Respiratory Conditions (Non-infectious)

Question 1

What are the different types of asthma?

Answer 1

Allergic (most common)
Infectious
Occupational
Exercise induced
Drug induced
Emotional

Question 2

What are the 3 key features of asthma?

Answer 2

Airway obstruction caused by 3 factors:

• bronchoconstriction
• bronchial oedema
• mucus plugging

Question 3

What are the SSX of asthma?

Answer 3

• dyspnoea (more marked in expiration)
• wheeze
• nocturnal cough and wheeze
• chest tightness
• recurrent respiratory tract infections

Question 4

What are the most common allergens involved in allergic asthma?

Answer 4

Dust
Pollen
Animal fur / feathers
Eggs, wheat, fish, milk, yeast

Question 5

What are the 3 main drug classes that can cause drug induced asthma?

Answer 5

1. aspirin
   and
2. NSAIDs
   (block COX pathway and cause a compensatory rise in leukotriene production)
3. beta blockers
   (prevent SNS from stimulating B2 receptors in lungs)

Question 6

What are complications of asthma?

Answer 6

Fatal asthma attack (status asthmaticus)

Spontaneous pneumothorax (air trapping causes formation of bullae that can burst and allow entry of air into pleural space)

Question 7

Which SSX are associated with status asthmaticus?

Answer 7

tachycardia
tachypnoea
sweating
inability to speak
compensatory posture
use of accessory muscles

late SSX:

• bradycardia
• confusion
• central cyanosis
• lapse in consciousness

Question 8

What are the 2 types of COPD?

Answer 8

Bronchitis and emphysema

Question 9

How are bronchitis and emphysema diagnosed?

Answer 9

Bronchitis is diagnosed by the presence of symptoms (productive cough on most days for 3 consecutive months, in 2 consecutive years)

Emphysema is diagnosed by pathological changes (distention of airways distal to terminal bronchioles)

Question 10

What is the definition of bronchitis and emphysema?

Answer 10

Bronchitis = chronic irritation of bronchial epithelium resulting in:

• mucus hypersecretion (hyperplasia of goblet cells)
• persistent inflammation
• replacement of ciliated cells with squamous cells

Emphysema = permanent distention and then destruction of air spaces distal to terminal bronchioles

Question 11

What is the pathology of bronchitis?

Answer 11

Long term irritation of bronchial epithelium, causing:

1. hyperplasia of goblet cells and mucus hypersecretion
2. persistent inflammation and oedema
3. replacement of ciliated cells with squamous cells (loss of mucus escalator)

Question 12

What is the pathology of emphysema?

Answer 12

1. elastase released by phagocytes during inflammation
2. elastase destroys elastin in alveolar walls
   - alveolar walls start to thin
   - alveoli become distended and overinflate
   - alveoli rupture and are destroyed
3. Blebs / bullae:
   - distended alveoli and air escaping from damaged alveoli can cause blebs/bullae
   - can rupture and cause pneumothorax

Question 13

What are the serious outcomes associated with COPD?

Answer 13

1. pulmonary HTN
   - persistent hypoxia stimulates pulmonary vasoconstriction
2. Cor pulmonale (right sided heart failure)
   - because of pulmonary HTN
3. Acute respiratory failure

Question 14

Which SSX do both bronchitis and emphysema have in common?

Answer 14

• increasing dyspnoea

- increasing hypoxia causing pulmonary vasoconstriction and pulmonary HTN

Question 15

What are the different SSX between bronchitis and emphysema?

Answer 15

Cough:

• B: productive
• E: ineffective

Breath sounds:

• B: noisier
• E: diminished

Chest:

• B: chest tightness
• E: barrel chest

Colouring:

• B: cyanosis
• E: flushing

Ventilatory drive:

• B: lowered
• E: heightened

Specific:

• B: digital clubbing, cyanosis
• E: purse lip breathing, speaking in short bursts