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My1 Resp > obstructive lung disease > Flashcards

obstructive lung disease Flashcards

1
Q

name the biggest obstructive diseases

A

asthma / COPD - chronic bronchitis and emphysema / alpha 1 antitrypsin deficiency

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2
Q

what are reversible aspects of asthma

A

bronchoconstriction and inflammation

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3
Q

what is airway remodelling

A

basement membrane thickens, collagen is deposited in submucosa and smooth muscle hypertrophy

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4
Q

what type of hypersensitivity is asthma, what is the brief immunological response

A

type 1 // inflammation –> APC –> TH2 –> B cells –> mast cells + eosinophils —> leukotrienes, histamine, chemokines

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5
Q

what can worsen asthma

A

allergens: animal hair, pollen, others: exercise, smoke, cold air

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6
Q

what are symptoms of asthma

A

periodic breathlessness, wheeze and dry cough, atopy, nasal polyps

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7
Q

what is a wheeze

A

high pitched sound on expiration

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8
Q

what indicates occupational asthma and what should be done for management

A

better at weekend –> refer

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9
Q

what causes occupational asthma

A

isocynataes, platinum salts, soldering, flour, epoxy

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10
Q

what can be done for asthma diagnosis

A

spirometry + FENO 1st line: reduced FEV1 and FEV1: FVC (FVC normal) / FENO >40 or >35 in children // PEFR (diurnal variation)

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11
Q

what age is testing for asthma advised from

A

5

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12
Q

after inhalation of a B2 antagonists, by what % should the FEV1/ PEFR increase by

A

more than 15%

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13
Q

what is the first line treatment guidelines for asthma

A
  1. SABA eg salbutamol when an attack happens
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14
Q

what is the second and 3rd line treatment to asthma

A
  1. ICS 3. ICS + SABA
  2. SABA + ICS + oral leukotriene eg montelukast
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15
Q

what is the 3rd line treatment in asthma

A
  1. increase dose of ICS, if no improvement add oral corticosteroid prednisolone
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16
Q

what would the PEFR be in moderate acute asthma

A

less than 80% predicted

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17
Q

what would the PEFR be in sever asthma

A

less than 50%

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18
Q

what would the PEFR be in life threatening asthma

A

less than 33%

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19
Q

if someone was hospitalised with severe asthma what would the treatment be

A

1) oxygen (40-60%) with salbutamol nebulised
2) add nebulised ipratropium 3) give hydrocortisone IV 4) Ipraprtium Neb 5) theophylinne (IV), 6) mag sulfate 7) anaeth

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20
Q

what are the symptoms of acute-severe asthma attack

A

Unable to finish sentences
PEFR less than 50% predicted
Tachycardia
RR more than 25 breaths/min

21
Q

what are the symptoms of a life threatening asthma attach

A

PEFR less than 30% predicted
Bradycardia, hypotension, silent chest
Exhaustion/confusion
Hypoxia, acidosis

22
Q

what is chronic bronchiectasis

A

chronic neutrophilic inflammation and mucous hyper-secretion, and bronchospasm (partially reversible)

23
Q

what is emphysema

A

alveolar collapse leading to impaired gas exchange, common with 1-antiprotease deficiency

24
Q

how can noxious particles eg smoking lead to inflammation

A

activate macrophages which release neutrophillic chemokines and the production of proteases which destroy alveolar wall (emphysema) and mucous hyper-secretion

25
Q

what is panicar emphysema

A

emphysema affecting the terminal bronchioles, everything in between damaged

26
Q

what are the main symptoms and signs of COPD

A

not episoidic, non-atopic, daily cough, progressibe breathlessness, wheezing and reduced breath sounds, Better when sitting up

27
Q

what can COPD progress too

A

impaired ABG, resp failure, right ventricular failure

28
Q

how can emphysema lead to cor pulmonale

A

reduced PaO2 leads to vasocontriction which increased pressure to right ventricle

29
Q

what diagnosis can be done for COPD

A

reduced FEV1, PEFR, FVC and normal FEV1: FVC ratio, less than 15% PEFR improvement with B2

30
Q

what is the treatment plan for COPD

A

1) SAMA 2) LAMA + LABA 3) ICS (predisnolone) /LABA/LAMA (antibiotic if infection)

31
Q

why do you need to be careful prescribing corticosteroids to COPD

A

can cause pneumonia

32
Q

what are the main differences in asthma and COPD

A

asthma is allergic, intermittent symptoms, non productive cough or breathlessness, eosinophillic, diurnal variation, normal ABG

33
Q

what are stabilisers used for

A

people with motility issues, makes it easier to take

34
Q

what is ACOS

A

asthma COPD overlapping syndrome, COPD with blood eosinophillia

35
Q

what is the target O2 sats of COPD patients and what % o2 is originally given

A

88% -92%, 24% - type II resp failure

36
Q

why do COPD patients need to be on lower O2

A

patient in hypoxic drive and so increasing O2 will also increase PaCO2

37
Q

what is type I resp failure

A

hypoxic + normal/ low CO2

38
Q

what is type II resp failure

A

hypoxic + hypercapnia

39
Q

which drugs are only given in asthma

A

cromones eg sodium chromoglicate, leukotriene antagonists eg monteleukast (CysLT1)

40
Q

what drugs are only for COPD

A

PDE4 inhibitor eg roflumilast

41
Q

what is bronchial hyper-responsiveness in asthma

A

ep damage exposes nerve endings leads to increased hypersensitivity

42
Q

in regards to hypersensitivity and hyper activity which is associated with mild and severe

A

mild= hyperS, severe = hyperS and hyperA

43
Q

in a non atopic individual what would happen in response to an allergen

A

low Th1 response

44
Q

in as asthmatic individual what immune changes happen

A

strong Th2 response, dendritic cells present to CD4+ T cells

45
Q

what doCD4+T cells release

A

IL4 which causes B cells to release IgE, this binds to FcE receptors in Mast cells and eisonophils

46
Q

what do eisonphils and mast cells release

A

histamine, leukotrienes, chemokines

47
Q

what immune cells are involved in COPD

A

neutrophils

48
Q

what causes occupational asthma

A

isocynataes, platinum salts, soldering, flour, epoxy

My1 Resp (16 decks)

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