Resp 9 - Asthma + COPD

Question 1

Define Asthma:

Answer 1

Chronic inflammatory disorder of the airways, resulting in reversible airway obstruction, via inflammation, bronchoconstriction and increased mucous

Question 2

List some environmental triggers of Asthma:

Answer 2

• Cold air
• Pollen
• Dust mites faeces
• Animals
• Exercise
• Perfume
• Emotional distress
• Car fumes
• Cigarette smoke
• NSAIDs/Beta-blockers
• Isocyanates (varnish)
• Acid anhydrase (paint)

Question 3

During an Asthmatic response to an environmental trigger, which cell process the trigger and present antigens to T lymphocytes?

Answer 3

Macrophages

Question 4

Which TH cells are activated in an Asthmatic response?

Answer 4

TH2

Question 5

What are the signs and symptoms of asthma?

Answer 5

• Wheeze
• Breathlessness
• Chest tightness
• Dry cough (worse at night, exercise-induced)

Question 6

Is asthma a restrictive or obstructive deficit?

Answer 6

Obstructive

Question 7

Explain the proper way to use an inhaler:

Answer 7

• Shake well
• Breathe in
• Hold for 10 seconds

Question 8

What is the treatment for mild, intermittent asthmatic episodes?

Answer 8

SABA as required

Question 9

What is the treatment for an Asthma attack?

Answer 9

• O2

- Salbutamol + Atrovent via nebuliser/IV

Question 10

Define COPD:

Answer 10

Chronic Obstructive Pulmonary Disorder:

Progressive airway obstruction, not fully reversible. Predominantly caused by smoking.

Question 11

What genetic deficiency can cause COPD?

Answer 11

alpha-1-antitrypsin deficiency

Question 12

What are the pathological changes in COPD?

Answer 12

• Enlargement of mucous-secreting glands of central airways
• Increased number of goblet cells
• Ciliary dysfunction
• Elastin breakdown = destruction of alveolar walls + loss of elastic recoil
• Formation of large air spaces = decreased SA for gas-exchange
• Vascular bed changes = pulmonary hypertension

Question 13

What type f heart failure are COPD patients most likely to develop?

Answer 13

• Right heart failure due to pulmonary hypertension

Cor pulmonale as caused by lung disease

Question 14

List some signs/symptoms of COPD:

Answer 14

• Cough
• Shortness of breath
• Pursed lip breathing
• Tachypnoea
• Use of accessory muscles when breathing
• Barrel-chest
• Hyper-resonance on percussion
• Distant breath sounds
• Reduced air entry
• Wheezing
• Central cyanosis (late COPD)
• Flapping tremors (late COPD)

Question 15

What is the symptom of lung hyperinflation?
What lung disease is this usually seen in?
What are the signs of this on an X-Ray?

Answer 15

Barrel-chest
COPD
Flattened diaphragm, hyperlucent lungs, ^ AP diameter

Question 16

Why should patients with COPD have an ABG?

Answer 16

To be assessed for respiratory failure

Question 17

What genetic test might you perform on a non-smoker who has developed COPD?

Answer 17

alpha-1 antitrypsin deficiency test

Question 18

List some pharmaceutical agents used to treat COPD:

Answer 18

• Bronchodilators ie Salbutamol
• Antimuscarinics
• Inhaled Corticosteroids
• Mucolytics ie Carbocysteine
• Theophylline

Question 19

What vaccines may you give to a patient with COPD?

Answer 19

Pneumococcal vaccine

Influenza vaccine

Question 20

What type of O2 would you give a hypoxic patient with COPD? Why?

Answer 20

24% or 28% O2
If higher % given, would lower respiratory drive, worsening hypoxia. This is due to modified ‘normal’ PO2 due to chronic hypoxia, by central chemoreceptors.

Question 21

Name some common complications of COPD:

Answer 21

• Recurrent pneumonia
• Pneumothorac
• Respiratory failure
• Cor pulmonale