Respiratory Disease Flashcards
Symptoms that are typically associated with respiratory disease include:
- Dyspnoea: shortness of breath associated with a wide range of respiratory pathology including pneumonia, asthma and chronic obstructive pulmonary disease (COPD).
- Cough: can be productive (e.g. pneumonia, COPD, bronchiectasis) or dry (e.g. pulmonary fibrosis, side effect of ACE inhibitors).
- Haemoptysis: the coughing up of blood originating from the respiratory tract below the level of the larynx. Haemoptysis is typically associated with lung cancer but can be a rare clinical feature of pulmonary embolism.
- Wheeze: a continuous, coarse, whistling sound produced in the respiratory airways during breathing. It is commonly associated with conditions such as asthma, COPD and anaphylaxis.
- Chest pain: typically worsened by deep inspiration due to being pleuritic in nature (e.g. pulmonary embolism, pleurisy).
- Systemic symptoms: these can include fatigue (e.g. lung cancer, COPD), fever (e.g. pneumonia), and weight loss (e.g. end-stage COPD, lung cancer).
pneumonia
an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing.
Respiratory risk factors
- Pre-existing respiratory disease (e.g. asthma, COPD)
- Family history of respiratory disease (e.g. cystic fibrosis, alpha-1 antitrypsin deficiency)
- Smoking
- Occupational exposure (e.g. coal mining, farming)
- Hobbies (e.g. bird keeping)
haemoptysis
the coughing up of blood.
Immunisation history:
Ask the patient if they have been vaccinated against respiratory diseases such as:
- Influenza
- Pneumococcus
- COVID-19
- Tuberculosis
Medical conditions relevant to respiratory disease include:
Asthma
COPD
Lung cancer
Bronchiectasis
Pulmonary fibrosis
Pulmonary embolism
Tuberculosis
Neuromuscular conditions (e.g. motor neurone disease)
Congestive heart failure
Cor pulmonale
Cystic fibrosis
Alpha-1 antitrypsin deficiency
COPD
Chronic obstructive pulmonary disease (COPD) is a lung disease characterised by persistent respiratory symptoms and airflow obstruction.
COPD is a triad of emphysema, chronic bronchitis and small airway fibrosis.
embolus/emboli
An “embolus” is a blood clot or a piece of plaque that acts like a clot. The word “emboli” means there is more than one clot or piece of plaque. When the clot travels from the site where it formed to another location in the body, it is called an embolism.
Bronchiectasis
Bronchiectasis is a chronic respiratory disease characterised by permanent bronchial dilation, due to irreversible damage to the bronchial wall.
Pulmonary fibrosis
it is a lung disease that occurs when lung tissue becomes damaged and scarred. This thickened, stiff tissue makes it more difficult for your lungs to work properly. As pulmonary fibrosis worsens, you become progressively more short of breath.
Pulmonary embolism
it is a potentially life-threatening medical emergency. It is a condition in which one or more emboli, usually arising from a blood clot formed in the veins, are lodged in and obstruct the pulmonary arterial system, causing severe respiratory dysfunction.
Tuberculosis
it is a granulomatous disease caused by the Mycobacterium tuberculosis complex. TB most commonly affects the lung, but it can affect almost any organ.
Congestive heart failure
it is a clinical syndrome involving reduced cardiac output because of impaired cardiac contraction. Typical clinical symptoms of CHF include shortness of breath, fatigue and ankle swelling.1
Cor pulmonale
it is a condition that causes the right side of the heart to fail.
Cystic fibrosis
it is an inherited condition that causes sticky mucus to build up in the lungs and digestive system. This causes lung infections and problems with digesting food.
Alpha-1 antitrypsin deficiency
an autosomal dominant condition which presents in younger patients (aged 20-40). Alpha-1 antitrypsin is a protease inhibitor with one of its actions being to prevent neutrophil elastase from breaking down alveolar structures. Therefore, a deficiency in alpha-1 antitrypsin leads to the increased destruction of alveolar structures, resulting in early-onset emphysema. Some cases of alpha-1 antitrypsin deficiency involve impaired secretion of alpha-1 antitrypsin by the liver, resulting in accumulation of it in the liver, and therefore cirrhosis.
Chronic granulomatous disease (CGD)
it is an inherited disorder that occurs when a type of white blood cell (phagocyte) that usually helps your body fight infections doesn’t work properly.
Commonly prescribed respiratory medications
Medications commonly prescribed to patients with respiratory disease include:
- Short-acting beta-2-agonist inhalers (e.g. salbutamol, terbutaline)
- Long-acting beta-2-agonist inhalers (e.g. salmeterol, formoterol)
- Inhaled corticosteroid inhalers (e.g. fluticasone, budesonide, beclometasone)
- Short-acting antimuscarinic inhalers (e.g. ipratropium)
- Long-acting antimuscarinic inhalers (e.g. tiotropium)
- Oral steroids (e.g. prednisolone)
- Theophylline
- Antibiotics (e.g. co-amoxiclav, doxycycline, azithromycin)
- Anticoagulants (e.g. warfarin, apixaban)
Some over the counter drugs which may impact the respiratory system include:
- Aspirin (may worsen haemoptysis if already present)
- St John’s Wort (an enzyme inducer which may reduce the effects of warfarin)
Medications with respiratory side effects include:
- Beta-blockers and NSAIDs (bronchoconstriction)
- ACE inhibitors (dry cough)
- Oestrogen-containing medication (increased risk of pulmonary embolism)
- Amiodarone and methotrexate (pleural effusions, interstitial lung disease)
Pulmonary Hypertension
is a pathophysiological disorder occurring when mean pulmonary artery pressure is >25mmHg at rest when assessed with right heart catheterisation.
Sarcoidosis
is a rare condition that causes small patches of swollen tissue, called granulomas, to develop in the organs of the body. It often affects the lungs and lymph nodes, and can also affect your skin.
Bronchiectasis
Bronchiectasis is a long-term condition where the airways of the lungs become widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection.
Obstructive Sleep Apnoea
Obstructive sleep apnoea (OSA) is a sleep disorder that is characterised by recurrent episodes of upper airway obstruction during sleep, which results in apnoea (temporary cessation of breathing) or hypopnoea (temporary decreases in breathing).
Obstructive sleep apnoea is a condition where the upper airway frequently becomes obstructed during sleep, resulting in short periods of apnoea (not breathing).