resp Flashcards
21 y/o male normally fit n well dry cough breathless no chest pain looks blue
possible diagnoses?
any other info needed?
asthma pneumonia pulmonary embolism pneumothorax heart failure
- full Hx
- explore in depth (onset, timing, variation, severity, exacerbating/relieving, associated symptoms)
- PMH, FH, DH
- SH (occupation, travel)
- exam findings
list some lung function tests
spirometry
lung volumes
transfer factor (lol tf is this?)
mouth pressures ?
list some radiological tests for resp
plain XR
CT
US
CMR/MRPA
ventilation/perfusion scan
what are some other resp tests?
objective assessment of function
bronchoscopy
thoracoscopy
oximetry
transcutaneous CO2 monitor
what is spirometry?
common office test used to assess how well your lungs work by measuring how much air you inhale/exhale and how quickly you exhale
what is the transfer factor test?
a test of the diffusing capacity of the lungs for CO (DLCO, also known as transfer factor for carbon monoxide or TLCO)
1 of the most clinically valuable tests of lung function …
measures the ability of the lungs to transfer gas from inhaled air to the RBC in pulmonary capillaries !
what is a CMR?
cardiovascular magnetic resonance (CMR) scan
gives us info on the structure of your heart and BV & how well they’re working
what is MRPA?
magnetic reasoning pulmonary angiography
2nd line to CTPA
what is CTPA?
CT pulmonary angiography
what is thoracoscopy?
medical procedure involving internal exam, biopsy, and/or resection of disease or masses within the pleural/thoracic cavity
define T1 resp failure ! LOL :)
low PaO2
normal/low PaCO2
define T2 resp failure
low PaO2
high PaCO2
what is common btwn t1 and t2 resp failure
both have low PaO2
what is the diff btwn t1/t2 resp failure
t1 is normal/low co2
t2 is high co2
what is PAO2?
ALVEOLAR O2
what is PaO2?
arterial O2
is PAO2 higher usually or PaO2?
PAO2
bc PaO2 is closer to mixed venous air than it is to inspired
what is the alveolar-arterial gradient normally?
less than 2 kPa
list some causes of a raised A-a gradient (alveolar-arterial) gradient
hypoventilation
v/q mismatch
anaemia
diffusion limitation
shunt (R-L or L-R)
how do u calculate PAO2?
≈ FiO2(PATM – pH2O) – (PaCO2/RER)
if there’s a normal gradient but low PaO2 what does this mean?
PAO2 must be low
hypoventilation
reduced FiO2 (or PATM)
what is ambient hypoxia
eg at altitude
NB: ambient = relating to the immediate surroundings of something
what can ambient hypoxia lead to?
widespread HPV
increasing pulmonary artery pressure
can (rarely) lead to pulmonary oedema
when does high altitude pulmonary oedema happen?
2-3d after ascent
how do u treat high altitude pulmonary oedema
descent
oxygen
pulmonary vasodilaotors
where does gas exchange begin?
bronchi, terminal bronchioles, respiratory bronchioles, alveolar ducts OR alveoli?
respiratory bronchioles
what is the path of air from trachea to alveoli?
trachea
main bronchus
segmental bronchus
bronchioles
terminal bronchioles
respiratory bronchioles
?alveolar ducts
?alveoli
list 5 functions of the lungs
gas exchange
acid-base balance
defence
hormones
heat exchange
what are diff aspects of the defence mechanisms in the lung?
mucosal barrier mast cells macrophages mucociliary clearance cough reflex
what kind of a disease is CF
single gene
what is the commonest monogenic recessive disorder
cystic fibrosis
what happens in CF? (6)
abnormal ion transport (Cl-)
impaired mucociliary clearance
recurrent and chronicinfections
impaired digestion
fertility problems
liver disease, diabetes
if FEV1/FVC ratio is < 0.7 (70%)
what is it? obstructive or restrictive?
obstructive
if FEV1/FVC ratio is <0.8
what is it? obstructive or restrictive?
restrictive
if there is an airways problem, is it obstructive or restrictive?
what is the FEV1/FVC ratio?
obstructive
FEV1/FVC ratio <0.7
what is lung parenchyma?
portion of the lung involved in gas transfer
- the alveoli
- alveolar ducts
- respiratory bronchioles
if there’s a problem w the lung parenchyma (alveoli/ducts/resp bronchioles) is it restrictive or obstructive?
what is the FEV1/FVC ratio?
restrictive
FEV1/FVC ratio normal
if there’s a problem with the chest wall/pleura is it restrictive or obstructive?
restrictive
what is transfer factor aka
diffusing capacity
test that looks at eg if u breathe CO, how well it is perfused and so acts as a surrogate for oxygen
what happens with low (transfer factor) TLCO?
a test of the diffusing capacity of the lungs for CO (DLCO, also known as transfer factor for carbon monoxide or TLCO)
thickening of the alveolar-capillary membrane
reduced lung volumes
what happens with high (transfer factor) TLCO
a test of the diffusing capacity of the lungs for CO (DLCO, also known as transfer factor for carbon monoxide or TLCO)
increased capillary blood volume
pulmonary haemorrhage
which, nearly always, reduces (transfer factor) TLCO?
a test of the diffusing capacity of the lungs for CO (DLCO, also known as transfer factor for carbon monoxide or TLCO)
COPD
pulmonary fibrosis
does COPD reduce TLCO?
a test of the diffusing capacity of the lungs for CO (DLCO, also known as transfer factor for carbon monoxide or TLCO)
yes
does polcythaemia reduce TLCO?
a test of the diffusing capacity of the lungs for CO (DLCO, also known as transfer factor for carbon monoxide or TLCO)
no
does pulmonary fibrosis reduce TLCO?
a test of the diffusing capacity of the lungs for CO (DLCO, also known as transfer factor for carbon monoxide or TLCO)
yes
does asthma reduce TLCO?
a test of the diffusing capacity of the lungs for CO (DLCO, also known as transfer factor for carbon monoxide or TLCO)
no
does L-R inracardiac shunt reduce TLCO?
a test of the diffusing capacity of the lungs for CO (DLCO, also known as transfer factor for carbon monoxide or TLCO)
no
what is interstitial lung disease?
an umbrella term for a large group of disorders that cause scarring (fibrosis) of the lungs
what is sarcoidosis a part of?
interstitial lung disease (which is an umbrella term)
what are some causes of breathlessness?
mechanical interference
weakness of resp pump
increased resp drive
increased wasted ventilation
psychological dysfunction
what is dyspnea
SOB
list some examples of mechanical interference with ventilation (which can lead to SOB)?
