reactivity

Question 4

what is the treatment at each stage of the cascade?

Answer 4

avoidance –> corticosteroids –> anti-leukotriene, anti-IgE, anti-IL4/5 –> bronchodilators

Question 5

what are some common triggers of asthma?

Answer 5

animal dander, dust mites, pollens, fungi, exercise, infection smoke, cold, NSAIDs & b-blockers

Question 6

what is the general presentation of asthma?

Answer 6

episodic breathlessness, diurinal variability, non-productive cough, wheeze, triggers, associated atopy, family history,

Question 7

how is asthma diagnosed?

Answer 7

peak flow diary, spirometry, reversibility testing (b2-agonists), provocation testing (histamine, exercise, allergen)

Question 8

in terms of diurnal variability, when is asthma worst?

Answer 8

morning

Question 9

what causes COPD?

Answer 9

noxious particles/gases from either smoking or environmental exposure

Question 10

what are the characteristic pathological changes in COPD?

Answer 10

inflammation, mucocilliary dysfunction and tissue damage

Question 11

what are the characteristics and symptoms of COPD?

Answer 11

late onset, frequent infective exacerbations, productive cough, progressive breathlessness, wheezing, non-atopic, reduced breath sounds

Question 12

what are the alveolar changes that occur in COPD?

Answer 12

collapse, mucosal and peribronchial inflammation and fibrosis, mucus hypersecretion

Question 13

what is the pathogenesis of COPD?

Answer 13

activation of alveolar macrophages but CD8 lymphocytes causing the release of inflammatory cytokines and chemotaxis which attract neutrophils. neutrophils release proteases which destroy the alveolar wall and cause mucus hyper secretion

Question 14

what is chronic bronchitis?

Answer 14

chronic neutrophilic inflammation causing mucus hypersecretion and partially reversible smooth muscle spasm & hypertrophy

Question 15

what is emphysema?

Answer 15

alveolar destruction causing impaired gas exchange and a loss of bronchial support (IRREVERSIBLE)

Question 16

what is the protease-antiprotease imbalance in COPD?

Answer 16

an increase in protease activity (neutrophil elastase, matrix metalloproteinases, etc) and corresponding decrease in anti - protease activity (a1AT deficiency, etc) which favours alveolar destruction

Question 17

when would a COPD patient be classified as high risk for exacerbations?

Answer 17

two exacerbations or more within the last year and/or an FEV1

Question 18

what is the chronic cascade?

Answer 18

progressive irreversible airflow obstruction –> impaired alveolar gas exchange –> respiratory failure –> pulmonary hypertension –> cor pulmonale –> death

Question 19

how is COPD management decided?

Answer 19

GOLD stage

Question 20

how do we manage COPD?

Answer 20

non-pharmalogical: smoking cessation, immunisation, exercise, oxygen (domiciliary), venesection, lung volume reduction, stenting

pharmalogical: LAMA, LABA, LAMA-LABA, LABA-ICS, PDE4I (roflumilast), antibiotics

Question 21

what type of inflammatory cell is involved in A) asthma and B) COPD

Answer 21

A) eosinophils

B) neutrophils

Question 22

how do we diagnose COPD?

Answer 22

spirometry, peak flow, symptom severity (mMRC/CAT), DLCO test (TLCO reduced)