respiratory disease - COPD, asthma, and lung cancer Flashcards
Risk factors, pathology, clinical signs, complications, diagnosis, and treatment for various respiratory conditions.
COPD includes
chronic bronchitis
emphysema
asthma
bronchiectasis
COPD definition
airflow obstruction caused by small airways disease and parenchymal destruction
emphysema risk factors
alpha-1-antitrypsin deficiency
coal dust
cadmium toxicity
COPD risk factors
middle aged men cigarette smoke occupational dust and chemicals pollution low socio-economic status childhood infections genetics
clinical definition of COPD
cough and sputum for 3 months in 2 consecutive years
pathology of COPD
mucous hypersecretion with bronchial mucous gland hypertrophy
loss of ciliated cells, squamous metaplasia
respiratory bronchiolitis
later stages of COPD
hypercapnia, hyperaemia, cyanosis
carcinogenic - dysplastic metaplastic squamous epithelium
clinical signs of COPD
cough dyspnoea/tachypnoea shortness of breath hyperinflation use of accessory muscles on inhalation low PaO2 high PaCO2 (low alveolar ventilation)
why do patients with COPD get pulmonary hypertension?
obliteration and vasoconstriction
pink puffer
weight loss
breathless
emphysematous
maintained pO2
blue bloater
cough
phlegm
cor pulmonale
respiratory failure (type 2)
complications of COPD
cor pulmonale - pulmonary hypertension and fluid overload
COPD spirometry
always abnormal
diagnosis of COPD
FEV1 <80% of predicted
FEV1:FVC ratio <70% predicted
staging of COPD
- FEV1 >80%
- FEV1 50-79%
- FEV1 30-49%
- FEV1 <30%
treatment for patients with upper lobe predominant emphysema
lung reduction surgery
treatment for mild COPD (stage 1)
ipratropium bromide
treatment for moderate COPD (stage 2)
tiotropium
treatment for severe COPD (stage 3)
glucocorticosteroid (beclamethasone diproprionate)
treatment for very severe COPD (stage 4)
home O2
first line treatments for COPD
stop smoking
exercise
ß2 agonists
atopy
tendency to develop IgE mediated reactions to common aeroallergens
incidence of asthma
1 in 11 children
1 in 12 adults
definition of asthma
increased irritability of bronchi causing spasm, paroxysmal attacks, over-distended lungs, mucous plugs in bronchi, and enlarged bronchial mucous glands
short-term/acute pathology of asthma
trigger –> IgE mediated type 1 hypersensitivity –> mast cell degranulation –> histamine and cytokines released –> bronchoconstriction, mucous production, and inflammation (increased vascular permeability)
long-term/chronic pathology of asthma
airways remodelling and repeated airway constriction –> smooth muscle hyperplasia and hypertrophy + mucous gland hyperplasia and metaplasia –> increased in goblet cells
clinical signs of asthma
intermittent dyspnoea chest tightness cough (nocturnal) sputum tachypnoea polyphonic wheeze hyper inflated chest hyper resonance
what is associated with later onset asthma?
nasal polyposis and aspirin sensitivity
why does asthma have a diurnal variation?
natural dip in catecholamines in the middle of the night
which patients are at risk of asthma death?
on 3 or more medications
frequently hospitalised
previous near fatal disease
psychosocial factors
diagnosis of asthma using peak expiratory flow
> 20% variation on >3 days/week for 2-4 weeks
diagnosis of asthma using bronchodilator reversibility testing
baseline spirometry –> salbutamol –> repeat spirometry after 15 minutes –> FEV1 increase by >15%
diagnostic tests for asthma
peak expiratory flow bronchodilator reversibility testing spirometry FBC (eosinophils) test for allergies and atopy chest XR O2 sats lung function testing
treatment for asthma
ß2 agonist - salbutamol
corticosteroid - beclomethasone
bronchial thermoplasty
what is the role of steroids in the treatment of asthma?
they reduce inflammation and mortality
treatment of severe eosinophilic asthma
anti-IgE
anti-IL5
oral steroids
additional immunosuppressants
treatment of acute asthma
high flow O2 and emergency ß agonists
risk factors for lung carcinoma
smoking (20 cigarettes a day increases risk by 10x)
asbestos
metallic toxins
other occupational exposures
where does small cell carcinoma arise?
peribronchial locations –> infiltrates the bronchial submucosa
clinical signs of lung carcinoma
late presentation cough dyspnoea weight loss debility central tumour mass nerve palsies (recurrent laryngeal and phrenic) Horner's syndrome weight loss loss of appetite fatigue metastatic signs
what percentage of patients already have metastases when diagnosed with small cell carcinoma?
70%
complications of lung small cell carcinoma
paraneoplastic syndromes
metastasis to lymph nodes, liver, bones, adrenal glands, and brain
paraneoplastic syndromes with lung carcinoma
secretion of PTH
SIADH
secretion of ACTH and other hormones
hypertrophic pulmonary osteoporosis-arthropathy
myasthenic syndrome (Eaton Lambert)
finger clubbing
migratory thrombophlebitis (red and painful swelling of skin)
non-infective endocarditis (Libman Sacks)
disseminated intravascular coagulation (DIC)
small cell carcinoma definition
an undifferentiated neoplasm composing of primitive appearing cells
lung small cell carcinoma treatment
radiation and combination chemotherapy
what percentage of lung cancers are non-small cell carcinoma?
85%
two types of lung non-small cell carcinoma
adenocarcinoma
squamous cell carcinoma
signs on CXR of lung carcinoma
pulmonary nodule mass or infiltrate mediastinal widening atelectasis hilar enlargement pleural effusion
diagnostic tests for lung carcinoma
physical examination FBC CXR bronchoscopy sputum cytology mediastinoscopy thoracentesis thoracoscopy transthoracic needle biopsy
non-small cell lung carcinoma treatment
surgery and chemotherapy
lobectomy - removing a section of lung
pneumonectomy - removing the entire lung
wedge resection - removing part of a lobe
risk factors for mesothelioma
asbestos exposure
pathology of mesothelioma
tumour of the lung pleura
diagnosis of mesothelioma
pleural thickening or effusion on CXR
bloody pleural fluid
histology
diagnosis is often made post mortem
treatment of mesothelioma
pemetrexed and cisplatin
intrapleural drain
(very high death rate)