obstruction to airflow
resistance to expansion of lungs (stiff lungs)
resistance to expansion of chest wall/diaphragm
asthma, emphysema, bronchitis
what can they lead to?
obstruction to airflow
fibrosis, LVF …
what can they lead to?
stiff lungs / resistance to expansion of lungs
pleural sickening, obesity, abdo mass …
what can they lead to?
resistance to expansion of chest wall/diaphragm
hypoxemia can lead to what?
metabolic acidosis can lead to what?
decreased cardiac output can lead to what?
increased respiratory drive
list some examples of things that may cause increased resp drive which can lead to SOB?
hypoxaemia
metabolic acidosis (renal disease, anaemia etC)
decreased CO
what can contribute to increased wasted ventilation
what might this result in?
capillary destruction eg emphysema/interstitial lung disease
large-vessel obstruction eg pulmonary emboli
SOB
what can contribute to increased wasted ventilation
what might this result in?
capillary destruction eg emphysema/interstitial lung disease
large-vessel obstruction eg pulmonary emboli
SOB
what can cause capillary destruction? what can this lead to?
emphysema, interstitial lung disease etc
causes increased wasted ventilation
which then can cause SOB
what is somatisation?
the manifestation of psychological distress by the presentation of physical symptoms
what are the 3 ways in which u can categorise lung disease?
- infection
- inflammation
- cancer
what does mouth pressure look at?
resp muscle weakness
if ur looking for a blood clot, what type of scan do u do?
CTPA
(CT pulmonary angiogram)
looks at pulmonary arteries
if ur looking for pleural fluid in the chest, what type of scan might u do?
ultrasound
if ppl have chronic pul hypertension, what are some tests used?
CMR
MRPA
what is an objective measure of SOB?
objective assessment of function
what are some practical non-radioactive procedureS?
bronchoscopy
thoracoscopy
if ur hypoventilating, what is co2 like?
normal or high
does anaemia affect oxygen tension?
no
but it does matter how much oxygen ur blood can take in total (capacity)
what is V/Q mismatch?
effectively R-L shunting
will a L-R shunt cause raised A-a gradient?
no, bc ur shunting oxygen in ur blood through ur lungs
what happens in asthma? (5)
increased irritability of bronchi causing spasm
paroxysmal attacks
overdistended lungs
mucus plugs in bronchi
enlarged bronchial mucous glands with excess secretions
what are the 2 broad clinical categories of asthma?
extrinsic and intrinsic
what are the 2+ types of extrinsic asthma
atopic = IgE/t1 hypersensitivity
occupational = t2 hypersensitivity
what is the barometric pressure like at high altitude?
lower
what is the PO2 like at high altitude (4000m) compared to sea-level?
≈60%
which of these is a well-recognised response to hypoxia?
a) bradycardia
b) atrial fibrillation
c) systemic vasoconstriction
d) pulmonary vasoconstriction
e) syncope
d) pulmonary vasoconstriction
if ur hypoxic, what happens systemically?
vasodilation
if ur hypoxic, what happens with pulmonary vessels?
vasoconstrict
so oxygen delivery is matched w/ oxygenation of alveoli
at high altitude, what do pulmonary vessels do?
vasoconstrict
has implications eg high altitude pulmonary oedema
WILL HIGH ALTITUDE PULMONARY OEDEMA COME UP ON THE EXAM
APPARENTLY NOT
“this will not come up in ur exam”
according to the lecturer
so I really wasted my time writing this huh
where does gas exchange begin?
respiratory bronchioles
what is the diff btwn small and large airways
small <2mm
large >2mm
what constitutes large airways?
>2mm
trachea
bronchi
bronchioles
what constitutes small airways?
<2mm
terminal bronchioles
resp bronchioles
alveolar ducts
alveolar sacs
what is the conducting zone of the resp pathway
trachea-bronchi-bronchioles-terminal bronchioles
what is the transitional and resp zone of the resp pathway
resp bronchioles-alveolar ducts-alveolar sacs
what breaks a breath hold?
raised CO2 in CSF!
central chemoreceptors sensing CO2 which diffuses readily across BBB and lowers CSF pH
which chemoreceptors respond to raised CO2 in CSF? central or peripheral?
central
what are central chemoreceptors sensitive to?
the pH of their environment
where are chemoreceptors OF THE CV system located?
carotid bodies
aortic bodies
where are carotid bodies located?
in carotid arteries than run through neck to brain
where are aortic bodies found?
aortic arch
what is an aortic body?
1 of several small clusters of peripheral chemoreceptors located along aortic arch
what are peripheral chemoreceptors?
extensions of PNS
repsond to changes in blood molecule conc (oxygen/CO2)
help maintain cardio-rest homeostasis
what is the diff btwn central and peripheral chemoreceptors
central - medullary chemoreceptors
peripheral - systemic arterial chemoreceptors in carotid/aortic bodies
why are central (medullary) chemoreceptors important?
mediate response to a rise in PaCO2
why are peripheral (arterial) chemoreceptors important?
essential for response to hypoxia/drop in blood pH (acidosis)
why are the lungs defence organs?
bc we inhale a lot of shit
what is the key genetic resp disorder?
CF
“CF IS IMPORTANT, MAY GET QUESTIONS ON IT IN THE EXAM”
…..hmmmmmmmm
remember to read over it!!!
what does the Bradford hill criteria look at?
causation
what does reduced FEV mean
reduction in amount of gas breathed out in a second
what is 1 of the key measures for obstructive lung disease
FEV
what does obstruction mean?
difficult to get air out
what does restriction mean?
difficult to get air in and out
wait…. what is TLCO again?
transfer factor bro
“bronchiectasis will probs come up in the context of infection”
LOOOOOL
what is the commonest site of infection
resp tract
approx how many resp tract infections do children/adults have ?
children: 2-5
adults: 1-2
define tonsilitis
infection of the tonsils
what is a sore throat aka
pharyngitis
what is inflammation of the trachea (spell it right too smh)
tracheitis
what is laryngitis
infection of the larynx
what is bronchiolitis
infection of small airways - bronchioles
what is inflammation of the pleura termed?
its often caused by an infection
pleurisy
what is bronchitis?
infection of large airways - bronchi
what is pneumonia?
infection of the alveoli and surroundinglung
the skin keeps everything in apart from what?
sweat
what is the urine systems defences against infection?
its sterile
urine flow is outwards
why are lungs prone to infection?
bc we need a v thin membrane for gas transfer
so there’s not much space for barriers or immune system or commensals
what are the sinuses like ?
