Obstructive Lung Diseases Flashcards
3 things you must have to have asthma?
Airway hyperresponsiveness, airway inflammation and reversible airflow obstruction.
What is type 2 asthma characterised by?
TH2 cells usually associated with allergy
What are the only drugs that will melt away eosinophilic inflammation and restore normal mucosal architecture?
Steroids
Explain the protease and anti-protease imbalance in COPD
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
What is COPD usually a combination of?
Chronic bronchitis and emphysema
What is asthma COPD overlap syndrome
- This is COPD with blood eosinophilia > 4%
- There will be reductions in exacerbations when given inhaled steroids.
- This is more reversible to salbutamol
Compare the FVC and TCLO in asthma and COPD
Asthma: Preserved FVC and TLCO
COPD: Reduced FVC and TLCO
Compare gas exchange in asthma and COPD
Asthma: normal gas exchange
COPD: impaired gas exchange
Is there diurnal variability in asthma or COPD?
Asthma
Which is allergic asthma or COPD?
Asthma.
COPD is not.
Compare coughs in asthma in COPD
Asthma: Non productive
COPD: productive
Compare corticosteroid response in asthma and COPD
Asthma: Good response
COPD: Poor response
What is a good marker of control in asthma?
The amount of salbutamol a patient needs
What is the risk of using steroids in COPD?
May cause pneumonia in COPD due to local immune suppression altered microbiome and impaired MC clearance especially with fluticasone due to prolonged lung retention
Why are inhaled steroids not used in acute asthma?
As airways are narrowed so not enough drug would reach the lungs
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.
5 and 2
In asthma usually the forced vital capacity is ____1____.
In COPD usually the forced vital capacity is ____2____.
1 preserved
2 reduced
Step wise treatment of asthma?
- 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
COPD step wise treatment?
- 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
Treatment of acute asthma attack?
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
In people with COPD who remain breathless what do you offer after a SABA?
LABA or LAMA
And a ICS if peak flow is less than 50%
Someone can’t speak in sentences is a sign of
severe asthma
Peak flow between 30 and 50 is a sign of
severe asthma
Tachypnoea is a sign of
severe asthma
Tachycardia is a sign of
severe asthma
Cyanosis is a sign of
life threatening asthma
Peak flow less than 33% is a sign of
life threatening asthma
Drowsiness is a sign of
life threatening asthma
Bradycardia is a sign of
life threatening asthma
Silent chest is a sign of
life threatening asthma
