Respiratory Disease

Question 1

definition of asthma

Answer 1

reversible airflow obstruction via bronchial hyper reactivity - muscles used to breath in but breathing out an issue as no muscles to expel air = wheezing

Question 2

why airway lumen shrinks in asthma

Answer 2

• allergen triggers IgE
• causes b and t cell interactions leading to mast cell degranulation
• causes bronchial smooth muscle contraction, mucosal oedema and excessive mucous secretion

Question 3

symptoms of asthma

Answer 3

• cough
• wheezing in expelling air
• shortness of breath
• worse at night and in morning
• diurnal variations

Question 4

how to gather evidence of asthma

Answer 4

peak expiratory flow rate (PEFR)

Question 5

asthma occurs in two events - can be worse later in the second event - what is the name of this response and what are the types of drugs administered to deal with each event?

Answer 5

asthma biphasic response

• short term 1st event = agonist
• later longer event = corticosteroids

Question 6

what are the 5 corse asthma drugs

Answer 6

1. intermittent short acting beta adrenergic agonists
2. regular long acting beta adrenergic agonists
   - 2 MUST be used alongside an inhaled response
   - then use 3 or 4
3. inhaled corticosteroids (low dose)
   - if not enough use 4
4. inhaled corticosteroids (high dose)
5. adjuvant therapy (for severe cases)

Question 7

purpose and action of beta adrenergic agonists

Answer 7

• for asthma and reduce bronchioconstriction

Question 8

purpose, action and when use required of corticosteroids

Answer 8

• for asthma, has immune and epithelial actions

- take EVERY DAY if taking >3 beta adrenergic agonists a week

Question 9

what 4 things the dental team need to know about asthma in relation to patients

Answer 9

1. if they have it
2. know severity
3. what sets off
4. know how to assess/treat patient having acute attack

Question 10

how are patients placed into the 4 tears of asthma severity

Answer 10

1. mild (blue and brown inhalers standard here)
   
   • bottom level = occasional short acting beta adrenergic agonist
   • second level = above and short acting corticosteroid
2. moderate (blue and purple)
   
   • third level = moved to using long acting beta adrenergic agonist and high dose inhaled corticosteroid
3. more severe
   
   • have to use other drugs
4. most severe
   
   • hospitalised by asthma in the last year

Question 11

definition of Chronic Obstructive Pulmonary Disease (COPD)

Answer 11

• mixed airway (large and small) obstructive reversible and irreversible destructive lung disease

Question 12

name of process in COPD that destroys the alveoli, small and large airways and how it works

Answer 12

• Bronchiectasis

- excessive mucous allows chronic infection damaging walling of airways and muscles of the walls

Question 13

name of the alveolar destruction caused by COPD’s bronchiectasis

Answer 13

• emphysema

Question 14

COPD risk factors

Answer 14

• asthma
• pollution
• age
• chronic bronchitis
• smoking

Question 15

outcomes of COPD

Answer 15

• reduced SA for gas exchange
• heart failure
• pneumonia risk
• respiratory failure (types 1&2)

Question 16

how is COPD managed

Answer 16

• oxygen supply
• long acting bronchodilators
• stopping smoking
• ## antibiotics

Question 17

what are the two types of respiratory failure that can occur due to COPD

Answer 17

type 1 - hypoxia/hypoxaemia = low oxygen [absorbed] (alveolar effect)

    - reduced SA for gas exchange
    - thickened alveolar walls
    - hyperventilate to compensate
    - THOUGH high oxygen in lungs just cant be absorbed

type 2 - Hypercapnia and hypoxia (poor ventilation)

    - only in acute respiratory failure 
    - restrictive lung defects/narrowing of airways
    - only 20% difference needed to trigger 
    - NOT treated with short term methods as messes up in long run due to respiration rate linked to O2 in blood

Question 18

what is cystic fibrosis

Answer 18

• genetic disease, recessive on chromosome 7 CFTR gene
• defect in cell chloride channels causing excessively sticky mucous secretions (either makes channel not open properly, pass Cl properly or at all)

Question 19

symptoms of cystic fibrosis

Answer 19

consistent cough
poor weight gain
persistent diarrhoea
repeated staphlococcus chest infections
- potentilly chronic bronchitis/bronchiectasis and malnutrition
- prone to liver disfunction, osteoporosis, reduced fertility and diabetes symptoms

Question 20

treatment for cystic fibrosis

Answer 20

• physiotherapy to remove mucous
• medication
  - lungs = bronchiodilators, steroids and antibiotics
  - digestive system = supplements and pancreatic enzyme replacement
  - stem cell therapy
  - CFTR modulators = help regulation of Cl channels
  - transplantation and exercise

Question 21

what are the two groups of lung tumours

Answer 21

1. small cell (25%)
2. non-small cell
   
   • squamous cell carcinoma (40%)
   • large cell
   • ademocacinoma

Question 22

lung cancer symptoms

Answer 22

• cough
• haemoptysis
• pneumonia
• metastasis
• dysphagia, superior vena cava obstruction,

Question 23

treatment of lung cancer

Answer 23

• periphery = removal

- small cell = chemoradiotherapy to extend life as incurable

Question 24

4 stages of lung cancer

Answer 24

stage i. localised (not at lymph nodes) and <5cm

ii. 5-7cm, localised but in nearby lymph nodes
iii. >7cm, localised but spread to other areas of chest
iv. metastatic

Question 25

what is sleep apnoea

Answer 25

• oral muscles relax causing airway obstruction for short periods when sleeping
• can cause hypoxia

Question 26

what are the treatments for sleep apnoea

Answer 26

mechanical
i. oral appliance pulls tongue forward
ii. CPAP machine = mask keeping pressure on airways
therapy
- prevent sleeping on back
- bags over shoulders