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MD3001 Respiratory > Obstructive Lung Disease > Flashcards

Obstructive Lung Disease Flashcards

1
Q

What is the diagnostic test for obstructive airway diseases?

A
  • spirometry
  • quantitative, objective measurement of lung function
  • can be used to monitor the course of disease
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2
Q

Describe the relationship between radius and resistance according to respiratory illness

A

if radius of airway narrows (decreases) resistance to airflow increases and work of breathing increases

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3
Q

Describe how the physiology of airways change due to asthma and COPD

A

Asthma:

  • inflammation
  • swelling
  • fibrosis
  • increased mucus production

COPD:

  • breakdown in elastic fibres holding airway opening
  • not present in asthma
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4
Q

Describe what values you would see in a spirometry if the patient had an obstructive/restrictive respiratory illness

A

Obstructive disorder:

  • FEV1 reduced <80% normal
  • FVC reduced but to lower extent that FEV1
  • FEV1/FVC ratio less than 0.7

Restrictive disorder:

  • FEV1 reduced <80% normal
  • FVC reduced <80% than normal
  • FEV1/FVC ration normal >0.7
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5
Q

What is forced vital capacity and how must the patient breathe to measure this?

A
  • total volume in the lungs minus the residual volume

- after slow maximal inspiration, patient exhales as hard and as long as possible

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6
Q

What is FEV1/FVC ratio a measure of?

A

airflow obstruction

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7
Q

What are examples of obstructive lung disease?

A
  • asthma
  • COPD
  • bronchiectasis
  • cystic fibrosis
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8
Q

Describe the contrasting features of asthma and COPD

A

Asthma / COPD:
non smoking / smoking
allergic / non-allergic
younger / over 50s
intermittent / chronic
non-progressive / progressive
eosinophil infiltration / neutrophils
diurnal variation / no diurnal variation
good corticosteroid response / poor corticosteroid response
good bronchodilator response / poor bronchodilator response
preserved FVC and TLCO/ reduced FVC and TLCO
normal gas exchange / impaired gas exchange

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9
Q

What are the symptoms to consider for asthma?

A
  • wheeze
  • breathlessness
  • chest tightness
  • cough
  • especially if diurnal variation in symptoms and history of atopy
  • symptoms in response to allergen, exercise and cold air
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10
Q

Describe the pathophysiology of asthma

A

3 components:

  • airway narrowing/obstruction (reversible)
  • airway hyper-responsiveness
  • airway inflammation (eosinophils)

Important mediators:

  • leukotriene B4 and cysteinyl-leukotrienes (C4 and D4)
  • IL-4, IL-5, IL-13
  • tissue damaging eosiniphil proteins
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11
Q

What things that worsen the symptoms of asthma?

A
  • virus
  • allergens (animal dander, dust mites, pollens, fungi)
  • cold
  • food/nutrition
  • chemicals (smoke)
  • exercise
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12
Q

What is the non-pharmacological treatment of asthma?

A
  • achieve and maintain a normal BMI if overweight
  • breathing exercise programmes
  • stop smoking (patient and household members)
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13
Q

What are the features of moderate acute asthma?

A
  • increasing symptoms
  • PEF >50-75% (peak expiratory flow)
  • no features of acute severe asthma
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14
Q

What is the criteria for acute severe asthma?

A

any one of:

  • PEF 33-50%
  • respiratory rate of 25 breaths per minute or more
  • heart rate of 110 or more
  • inability to complete sentences in one breath
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15
Q

What is the criteria for life-threatening asthma?

A

any one of the following in a patient with severe asthma:

  • altered consciousness
  • exhaustion
  • arrythmia
  • hypertension
  • cyanosis
  • silent chest
  • poor effort
  • PEF < 33%
  • SpO2 < 8kPa
  • normal PaCO2
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16
Q

What is the criteria for near fatal asthma?

A
  • raised PaCO2

- requires ventilation

17
Q

What is the management of acute severe asthma?

A

immediate treatment:

  • oxygen SpO2 94-98%
  • SABA via nebuliser
  • IV steroid (hydrocortisone) then switch to oral steroid (prednisolone)

if patient it still not improving:

  • IV magnesium sulphate
  • switch from nebulised to IV salbutamol or methylxanthine

monitor blood gases and patient exhaustion/alertness

18
Q

What is COPD?

A
  • common, preventable, treatable disease
  • characterised by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases
  • exacerbations and comorbidities contribute to overall severity in individual patients
19
Q

What things affect COPD?

A
  • tobacco smoking
  • individual susceptibility
  • host factors
  • genetic abnormalities (eg. a1 antitrypsin deficiency)
  • abnormal lung development
  • age and sex (females)
20
Q

What is a1 antitrypsin deficiency?

A
  • enzyme in liver that counteracts proteinases
  • early onset COPD (<45 years)
  • Z-At gene
  • autosomal codominance
  • emphysema most marked in lower lobe of CXR
21
Q

Describe the pathophysiology of a1 antitrypsin deficiency in COPD

A
  • inflammation and fibrosis of bronchial wall
  • hypertrophy of submucosal glands and hypersecretion of mucous
  • loss of elastic, parenchymal lung fibres
  • consider diagnosis if presents with breathlessness, chronic cough/sputum production and exposure to risk factors
22
Q

What is the clinical presentation of COPD?

A
  • insidious onset
  • usually 50/60s
  • chronic cough
  • sputum production (typically worse in morning)
  • increasing shortness of breath
  • diminishing exercise tolerance
  • history of exposure to risk factors
23
Q

Describe the presentation of the pink puffer

A
  • pink
  • increasing SOB but little cough
  • pursed lips
  • barrel chest due to air trapping (inc in anteroposterior diameter)
  • use of accessory muscle
  • decreased breath sounds
24
Q

Describe the presentation of a blue bloater

A
  • cyanosed
  • bloated: signs of right heart failure
  • productive cough
  • crackles and wheezes
25
Q

What are other presenting factors of COPD (than that of pink puffer/blue bloaters)?

A
  • weight loss
  • skeletal muscle dysfunction
  • CVS disease
  • depression
  • osteoporosis
26
Q

What are the 5 fundamentals of COPD care?

A
  1. support to stop smoking
  2. pneumococcal and flu vaccination
  3. pulmonary rehab
  4. co-develop a personalised self-management plan
  5. optimise co morbidities
27
Q

When would you give a patient domiciliary oxygen therapy?

A
  • patients with PaO2 < 7.3-8 kPa
  • must have stopped smoking
  • must be breathed for >15 hours a day to improve mortaltiy
28
Q

What are examples of restrictive lung diseases?

A
  • idiopathic pulmonary fibrosis
  • hypersensitivity pneumonitis
  • sarcoidosis
  • connective tissue disease related lung disease
29
Q

What are the clinical presentation and examination signs of restrictive lung disease?

A

symptoms:

  • dypnoea
  • dry cough
  • malaise

examination:

  • bilateral fine crackles
  • finger clubbing
30
Q

How do the lungs change in restrictive lung disease?

A
  • smaller lungs
  • decreased VC and FEV1
  • ratio maintained
  • 6 minute walk test is good prognostic indicator

MD3001 Respiratory (38 decks)

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