sterile
what do u have in the upper resp tract?
commensal flora
help to some extent
20% of us can be colonised by what? in the resp tract
S aureus
u can be colonised in a way that’s not harmful to u, but can be harmful to others
:/ upper RT to 1 person can be meningitis in the next person
how are pathogens cleared via swallowing?
normal swallowing reflex, epiglottis
neuro (timing) and anatomical factors
what is vital abt lung anatomy?
ciliated epithelium (mucociliary escalator)
mucus
goblet cells btwn ciliated cells - prod mucus
cilia helps waft everything upwards into trachea, throat, cough/swallow etc
constantly clearing out gunk
deep down into final terminal acinus/alveoli .. what are the humeral n cellular factors?
soluble factors: Ig’s, defensives, collectins
alveolar macrophages (1st responders, security guards) keeping a look out
B & T cells
neutrophils if required
what makes u more susceptible to resp infection?
swallowing can be affected by stroke/MND, surgery etc
altered lung physiology may be caused by CF, emphysema, bronchiectasis etc
OR extrinsic stuff like near problems, obesity, surgery
what is pneumonia?
infection that inflames the air sacs in one or both lungs.
air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing.
if a pt has suspected pneumonia, what else do u look at?
How sick is the patient?
Should they be managed in hospital?
Does the patient need antimicrobials?
Is there an alternative diagnosis; Heart failure Pulmonary embolus Cancer TB Interstitial lung disease
what are DD for pneumonia?
HF pulmonar embolus cancer TB interstitial lung disease
what is hop avg for pneumonia
6-8 days
who’s at risk of pneumonia?
infants/elderly
COPD, other chronic lung
immunocompromised
nursing home residents
diabetes
congestive heart disease
alcohol/IVDU
what are symptoms of pneumonia?
fevers
sweats
rigors
(basically generic infection response)
cough, sputum
SOB
may get pleuritic chest pain (worse on deep breathing)
any sensation from inside lungs .. not pain .. feels like irritation - cough
lining of lung has nerve endings so can localise pain
hence pleuritic pain!
:)
hurts patient to take a big breath
don’t wanna cough, can’t aerate lungs
PAIN CONTROL IS V IMPORTANT IN PNEUMONIA TO HELP PPL GET BETTER!
what are some signs of pneumonia?
abnormal vital signs:
raised HR, raised RR
low BP
fever
dehydration
signs of lung consolidation:
- dull to percussion
- decreased air entry
- bronchial breath sounds
- ± hypoxia
what are some investigations for pneumonia?
CXR
FBC (WBC - marker of severity, diagnosis)
biochem (U&E, LFTs)
CRP (for diagnosis)
pulse oximetry (severity, if required, ABG for failure)
microbio tests
always check for what with pneumonia patients?
HIV
pneumonia is common in HIV patients
what are some indicators of pneumonia severitY?
Delerium = Confusion
Renal impairment = Urea rise
Increased oxygen demand -
Respiratory rate high
BP drop
????SEPSIS!
who is sepsis more likely in
those who’s physiology already impaired by age or comorbidity
what is CURB65?
mnemonic for pneumonia that predicts mortality!!!!! (higher score is higher mortality)
C - confusion U - urea ≥7mmol/L is bad R - resp rate ≥30/min B - BP; low A - age ≥65
generally, if someones sick?
broad spectrum
IV
what are disadvantages of using a multiple-AB (nuclear missile approach)
promotes AB resistance
side effects
AB associated diarrhoea etc
expensive
what are disadvantages/adv of using a “sniper” single, small AB approach?
Might miss
More tolerable
Saves other choices
Cheaper
what is the most common cause of pneumonia?
Streptococcus pneumoniae (40%)
also mycoplasma pneumonia (≈10% that peaks in epidemic seasons)
how do u treat S. pneumoniae
beta-lactam ABs; amoxicillin
if TB is suggestive, consider what?
acid fast bacilli stain
culture for TB
what is TB?
bacterial infection
spread through inhaling tiny droplets from the coughs/sneezes of an infected person.
mainly affects the lungs. but can affect any part of the body, including the glands/bones/NS
what is TB caused by
mycobacterium tuberculosis (MTB)
when are lung abscesses seen?
in aspiration
alcoholics often :(
how do u treat lung abscesses
prolonged ABs - for up to 6 weeks
may need surgical drainage
what is the diff btwn HAP and CAP
hospital acquired pneumonia
community acquired CAP
what is HAP
hosp acquired pneumonia
acquired min 48h after hosp admission
(elderly, post op etc)
diagnosis: new fever, new radiological findings, CRP incr, increasing oxygen requirements)
what is the gen principle for treatment for HAP?
‘start broad’
then ‘focus’ treatment
what happens in bronchiolitis?
inflammation of bronchioles/mucus production
causes airway obstruction
what are examples of sore throats
pharyngitis
tonsilitis
what are examples of a common cold
rhinitis
sinusitis
in healthy adults, w/ bronchitis, is bacteria often a cause?
nah, its rarely a cause in healthy adults
majority are viral, as those causing other infections of upper airways
what are some clinical features of bronchitis?
cough
SOB, wheeze
fever
systemic features of infection unusual - suggest flu/pneumonia
what are some investigations for bronchitis?
CVR to exclude pneumonia, usually normal
viral/bac throat swabs
serology 4 mycoplasma, chlamydia
what is the treatment for bronchitis?
none usually, bc its viral
little evidence for antimicrobials being helpful
what happens in asthma, pathology wise
bronchial obstruction
mucus plugging of bronchi
bronchial inflammation
bronchial wall smooth muscle hypertrophy
thickening of bronchial BM
what is intrinsic asthma associated with
recurrent chest infections
chronic bronchitis
not immune-mediated
what is the mechanism for aspirin induced asthma?
unknown
what is occupational asthma caused by?
work-associated inhaled agent
acts as either a non-specific stimulus
what can acute chronic localised obstruction progress to
bronchiectasis
what is classical for chronic obstruction?
centred on bronchi/bronchioles
‘obstructive’ pulmonary function tests
what happens in chronic bronchitis
productive cough for 3m in 2 consecutive years
mucus hyper secretion - bronchial mucous gland hypertrophy
tobacco smoking-induced mainly
some asthma effects
who does chronic bronchitis tend to affect
middle aged heavy smokers
some following chronic pollution
how does chronic bronchitis progress
often starts mild
severe;:
hypercapnia
hypoxaemia
cyanosis (blue bloaters)
coexisting emphysema (pink puffers)
what does blue bloater refer to?
generalised term referring to a person who is blue and overweight.
usually SOB and chronic cough.
old term - now recognised as severe chronic BRONCHITIS
what does pink puffer refer to?
generalized term for a person who is thin, breathing fast and is pink.
usually SOB and pursed lip breathing
old term - now recognised as as severe EMPHYSEMA
what happens in emphysema
alveolar airspaces enlarge
destruction of elastin in walls
frequent association with chronic bronchitis
what is emphysema?
permanent enlargement of airspaces distal to terminal bronchioles due to destruction of walls
(linked w cig smoking)
what is a major cause of cig smoking?
emphysema
what is emphysema a type of?
