obstructive lung disease Flashcards
name the biggest obstructive diseases
asthma / COPD - chronic bronchitis and emphysema / alpha 1 antitrypsin deficiency
what are reversible aspects of asthma
bronchoconstriction and inflammation
what is airway remodelling
basement membrane thickens, collagen is deposited in submucosa and smooth muscle hypertrophy
what type of hypersensitivity is asthma, what is the brief immunological response
type 1 // inflammation –> APC –> TH2 –> B cells –> mast cells + eosinophils —> leukotrienes, histamine, chemokines
what can worsen asthma
allergens: animal hair, pollen, others: exercise, smoke, cold air
what are symptoms of asthma
periodic breathlessness, wheeze and dry cough, atopy, nasal polyps
what is a wheeze
high pitched sound on expiration
what indicates occupational asthma and what should be done for management
better at weekend –> refer
what causes occupational asthma
isocynataes, platinum salts, soldering, flour, epoxy
what can be done for asthma diagnosis
spirometry + FENO 1st line: reduced FEV1 and FEV1: FVC (FVC normal) / FENO >40 or >35 in children // PEFR (diurnal variation)
what age is testing for asthma advised from
5
after inhalation of a B2 antagonists, by what % should the FEV1/ PEFR increase by
more than 15%
what is the first line treatment guidelines for asthma
- SABA eg salbutamol when an attack happens
what is the second and 3rd line treatment to asthma
- ICS 3. ICS + SABA
- SABA + ICS + oral leukotriene eg montelukast
what is the 3rd line treatment in asthma
- increase dose of ICS, if no improvement add oral corticosteroid prednisolone
what would the PEFR be in moderate acute asthma
less than 80% predicted
what would the PEFR be in sever asthma
less than 50%
what would the PEFR be in life threatening asthma
less than 33%
if someone was hospitalised with severe asthma what would the treatment be
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
what are the symptoms of acute-severe asthma attack
Unable to finish sentences
PEFR less than 50% predicted
Tachycardia
RR more than 25 breaths/min
what are the symptoms of a life threatening asthma attach
PEFR less than 30% predicted
Bradycardia, hypotension, silent chest
Exhaustion/confusion
Hypoxia, acidosis
what is chronic bronchiectasis
chronic neutrophilic inflammation and mucous hyper-secretion, and bronchospasm (partially reversible)
what is emphysema
alveolar collapse leading to impaired gas exchange, common with 1-antiprotease deficiency
how can noxious particles eg smoking lead to inflammation
activate macrophages which release neutrophillic chemokines and the production of proteases which destroy alveolar wall (emphysema) and mucous hyper-secretion
what is panicar emphysema
emphysema affecting the terminal bronchioles, everything in between damaged
what are the main symptoms and signs of COPD
not episoidic, non-atopic, daily cough, progressibe breathlessness, wheezing and reduced breath sounds, Better when sitting up
what can COPD progress too
impaired ABG, resp failure, right ventricular failure
how can emphysema lead to cor pulmonale
reduced PaO2 leads to vasocontriction which increased pressure to right ventricle
what diagnosis can be done for COPD
reduced FEV1, PEFR, FVC and normal FEV1: FVC ratio, less than 15% PEFR improvement with B2
what is the treatment plan for COPD
1) SAMA 2) LAMA + LABA 3) ICS (predisnolone) /LABA/LAMA (antibiotic if infection)
why do you need to be careful prescribing corticosteroids to COPD
can cause pneumonia
what are the main differences in asthma and COPD
asthma is allergic, intermittent symptoms, non productive cough or breathlessness, eosinophillic, diurnal variation, normal ABG
what are stabilisers used for
people with motility issues, makes it easier to take
what is ACOS
asthma COPD overlapping syndrome, COPD with blood eosinophillia
what is the target O2 sats of COPD patients and what % o2 is originally given
88% -92%, 24% - type II resp failure
why do COPD patients need to be on lower O2
patient in hypoxic drive and so increasing O2 will also increase PaCO2
what is type I resp failure
hypoxic + normal/ low CO2
what is type II resp failure
hypoxic + hypercapnia
which drugs are only given in asthma
cromones eg sodium chromoglicate, leukotriene antagonists eg monteleukast (CysLT1)
what drugs are only for COPD
PDE4 inhibitor eg roflumilast
what is bronchial hyper-responsiveness in asthma
ep damage exposes nerve endings leads to increased hypersensitivity
in regards to hypersensitivity and hyper activity which is associated with mild and severe
mild= hyperS, severe = hyperS and hyperA
in a non atopic individual what would happen in response to an allergen
low Th1 response
in as asthmatic individual what immune changes happen
strong Th2 response, dendritic cells present to CD4+ T cells
what doCD4+T cells release
IL4 which causes B cells to release IgE, this binds to FcE receptors in Mast cells and eisonophils
what do eisonphils and mast cells release
histamine, leukotrienes, chemokines
what immune cells are involved in COPD
neutrophils
what causes occupational asthma
isocynataes, platinum salts, soldering, flour, epoxy
