Obstructive respiratory disease

Question 1

Define asthma

Answer 1

Chronic inflammatory disorder of the large airway - recurrent episodes of reversible airway narrowing.

Question 2

Epidemiology of asthma

Answer 2

1. Typically diagnosed in adolescence

2. More common in the developed world

Question 3

RF asthma

Answer 3

1. Atopy (tendency to produce IgE in response to environmental allergens)
2. FHx
3. Premature birth
4. Obesity
5. Poor socioeconomic status

Question 4

Pathophysiology of asthma

Answer 4

1. IgE antibodies produced in response to allergens
2. Causes mast cell degranulation -> histamine -> bronchoconstriction and smooth muscle contraction
3. Airway narrowing and inflammation + increased mucus production

Question 5

Triggers for asthma

Answer 5

1. Cold
2. Stress
3. Allergens
4. Smoking
5. NSAIDs, b-blockers
6. Exercise

Question 6

Clinical features of asthma

Answer 6

1. Dry cough (worse in morning and evening)
2. Wheeze/breathlessness
3. Worse with exercise
4. Exacerbations related to triggers
5. Chest tightness

Question 7

Investigations for asthma

Answer 7

1. Spirometry - FEV1/FVC<0.7 - obstruction
2. PEF1 diary - on salbutamol
3. Sputum/blood culture/ABG - rule out pneumothorax/effusion

Question 8

Guidelines for management of asthma

Answer 8

1. SABA
2. SABA + ICS
3. SABA + ICS + LABA
4. SABA + ICS + LABA + 4th

Question 9

What drugs are used for asthma

Answer 9

Beta agonists
1. SABA - salbutamol
2. LABA - salmeterol
Muscarinic antagonists
1. SAMA - iprotropium
2. LAMA - tiotropium
Inhaled corticosteroids
Prednisolone

Question 10

Acute asthma attack

Answer 10

1. Oxygen (>92%)
2. Nebulised salbutamol
3. Prednisolone

Question 11

Define COPD

Answer 11

Chronic obstructive pulmonary disorder - progressive disorder of irreversible lung obstruction

Question 12

2 types of COPD

Answer 12

1. Chronic bronchitis - blue bloaters

2. Emphysema - pink puffers

Question 13

Pathophysiology of chronic bronchitis

Answer 13

1. Airway narrowing due to inflammation and increased mucus production
2. Hypertrophy and hyperplasia of mucus secreting glands

Question 14

Pathophysiology of emphysema

Answer 14

1. Dilatation and destruction of lung tissue distal to the bronchi
2. Loss of elastic recoil of the alveoli
3. Reduced compliance and gas exchange in alveoli

Question 15

RF COPD

Answer 15

1. Smoking
2. Alpha 1 antitrypsin deficiency
3. Occupational hazards (coal dust, chemicals)

Question 16

Signs and symptoms of COPD

Answer 16

1. Progressive dyspnoea
2. Wheeze (expiratory)
3. Productive cough (clear mucus)
4. Barrel-shaped chest
5. Ankle swelling (HF)
6. Cor pulmonale
   Worse in cold/damp

Question 17

Investigations for COPD

Answer 17

1. Spirometry - FEV1/FVC <0.7 FEV1<80% predicted
2. CXR - 6 ribs visible, hyperinflated, flat diaphragm
3. DLCO - reduced diffusion pattern of CO2

Question 18

Management of COPD

Answer 18

1. Stop smoking!!!!!
2. SABA/LABA/ICS
3. Mucolytics - carbocisteine
4. LTOT