Obstructive Lung Diseases

Question 1

3 things you must have to have asthma?

Answer 1

Airway hyperresponsiveness, airway inflammation and reversible airflow obstruction.

Question 2

What is type 2 asthma characterised by?

Answer 2

TH2 cells usually associated with allergy

Question 3

What are the only drugs that will melt away eosinophilic inflammation and restore normal mucosal architecture?

Answer 3

Steroids

Question 4

Explain the protease and anti-protease imbalance in COPD

Answer 4

Proteases break down connective tissues in the lung parenchyma and also stimulate mucus hyper secretion and activity is counteracted by protease inhibitors. However, in COPD there is imbalance between proteases and antiproteases (either an increase in proteases, or a deficiency of antiproteases) which leads to inflammatory changes in the airways including damage of the respiratory mucosa

Question 5

What is COPD usually a combination of?

Answer 5

Chronic bronchitis and emphysema

Question 6

What is asthma COPD overlap syndrome

Answer 6

• This is COPD with blood eosinophilia > 4%
• There will be reductions in exacerbations when given inhaled steroids.
• This is more reversible to salbutamol

Question 7

Compare the FVC and TCLO in asthma and COPD

Answer 7

Asthma: Preserved FVC and TLCO
COPD: Reduced FVC and TLCO

Question 8

Compare gas exchange in asthma and COPD

Answer 8

Asthma: normal gas exchange
COPD: impaired gas exchange

Question 9

Is there diurnal variability in asthma or COPD?

Answer 9

Asthma

Question 10

Which is allergic asthma or COPD?

Answer 10

Asthma.

COPD is not.

Question 11

Compare coughs in asthma in COPD

Answer 11

Asthma: Non productive
COPD: productive

Question 12

Compare corticosteroid response in asthma and COPD

Answer 12

Asthma: Good response
COPD: Poor response

Question 13

What is a good marker of control in asthma?

Answer 13

The amount of salbutamol a patient needs

Question 14

What is the risk of using steroids in COPD?

Answer 14

May cause pneumonia in COPD due to local immune suppression altered microbiome and impaired MC clearance especially with fluticasone due to prolonged lung retention

Question 15

Why are inhaled steroids not used in acute asthma?

Answer 15

As airways are narrowed so not enough drug would reach the lungs

Question 16

Particles less than _____ microns will get past the carina, particles more will get stuck in the trachea. For the drug to get to the small airways (generation 8) they need to be less than ____ microns in diameter.

Answer 16

5 and 2

Question 17

In asthma usually the forced vital capacity is ____1____.

In COPD usually the forced vital capacity is ____2____.

Answer 17

1 preserved

2 reduced

Question 18

Step wise treatment of asthma?

Answer 18

• Those with a diagnosis of asthma should be prescribed a SABA for relief of symptoms
• The frequency of use of a SABA is a good measure of asthma severity and control
• If a preventer is needed inhaled ICS has been shown to be the most effective and is first line in adults and most children
• Can add on other preventer therapies which seems to be patient dependent on what is prescribed e.g. Leukotriene receptor antagonists (montelukast), LABAs, Sodium cromoglicate and theophylline (methylxanthines)
• Very unresponsive asthma may be referred for monoclonal antibody treatment

Question 19

COPD step wise treatment?

Answer 19

• Before pharmacological therapy must offer smoking cessation, pneumococcal and influenza vaccines, offer pulmonary rehab, optimize treatment of co-morbidities
• If struggling with breathlessness and it is limiting their exercise can offer inhaled therapies
• First step is SABA or a SAMA
• If still struggling offer steroids if they show asthmatic features, or a LABA + LAMA combination
• If asthmatic features and no relief still then offer LABA + ICS, then LABA + LAMA + ICS if that doesn’t work
• If no asthmatic features but LABA + LAMA not worked can change to LABA + LAMA + ICS

Question 20

Treatment of acute asthma attack?

Answer 20

OH SHIT MAN – Acute Asthma Treatment 
Oxygen 100% through a non-rebreather mask
Salbutamol Nebulised back-to-back.
Hydrocortisone IV or Prednisolone PO
Ipratropium Bromide Nebulised hourly
Theophylline IV or aminophylline IV
Magnesium and call an
Anaesthetist / ambulance

Question 21

In people with COPD who remain breathless what do you offer after a SABA?

Answer 21

LABA or LAMA

And a ICS if peak flow is less than 50%

Question 22

Someone can’t speak in sentences is a sign of

Answer 22

severe asthma

Question 23

Peak flow between 30 and 50 is a sign of

Answer 23

severe asthma

Question 24

Tachypnoea is a sign of

Answer 24

severe asthma

Question 25

Tachycardia is a sign of

Answer 25

severe asthma

Question 26

Cyanosis is a sign of

Answer 26

life threatening asthma

Question 27

Peak flow less than 33% is a sign of

Answer 27

life threatening asthma

Question 28

Drowsiness is a sign of

Answer 28

life threatening asthma

Question 29

Bradycardia is a sign of

Answer 29

life threatening asthma

Question 30

Silent chest is a sign of

Answer 30

life threatening asthma