COPD
what happens in emphysema over time?
air sacs weaken and rupture - creating larger air spaces instead of many small ones.
what proportion of lung capacity is destroyed before symptoms of emphysema
1/3
what are clinical features of ‘pure’ emphysema
reduced PaCO2
normal PaO2
at rest
(due to overventilation - pink puffers)
also:
- weight loss bc metabolic demands
- RHF
- overinflated chest
- poor O2 delivery to tissues
define bronchiectasis
permanent dilatation of bronchi/bronchioles
what is permanent dilatation of bronchi/bronchioles termed?
bronchiectasis
which lung lobes are usually affected by bronchiectasis?
lower
what are symptoms of bronchiectasis
chronic cough
large quantities of foul-smelling sputum
flecked with blood sometimes
what are some complications of bronchiectasis?
pneumonia
fungal colonisation
emphysema
septicaemia
metastatic abscesses eg brain/heart
further necrosis/destruction of lung tissue leading to pulmonary fibrosis
summarise bronchiectasis (3)
results from bronchial obstruction w/ distal infection n scarring
destruction of bronchial and alveolar walls
dilatation of the airways
what happens in interstitial lung disease?
increased amount of lung tissue
increased stiffness n decreased compliance
is chronic interstitial disease fibrosis + or - ?
+
what is fibrosing alveolitis aka
idiopathic pulmonary fibrosis
what happens in fibrosing alveolitis/idiopathic pulmonary fibrosis ?
finger n toe clubbing
results in end-stage fibrosis (honeycomb lung)
unknown aetiology
what is pneumoconiosis?
lung disease caused by inhaled dust
what is sarcoidosis?
granulomatous disease affecting mainly lungs, but also LN in a greater freq
do more men or women get lung cancer
men
what proportion of all cancer deaths come from lung cancer
1/3
list some causes of lung cancer
cigarettes (majority)
- passive smoking = 2x normal
occupational eg asbestos
lung fibrosis
what are some symptoms of lung cancer?
cough
recurrent chest infections
haemoptysis (coughing up blood)
increasing SOB
general malaise
weight loss
what is haemoptysis?
coughing of blood
what is the most common lung cancer?
metastatic carcinoma
more common than primary lung carcinoma
what are lung cancers broadly divided into?
small cell lung carcinoma
non-small cell lung carcinoma
what is the spread of small cell lung carcinoma like at presentation?
usually has spread
what is the primary/standard treatment for small cell lung carcinoma?
chemotherapy
what is the primary/standard treatment for non-small cell lung carcinoma (large cell)?
surgery/radiotherapy
chemo may be offered
what are investigations for lung cancer?
cytology
histology
via sputum/biopsy etc
resp drug nomenclature: if it ends in “….mab” ????
Monoclonal AntiBody
resp drug nomenclature: if it ends in …sone/lone ?????
corticosteroid
resp drug nomenclature: if it ends in ….terol ????
bronchodilators
resp drug nomenclature: if it ends in ….nib ???
kinase INhiBitor
what is an example of a monoclonal antibody resp drug
reslizuMAB
what are 2 examples for corticosteroids resp drugs
dexamethaSONE
prednisoLONE
what is an example of a bronchodilator (resp) drug
salmeTEROL
what is an example of a kinase inhibitor resp drug
nintedaNIB
how are inhaled medicines delivered?
directly to the lung
via oral or nasal route
what do inhalers deliver
dry powder formulation
what do nebulisers deliver
medication in the form of aerosols
what are conducting airways like in terms of drugs?
smaller SA
lower regional blood flow
high filtering capacity (mucociliaryescpalator)
removes up to 90% of delivered drugs
what is the resp circulation like in terms of drugs?
accounts for 95%+ of lungs SA
directly connected to systemic circulation
bettter than conducting airways
other than IV - what’s the 2nd best way of getting drugs in?
inhaled
why is inhalation technique important?
if patients inhale too forceful - particle deposition in upper aiways/mouth/throat is dominant n lung deposition falls
intranasal or oral which is better?
oral bc allowed to administer v small particles .. nose has anatomical limitation bc narrow airway lumen
list some delivery systems for inhaled drugs
pressurised metered-dose inhalers (PMDIS) [like Ammi]
spacer devices
dry powder inhalers (DPIS)
nebulisers
what are some adv to inhaled meds?
lungs - naturally permeable to peptides
large SA
rapid absorption
fewer drug metabolising enzymes than blood/liver
how do PMDIS work
device is activated by the user pressing down on the top of the container
resulting in the release of a fine spray containing propellant and drug
how do spacer devices work
slow down the particles of the drug and allow more time for evaporation of the propellant so that more of the drug can be inhaled
how does DPIS (dry powder inhalers) work
dpis do not have a propellant — instead, on activation, the device releases a small amount of drug in powder form, which is then inhaled
(this requires the person to have sufficient inspiratory effort to breathe in the powder).
how do nebulisers work
nebulizers work by dispersing a liquid into a fine mist which can be inhaled through a mask or mouthpiece.
main adv is that no coordination is required by the user, and high doses of drug can be delivered to the airways.
what are 2 reasons why airways may be obstructed
tightening of airway smooth muscle
lumen occlusion by mucus and plasma airway wall thickening
what can bronchoconstriction lead to
airflow obstruction
when is bronchoconstriction most commonly seen?
asthma and COPD
how is ASM (airway smooth muscle) primed in asthma?
to contract
and is resistant to relaxation
what are the most frequently used inhaled meds
bronchodilators
what are bronchodilators split into?
adrenergic - SYMPATHETIC
(causes bronchodilation)
anti-cholinergic - PARASYMPATHETIC
(block bronchoconstriction)
what do adrenergic bronchodilators do?
cause bronchodilation
what do anticholinergics do?
block bronchoconstriction
how do b2 agonists act on b2 adrenoceptors?
