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Respiratory > Obstructive Lung Disease > Flashcards

Obstructive Lung Disease Flashcards

1
Q

How can the tone of smooth muscle be described in COPD and asthma?

A 
COPD = Hypertrophic
Asthma = Twitchy
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2
Q

What 3 sets of words can be used to describe asthma?

A

Early / Late Onset
Atopic / non-atopic
Extrinsic / Intrinsic

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3
Q

What is the asthma triad?

A

Airway Inflammation
Reversible Airflow Obstruction
Airway Hyper-responsiveness (AHR)

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4
Q

Evolution of asthma?

A

Brief symptoms - Bronchoconstriction
Exacerbations AHR - Chronic airway inflammation
Fixed airflow obstruction - Airway remodelling

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5
Q

What are the 3 hallmarks of asthma remodelling?

A

Thickening of BM
Collagen deposition in submucosa
Smooth muscle hypertrophy

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6
Q

Type of leukocyte involved in asthma? COPD?

A

Usually;
Asthma - Eosinophil.
COPD -Neutrophil

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7
Q

What are the conducting and acinar zones?

A

Conducting are the first 17 levels of the large airway that carry out gas transport to the last 6/7 levels in the small airways where gas exchange can occurred (acinar zone)

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8
Q

What is obstructive airway disease? Examples?

A

Any respiratory disease characterised by air trapping due to narrowing of airways or increased secretions or both.

Asthma, chronic bronchitis, emphysema.

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9
Q

Examples of asthma triggers?

A

Allergens:
Dust mites, pollens, animal dander

Other:
Exercise, smoke, cold, drugs (beta-blockers), chemicals, viral infection.

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10
Q

Clinical signs of asthma?

A

Episodic symptoms and signs, Diurnal variability, non-productive cough with wheeze, triggers, blood eosinophil > 4%, FH, associated atopy causes increased IgE which causes rhinitis, conjuctivittis, eczema.

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11
Q

How is asthma diagnosed?

A

History and examination,

Diurnal variation of peak flow, Reduced FEV1/FVC, Provocation testing results in bronchospasm.

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12
Q

How can asthma be provoked in a clinical setting?

A

Exercise

Histamine/metacholine

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13
Q

The multifactorial disease process of COPD can be summarised under which 3 headings?

A

Mucocillary dysfunction
Inflammation
Tissue damage

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14
Q

Characteristics and symptoms of COPD?

A

Exacerbations, reduced lung function, breathlessness, worsening quality of life.

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15
Q

What causes COPD?

A

Exposure to noxious gases.

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16
Q

Disease process of COPD?

A

Noxious gas (Cigarette smoke) activates macrophages and airway epithelial cells which release neutrophil chemotactic factors, cytokines and mediators. Neutrophils and macrophages then release proteases that breakdown lung parenchyma (emphysema) and stimulate mucous hyper-secretion (bronchitis)

17
Q

In COPD what is there an imbalance of?

A

Proteases and anti-proteases.

18
Q

What is normal mucociliary function? When does this stop?

A

Mucous moved out of airways by cilia.

When damage is caused by neutrophil elastase.

19
Q

How is emphysema visible?

A

Increased air spaces caused by proteases.

20
Q

Features of emphysema?

A

Alveolar destruction,
Impaired gas exchange,
Loss of bronchial support,
Irreversible.

21
Q

Features of chronic bronchitis?

A

Chronic neutrophillic inflammation, Mucus hypersecretion, mucociliary dysfunction, smooth muscle spasm and hypertrophy,partially reversible.

22
Q

What indicates high risk of COPD?

A

2 or more exacerbations in the last year or FEV1 ration < 50%

23
Q

Clinical presentation of COPD?

A

Chronic symptoms, smoking, non-atopic, productive cough, prog breathlessness, frequent infective exacerbations, chronic bronchitis (wheeze), emphysema (reduced breath sounds).

24
Q

Why is stopping smoking important?

A

Arrests further decline in lung volume.

25
Q

What is the chronic cascade in COPD?

A

Prog fixed airflow obstruction, impaired alveolar gas exchange, resp failure, pulmonary hypertension, right ventricular hypertrophy/failure, death.

26
Q

Bronchodilator and corticosteroid response in asthma v COPD?

A

Astham - Good

COPD - Ineffective

27
Q

Non pharmacological COPD management?

A

Smoking cessation
Immunisation
Domiciliary oxygen
Physical activity

28
Q

Pharmacological management of COPD?

A

LAMA/LABA mono
LABA/LAMA combo
ICS/LABA combo
ICS/LABA/LAMA combo

Respiratory (7 decks)

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