Respiratory Flashcards
What is ABPA characterised by?
ABPA is characterised by an exaggerated immune response (hypersensitivity reaction) to the fungus Aspergillus, most commonly Aspergillus fumigatus.
In which populations does ABPA occur most often?
ABPA occurs most often in people with asthma or cystic fibrosis (CF).
Where are Aspergillus spores commonly found?
Aspergillus spores are ubiquitous in soil and are commonly found in the sputum of healthy individuals.
What spectrum of diseases is Aspergillus fumigatus responsible for?
Aspergillus fumigatus is responsible for a spectrum of pulmonary diseases called aspergilloses.
What does ABPA cause in the airways?
ABPA causes airway inflammation, leading to bronchiectasis.
How do Aspergillus spores affect the respiratory system in healthy individuals?
In healthy individuals, innate and adaptive immune responses are triggered, leading to mucociliary clearance and successful phagocytosis of the spores, clearing the infection.
What factors increase the risk of ABPA in individuals with predisposing lung diseases?
Factors include the presence of asthma, CF, chronic granulomatous disease, or Hyper-IgE syndrome.
What clinical history raises suspicion of ABPA?
Worsening asthma or CF symptoms, along with episodic fever, cough, and mucus plugging.
What immunological tests are useful for diagnosing ABPA?
Elevated IgE, Aspergillus-specific IgE and IgG, and eosinophilia.
What radiological findings are indicative of ABPA?
Fleeting or migratory pulmonary infiltrates and central bronchiectasis on CT scans.
What is the significance of sputum testing in ABPA diagnosis?
Sputum cultures may show Aspergillus growth, though it is not always definitive for ABPA.
What are the ISHAM criteria for diagnosing ABPA?
Elevated total IgE, positive Aspergillus IgE, radiological findings, and evidence of central bronchiectasis.
What are common symptoms of ABPA in patients with asthma?
Wheezing, coughing, dyspnoea, and exercise intolerance.
What symptoms suggest bronchiectasis in moderate and severe cases of ABPA?
Thick sputum production (often containing brown mucus plugs), pleuritic chest pain, and fever.
When should ABPA be suspected in patients with asthma?
When patients have symptoms of ongoing infection that do not respond to antibiotic treatment.
What are the stages of ABPA?
Stage 1 (Acute), Stage 2 (Remission), Stage 3 (Exacerbation/Relapse), Stage 4 (Corticosteroid-Dependent), and Stage 5 (Fibrotic).
What characterises Stage 1 (Acute) of ABPA?
Symptoms and signs of inflammation, elevated IgE, and lung infiltrates.
What happens in Stage 5 (Fibrotic) of ABPA?
Permanent lung damage, including bronchiectasis and fibrosis, leading to chronic respiratory failure.
What are the primary goals of ABPA treatment?
To reduce lung inflammation, prevent exacerbations, and halt disease progression.
What is the mainstay of treatment for ABPA?
Oral corticosteroids (e.g., prednisone).
What role do antifungal agents play in ABPA treatment?
They reduce the fungal load in the lungs, lowering the antigenic stimulus for the immune system.
What is the use of biologic therapy in ABPA?
Monoclonal antibodies, such as omalizumab, are used in refractory cases to target specific parts of the immune response and reduce inflammation.
How are bronchodilators used in ABPA management?
Regular use of inhaled bronchodilators helps improve airflow and manage bronchoconstriction in patients with asthma.
What is the prognosis for ABPA with early diagnosis and proper management?
Many patients can achieve long-term remission and maintain good lung function.
What complications can arise from untreated or poorly managed ABPA?
Chronic bronchiectasis, pulmonary fibrosis, and reduced quality of life.
How can environmental control help prevent ABPA?
Minimising exposure to environments with high fungal concentrations, such as compost heaps or moldy areas.
Why is maintaining good control of underlying asthma important in preventing ABPA?
It helps reduce the risk of developing ABPA.
Caplan Syndrome
Coal worker’s pneumoconiosis+rheumatoid arthritis.
How does HRCT differ from standard CT?
Slice thickness: HRCT uses very thin slices (usually 1-1.5mm) for fine detail.
Resolution: superior spatial resolution to visualise small structures such as alveoli and interstitial spaces.
Reconstruction: optimised for lung detail (uses a high spatial frequency algorithm, often called a bone algorithm).
Scan area: typically focuses on select areas of the lungs, not the entire chest, to reduce radiation exposure).
Contrast: rarely used contrast agents unless needed for specific assessments.
Antifibrotic medications used in the management of ILD.
Pirfenidone
Nintedanib
What is EAA/HP and what causes it?
EAA, also known as Hypersensitivity Pneumonitis (HP), is an inflammatory condition of the lungs caused by inhalation of various organic dusts, molds, or chemicals.
Common causes include exposure to: ______________.
Organic Dust: Found in farming, bird handling, and woodworking.
- Moulds and Fungi: Typically in damp environments.
- Chemicals: Certain substances in paints or plastics.
Acute symptoms of EAA/HP?
Fever, chills, cough, chest tightness, and dyspnoea, appearing 4-6 hours after exposure.
Inspiratory capacity + expiratory reserve volume
Vital capacity
Diagnostic test for Kartagener’s?
Nasal NO.
Why?
Patients with primary ciliary dyskinesia typically have very low levels of nasal NO.
Where is NO produced and why is it relevant in Kartagener’s?
Paranasal sinuses.
It plays a role in the regulation of ciliary motility.