cause smooth muscle relaxation
bronchodilator
inhibits histamine release from lung mast cells
what are SABAs
short acting b2-adrenoceptor agonists
what is an example of SABA
salbutamol
what is an example of a LABA
formoterol
or salmeterol
what do ultra-LABAs allow
whats an example
once-daily dosing
indacaterol
what are LABAs often combined with?
and why?
corticosteroids
for the treatment of asthma and with an inhaled long-acting antimuscarinic agent (LAMA) for treating COPD patients
what does LAMA stand for
long-acting antimuscarinic agent
what is the role of ACh in the resp system?
contracts ASM (airway smooth muscle)
by activating muscarinic receptors
on smooth muscle cells
what do anticholinergics do?
block ACh binding to muscarinic receptors (M1-5)
when anticholinergics block muscarinic receptors on ASM, what does it prevent?
muscle contraction
gland secretion
also enhances neurotransmitter release
what is atropine?
naturally occurring anticholinergic
reverses bronchoconstriction caused by PS nerve stimulation
anticholinergics are often used in combo with anti-inflammatory steroids in the treatment of what?
asthma
COPD
inflammatory cells such as neutrophils and eosinophils inappropriately persist in the airway and lead to …. (2)
direct tissue damage
perpetuation of inflammation
what are corticoseroids aka
glucocorticoids
what is the most effective anti-inflammatory for asthma
corticosteroids/glucocorticoids
are glucocorticoids effective in COPD/CF ?
nope :/
severe asthmatics can become resistant to what?
glucocorticoids
what is an ICS inhaler?
inhaled corticosteroid
name an example of a ICS inhaler
beclomethasone dipropionate
how do inhaled corticosteroids (ICS) reduce inflammation? (3)
suppress prod of mediators
reduce adhesion molecule expression
inhibit inflammatory cell survival in the airway
what do ICS inhalers do?
reduce number of inflammatory cells in the airways
what are some side effects of ICS inhalers such as beclomethasone dipropionate
loss of bone density
adrenal suppression
cataracts, glaucoma
when is corticosteroid resistance common?
in COPD
less common in asthma
COPD patients who are responsive to corticosteroids are thought to have what?
concomitant asthma
which may explain the element of sensitivity to ICS
inhaled b2-agonsits are frequently used together with what (for asthma)
glucocorticoids as a fixed combo inhaler
what is bronchiectasis
abnormal dilation of the bronchi
what are 2 signs of bronchiectasis
excessive sputum production
chest pain
what is bronchiectasis associated with
cystic fibrosis
what does bronchiectasis have an overlap with
COPD
asthma
what is pathophysiology of bronchiectasis thought to be de to?
excessive and persistent inflammation in the lung
how do u treat bronchiectasis? (3)
ABs to treat infective elements
physical therapy clears airways
surgery n transplantation for severe disease
BUT strategies aim to reduce symptoms rather than underlying cause
excessive fibrous connective tissue leads to what? (3)
permanent scarring
airway wall thickening
breathing difficulties
what is a hallmark of interstitial lung diseases?
fibrosis
what is a lace-like network of tissue that extends throughout lungs and provides support to alveoli?
the interstitium of the lung
what is the tissue btwn alveoli and bloodstream called
interstitium
how do interstitial diseases present typically?
present with :
cough and/or breathlessness
on exertion
what are treatment options like for fibrosis?
limited
what is the best option for fibrosis?
transplantation
some forms of fibrosis respond to what?
corticosteroids
what is pirfenidone?
a new/commoly used AB in fibrosis
has an AF, AI & AO properties
(oral)
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define resp failure
inability of lungs to adequately oxygenate arterial blood supply and/or eliminate CO2 from venous supply
does hypoxia break breath hold?
no, hypercapnia does
remember, shunt in resp med = diff to shunt in CVS
…
what is v/q mismatch
imbalance btwn ventilation and perfusion
what is normal V/Q?
0.8
when there’s dead space, what is V/Q ratio?
infinity (bc dividing by 0)
eg pulmonary embolus
no blood flowing through capillary
fully ventilated alveolus w no blood flow through it
normal alveolus
red blood supply
what is the V/Q ratio like?
increased V/Q
shunt - normal blood supply
can’t pick up oxygen
problem at alveolar level
what is the V/Q ratio like?
V/Q = 0
what are some signs of t1 resp failure
cyanosis
incr RR (tachypnoea)
accessory muscle use
tachycardia
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what kind of person is obstructive sleep apnoea more common in?
obese ppl
fat around neck occludes ___________
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what are some clinical signs of hypercapnia
bounding pulse ? ? ? ?
treatment of resp failure?
depends on cause !
treatment of t1 resp failure?
oxygen
treat underlying cause
if unable to maintain adequate oxygenation –> CPAP
treatment of t1 resp failure? (3)
oxygen (94-98%)
treat underlying cause
if unable to maintain adequate oxygenation –> CPAP (continuous positive airways pressure)
how is oxygen delivered
nasal cannula (up to 4L/min)
simple face mask (can’t measure inspired amt)
venturi mask (v important)
non-rebreathe mask
treatment of t2 resp failure? (3)
oxygen, but be careful (88-92%)
treat underlying cause within 1hr of med treatment
if unable to maintain adequate oxygenation/removal of CO2 –> NIV (non-invasive ventilation)
what is target sats for t1 resp failure
94-98%
what is target sats for t2 resp failure
88-92%
go over case studies from this lecture
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with a flare of asthma, expect to see what co2?
low
when it goes high - sig warning sign!!!!!!!!!!!
sign that pt is becoming tired
need to take it seriously
what is the most common cause of hyperaemia?
V/Q mismatch
alveolar hypoventilation can cause what?
t2, hypercapnia resp failure
usually give what in resp failure?
oxygen
what is crucial in guiding management of resp failure patients?
ABG
what are interventions for COPD (cheapest/PH –> to most expensive)
flu vaccination
stop smoking support
pulmonary rehab
tiotropium
LABA
what does COPD lump together
bit vague
inc lots
emphysema (pathological - destruction of lung tissue)
bronchitis (clinical - cough/phlegm)
bronchiolitis (clinical)
what is the NICE definition of COPD (4/5)
characterised by airflow obstruction
usually progressive
not fully reversible
doesn’t change markedly over several months
predominantly caused by smoking
[not NICE] s/t to do with inflammation, env, noxious particles/gases. its an inflammatory response to that
what is the predominant cause of resp deaths
COPD
can’t have COPD unless u fill which spirometric criteria?
FEV1/FVC < 0.7
what is the diff btwn COPD and asthma?
asthma is reversible
what are the 2 mechanisms underlying airflow limitation in COPD?
small airways disease
parenchymal destruction
what happens in small airways disease
airway inflammation
airway fibrosis, luminal plugs
increased airway resistance
THUS airflow limitation
what happens parenchymal destruction?
loss of alveolar attachments
decrease of elastic recoil
THUS airflow limitation
what are physiological changes in COPD?
poor v/Q match
low PaO2
poor ventilation may give high pCO2
obliteration/vasoconstriction –> pulmonary hypertension
list 9 clinical features of COPD
old old patients smoker male predominance SOB cough phlegm wheeze raised respiratory weight hyperexpansion/barrell shaped chest cyanosis weight loss 'cor pulmonale' - heart failure
WHAT IS COR PULMONALE
abnormal enlargement of the RHS of heart as a result of disease of the lungs or the pulmonary BV
what is a phenotype for pink puffers?
weight loss
breathless
emphysematous
maintained PO2
whats a phenotype for blue bloaters?
cough
phlegm
cor pulmonale (enlarged RHS of heart)
resp failure
what is a typical COPD patient
older
smokers
male traditionally
apart from smoking, what are some COPD risk factors?
occupational dust/chemicals
env tobacco smoke
indoor/outdoor air pollution
socioeconomics - of parent ! in-utero development
what is the effect of mixing cannabis and marijuana for COPD?
synergestic effect !
worse effect than either on their own .. nobody knows why
what is the MRC dyspnoea scale for COPD pts?
1 - SOB on marked exertion
2 - SOB on hill
3 - has to stop for breath when at own pace
4 - stops for a few mins after walking on flat level
5 - too breathless to leave house or on dressing/undressing
what are DD for COPD
other causes of SOB HF pulmonary emmbolus pneumonia lung cancer asthma bronchiectasis
what is bronchiectasis
LT cond - airways become abnormally widened
–> leading to a build-up of excess mucus that can make the lungs more vulnerable to infection.
most common symptom is phlegmmy cough
allergic inflammation (asthma) is characterised by the recruitment of what?
eosinophils
what is atopy?
the tendency to develop IgE mediated reactions to common aeroallergens
what subgroups can asthma be divided into?
eosinophilic
non-eosinophilic
what can eosinophilic asthma be divided into?
atopic asthma (developing immune response to common aeroallergens)
and non-atopic
name 3 causes of atopic asthma
fungal allergy
common aeroallergens
occupation, pets, exposures
what are 3 types of non-eosinophilic asthma?
non-smoking, non-eosinophilic
smoking associated
obesity related
what is often the presenting complaint w asthma?
episodic wheeze
cough, breathlessness
diurnal variation
list some provoking factors for asthma
allergens
infections
menstrual cycle
exercise
cold air
laughter/emotion (LOOOL)
how do u check the severity of asthma?
level of treatment required (no. of inhalers)
A&E attendances, admissions, HDU/ITU care, ventilation
attendance at GP for courses of ABs/steroids
how do u assess day to day severity of asthma
recent nocturnal waking?
usual asthma symptoms in a day?
interference with ADLs?
what does ADL stand for
activities of daily living
what do u look at in an asthma history (4)
age of onset (did it get better at any point?)
childhood resp disease
any unusual features at start eg sudden onset, weight loss
obvious causes such as chlorine exposure
what are some associated problems w asthma?
eczema, hayfever
nasal disease
other food/drug allergies
reflux disease
what PMH do u look at w asthma?
always vital part of history
previous pneumonias (bronchiectasis?)
neuro/renal problems (vasculitis?)
what do u look at in terms of drugs w asthma patients?
what should they be taking?
what do they ACTUALLY take?
are they taking beta blockers orally or topically?
are they sensitive to NSAIDs or aspirin?
any drugs w potential interactions? eg theophyllines
what do u look at in family history of asthmatics!
DO THEY SMOKE?
atopy is an inherited tendency
FHx of asthma, eczema and hayfever
are there pets?
psych history
is atopy environmental?
inherited
what do u look at in an occupational history?
exposure to dusts/fumes/allergens
lab workers, vet staff, animal breeders
paint sprayers
bakers
is asthma worse at work/better on holiday?
how is COPD diff to asthma?
COPD - later disease of mainly smokers
COPD is mores progressive SOB
COPD has less diurnal variation/diurnal variation
what do u expect to see in a physical exam of an asthmatic
may be normal
wheeze, polyphonic, expiratory, widespread
absence of crackles, sputum, other signs
what tests do u do for asthma
blood count: eosinophils
tests for atopy/allergy: IgE, SPTs
chest XR often useful
oxygen sats
what do u find in lung function testing (asthmatics)
airways obstruction may be present
(reduced FEV1 and FEV1/FVC ratio)
PEFR reductions from % predicted
what is a marker of eosinophilic inflammation?
what is a problem w this?
exhaled nitric oxide (FeNO)
not specific
suppressed in smokers
elevated with viral infections and rhinitis
who is at risk of asthma death? (5)
≥3 classes of treatment
recent admission/frequent attender
previous near-fatal disease
brittle disease
psychosocial factors
what are some DD for asthma? (8)
bronchiolitis bronchiectasis CF PE hyperventilation bronchial obstruction (foreign body, tumour) COPD
what is bronchiolitis
inflammation of bronchioles
caused by a virus known as the respiratory syncytial virus (RSV), which is spread through tiny droplets of liquid from the coughs or sneezes of someone who’s infected.
the infection causes the bronchioles to become infected & inflamed
what are the 4 goals for asthma treatment?
to improve control
to address important issues for the patient eg exercise
what is important in asthma care?
avoidance of triggers !!!! (allergens, occupational)
list some examples of bronchodilators for asthma
beta agonists
LABAs
anticholinergics
are steroids inflammatory or anti-inflammatory?
steroids = short for corticosteroids
decrease inflammation so anti-inflammatory !
what do bronchodilators treat ?
symptoms not the disease
why are bronchodilators and steroids used for asthma?
bronchodilators for symptoms
steroids to reduce airway inflammation nd decrease mortality risks
why isn’t everyone given oral steroids? (3)
systemic (diabetes, cataracts, osteoporosis, skin thinning, easy bruising etc)
topical (hoarse voice, oral candida, etc)
adrenal suppression
why may a spacer be used? (2)
to improve delivery
minimise side effects
which 2 tests are always done at TB units?
acid-fast bacilli (AFB) smear and culture
what is the top infectious killer in the world?
TB
list some risk factors for TB
born in high prevalence area
IVDU
homeless
alcoholic
prisons
HIV+
how do you catch TB?
aerosol/spitting/sneezing
from infected individual’s lung to another
what is omalizumab anti?
anti-IgE
for atopic allergic disease
what is TB caused by?
mycobacterium tuberculosis (so a mycobacteria)
what is pneumonia?
lung inflammation caused by bacterial/viral infection
how you recognise a severe asthma attack?
do PEFR, full clinical assessment
oximetry
CXR if suspect pneumothorax, life threatening asthma, failure to respond
what values do u get for a severe asthma attack?
any 1 of:
PEFR 33-50% predicted
RR ≥ 25
HR ≥ 110
inability to complete sentences
what values do u get for a life threatening asthma attack?
any 1 of:
PEFR < 33%
SaO 2 < 92%
PaO2 < 8kPa
normal PaCO2 4.6-6kPa
altered conscious level, exhaustion, arrhythmia, hypotension, silent chest, cyanosis
what is immediate management for asthma attack?
oxygen 40-60%
salbutamol neb 5mg (± ipratropium if life threatening)
prednisolone 30-60mg (± hydrocortisone 200mg IV)
ABGs
watch for key complications: tension pneumothorax, arrhythmias, hypokalaemia
CXR if suspected as above or failure to respond to treatment
what is pneumothorax?
when air leaks into the space between your lung and chest wall.
this air pushes on the outside of your lung and makes it collapse.
how do u monitor response to asthma treatment?
PEFR check within 15-30 mins
oximetry to maintain sats > 92%
repeat ABG within 2hrs if severe attack
if deteriorating despite maximal treatment with worsening hypoxia/hypercapnia etc –> ITU transfer
watch K+, glucose
consider rehydration
whens should an asthma patient be transferred to ITU
if deteriorating despite maximal treatment
worsening hypoxia/hypercapnia
coma/exhaustion
when do u discharge an asthma patient? (6)
opportunity to educate and prevent readmissions
achieve PEFT >75% and <25% variability
prednisolone 7-14d
asthma action plan
nurse-led follow up
early clinical review (48hrs at GP surgery)
what does enteral admission refer to?
food/drug administration via the human GI tract
what is TB caused by?
mycobacterium tuberculosis (so a mycobacteria)
how do u treat a latent TB infection
single drug for a long time
what is tuberculosis caused by?
mycobacterium tuberculosis
what % of ppl infected w TB are aware they’re infected?
abt 5%
when may TB present?
if immune system becomes debilitated eg AIDS/immune issues
what happens in extra pulmonary TB?
lymph node TB
bone
abdo TB
GU TB
CNS TB
what kinda symptoms do u get with primary TB?
asymptomatic
mild flu like illness
what can systemic TB affect?
kidneys - sterile pyuria
meningitis
hepatitis etc
what do u get if u have a positive result for TB?
CXR to see active disease
which kind of TB sufferers are most infectious?
adults w reactivated TB
what do visitors of TB patients do?
wear masks that filter 95% of aerosols
how do u treat an active TB infectin
AB combo
how do u treat a latent TB infection
single drug for a long time
what % of ppl don’t have any disease?
≈95%
who is the BCG vaccine given to?
neonates from high risk groups
if 1 parent is born in a highTB risk country
what happens in pulmonary TB?
cough over 3/52w
chest pain
breathlessness
haemoptysis (coughing up blood)
how do u diagnose active TB definitively
microbio
sputum
urine
CSF
biopsy specimen: any LN
for any chronic illness with fever and weightloss, think what?
TB
what is Mantoux?
tuberculin skin test
uses an ID injection of tuberculin.
Is TB curable
yes
what are the 3 separate “genera” of the orthomyxoviridae family
influenza A, B & C
what is crucial to reduce relapse/resistance of TB?
compliance
who gets increased risk of drug resistance to TB? (4)
previous treatment
high risk area
contact of resistant TB
poor response to therapy
which vaccine is given for TB?
BCG
who is the BCG vaccine given to?
neonates from high risk groups
if 1 parent is born in a highTB risk country
where can TB affect?
any site
what is the commonest site of TB infection?
lung
for any chronic illness with fever and weightloss, think what?
TB
what is influenza?
acute resp illness caused by infection w/ influenza virus
what is influenza a member of?
the orthomyxoviridae family
what are the 3 separate “genera” of the orthomyxoviridae family
influenza A, B & C
what are the main human pathogens
influenza A and B
what causes seasonal epidemics of flu?
antigenic drift
what causes pandemics of flu?
antigenic shift
what is antigenic shift?
gene re-assortment and major antigenic variation
what is antigenic drift?
minor antigenic variation
what is the diff btwn epidemic n pandemic?
epidemic - within a community
pandemic - world-wide
which out of influenza A, B & C is a relatively minor disease?
C (mild symptoms/asymptomatic)
which influenza is most often seen in children?
influenza B
what kinda outbreaks can influenza B cause?
sporadic eg schools, care homes, garrisons
most often seen in children
which type of ppl is flu mortality risk higher?
those w underlying medical conditions
chronic cardiac and pul. diseases, old age, chronic met diseases, immunosuppressed
what kinda influenza causes severe outbreaks/pandemics?
Influenza A
what makes something an outbreak?
2+ linked cases
out of smallpox, HIV, pandemic flu, seasonal flu and measles what generates the highest number of secondary cases?
measles
how is measles transmitted
airborne
how is smallpox transmitted
social contact
how is HIV transmitted
sexual contact
how do govts work prior to pandemics?
int. surveillance
virus/vaccine research
stock piling of drugs
how can flu be characterised? (symptom wise?
upper and lower resp tract symptoms
what are some complications of flu?
bacterial pneumonia
can be life threatening
what type of treatment is good for flu?
supportive care
eg oxygenation, hydration, maintain homeostasis
what makes something an outbreak?
2+ linked cases
what is infection control for flu? (4)
hand hygiene
universal precautions
surgical masks
patient segregation
what is the incubation period for pandemic flu, and when is it infectious?
IP - 1-4days
infectious from onset to 4-5 days after
what are 3 factors that might mean we will get more pandemics?
more travel
more people
intensive farming (more animal contacts w ppl, factory farming breeding grounds for viruses)
how do u control avian flu (mild disease in birds)
reduce population of (cull) affected birds
disinfect farms
vaccinate workers
how do govts work prior to pandemics?
int. surveillance
virus/vaccine research
stock piling of drugs
what are some staff issues bc of a flu?
anxiety/unwilling to work
childcare
adequate protection
what are possible population-wide interventions for flu?
travel restrictions
restrictions of mass public gatherings
schools closure
screening of ppl entering UK
voluntary home isolation of cases
what is swine flu a reassortment of?
swine, avian and human flu virus
what are the 2 phases of managing flu?
containment phase (identifying cases, treatment, contact tracing, large scale prophylaxis)
treatment phase (treat cases only, national flu pandemic service)
how do u manage cases of flu?
call centres
non medical staff manage cases according to an algorithm
home delivery of anti virals
how is the UK prepared for a flu outbreak? what drug?
stockpiling of antiviral drugs
mostly tamiflu
how does tamiflu work?
UK stockpiles 30mill courses
given within 24-48h of contact
reduces hose by 50%
when are face masks useful?
worn correctly
changed frequently
removed properly
disposed safely
used in combo w good universal hygiene practice
what are some staff issues bc of a flu?
anxiety/unwilling to work
childcare
adequate protection
what are possible population-wide interventions for flu?
travel restrictions
restrictions of mass public gatherines
schools closure
screening of ppl entering UK
voluntary home isolation of cases
how does the PEF vary in COPD vs asthma?
COPD - minimal variation
asthma - day-to-day and diurnal variation
all COPD patients benefit from regular what?
physical activity
what is spirometry in asthma like
may be normal
how does COPD respond to steroids?
not v well
how do asthmatics respond to steroids?
well
COPD is often found with what?
other diseases
what can COPD be comorbid with (long list)
cardiac disease cancer renal failure diabetes weight loss depression anxiety osteoporosis
what happens w reduced COPD risk? (3)
- prevented disease progression
- prevented/treated exacerbations
- reduced mortality
which 2 things reliably increase LT smoking abstinence rates?
pharmacotherapy
nicotine replacement
all COPD patients benefit from regular what?
physical activity
LABD reduce what in COPD?
exacerbations, related hospitalisations
inhaled corticosteroid therapy is associated with what?
increased risk of pneumonia
list some therapeutic COPD meds
SABAs, LABAs
SAACs, LAACs
what are the 2 goals of COPD therapy?
to reduce symptoms
to reduce risk
what happens w reduced COPD symptoms? (2)
- improved exercise tolerance
2. improved health status
what happens w reduced COPD risk? (3)
- prevented disease progression
- prevented/treated exacerbations
- reduced mortality
which medications are central to symptomatic management of COPD?
bronchodilators (b2 agonists, anticholinergics, combo)
the effects of work on health can be what? (4)
acute
cumulative
progressive (disease progression after exposure ceases)
diseases with latencies
LABD reduce what in COPD?
exacerbations, related hositalisations
inhaled corticosteroid therapy is associated with what?
increased risk of pneumonia
what is occupational medicine?
branch of medicine concerned w/ interaction btwn work n health
what 4 aspects does occupational med look at?
- individual workers
- groups of workers
- workplace effects on surrounding population
- health of employers’ customers/clients
what is the most common work-related ill health in GB?
stress, depression, anxiety :(
long-time worklessness is a great risk to health, why?
social exclusion n poverty
loss of fitness/wellbeing
trapped on benefits to retirement
2-3x risk of MH/poor health
how will action to reduce health inequalities ave economic benefits?
in reducing losses from illness associated with health inequalities
the effects of work on health can be what? (4)
acute
cumulative
progressive (disease progression after exposure ceases)
diseases with latencies
what is the diff btwn hazard and risk
hazard = potentially harmful
risk = probability of harm
what are the 10 key components of good work?
- precariousness (Stable, risk of loss)
- individual control
- work demands
- fair employment
- opportunities
- prevents social isolation/discrim/violence
- share info, participate in decision making
- work/life balance
- reintegrates sick/disabled
- promotes health n wellbeing
what 3 factors should raise suspicion of an occupational aetiology?
an illness that fails to respond to standard treatment
does not fit the typical demographic profile
or is of unkwnown cause
what are 5 occupational screening questions?
- what type of work do u do?
- do u think ur health problems might be related to ur work?
- are ur symptoms different at work and at home?
- are u current exposed to chemicals, dusts, metal, radiation, noise or repetitive work or have been in the past?
- are any of ur co-workers exp similar symptoms?
what does occupational lung disease represent?
a wide-range of resp conditions
caused by inhaling a harmful substance in the workplace
long-time worklessness is a great risk to health, why?
social exclusion n poverty
loss of fitness/wellbein
trapped on benefits to retirement
2-3x risk of MH/poor health
how will action to reduce health inequalities ave economic benefits?
in reducing losses from illness associated with health inequalities
define disability
physical/mental impairment
which has a substantial LT adverse effect on a person’s ability to carry out normal activities
how can employers reasonably adjust work for disabled ppl?
altered working hours
allow absences for medical treatment
give additional training
special equipment
provide additional support
what are 3 primary preventions for occupational health?
monitor risk
controlling hazards
promotion
what are 3 secondary preventions for occupational health?
screening
early detection
task modification
what are 2 tertiary preventions for occupational health?
rehab
support
what does occupational lung disease represent?
a wide-range of resp conditiosn
caused by inhaling a harmful substance in the workplace
what is the diff btwn inhalable vs respirable dusts?
inhalable - can enter resp tract
respirable - can penetrate to an alveolar level
dusts are solid particles usually how many microns in size?
1-1000
inhalable dust is how big?
less than 100 microns
respirable dust is how big?
less than 10 microns
what is occupational asthma like ?
latent period
deteriorating symptoms
gradual improvement
depression
what are fumes?
small (less than 1 micron) solid particles suspended in the air
dust and fumes are both solid particles suspended in the air. what’s the diff?
size
dust = 1-1000 microns fumes = less than 1 micron
what is mist?
liquid particles suspended in the air
list 4/5 causes of occupational lung disease
dust mist fumes inhaled vapours n gases
a workers response to a workplace exposure is variable and dependant on a range of factors including? (3)
- physical/chemical nature of the agent
- duration/dose of exposure
- individual susceptibility
what % of all adult onset asthma is occupational?
15%
what is the majority of occupational asthma induced by?
allergy to inhaled agent at work
what is pneumoconiosis?
lung disease caused by inhalation of a mineral dust eg asbestosis
name 3 asbestos-related lung diseases
pleural disease
pulmonary fibrosis
cancer
what is a harmless marker of exposure ?
pleural plaques
what do pleural plaques consist of
layers of collagen
often calcified
what happens w asbestosis?
progressive breathlessness
decades long latency
no effective treatment
may progress slowly
what is asbestosis?
interstitial lung fibrosis associated with asbestos inhalation
what is a mesothelioma?
rapidly progressive and incurable pleural cancer
what often presents as an unexplained pleural effusion?
mesothelioma
