Respiratory diseases Flashcards
What are the types of Asthma?
Atopic
Non- Atopic
Occupational
What type of reaction is Atopic Asthma?
Hypersensitivity reaction Type I
What are people with Atopic Asthma likely to have a history of in their family?
Atopy
What T cells are activated during an asthma attack?
T Helper Type II Lymphophytes
What is the main granulocyte responsible for asthma and how is it stimulated and how does it create asthmatic symptoms?
Eosinophils - activated by IL-5.
these release IL - 3 & 4
this stimulates Plasma Cell production of IgE.
IgE bind with Mast Cells, making them ultrasenastitive to the original antigen
What are the two phases of asthma?
Early Phase - immediate bronchoconstriction
Late Phase - arrival of further inflammatory cells which induce further inflammation
What remodeling occurs to the bronchi?
Increased vascular permeability Loss of epithelial cells Hypertrophy of goblet cells - increased muscous Hypertrophy of the smooth muscle Myofibroblast accumulation
What are the main treatments for Asthma?
Anti-inflammatories
Bronchodilators
Anticholinergics
Name a Beta 2 Blocker used in treatment of asthma
Salbutamol ; Salmetarol
Name two inhaled steroids
Beclomethasone ; Fluticasone
What receptor does Salbutamol work on?
Beta II
WHat receptor does Tiotropium work on?
Muscarine III
In COPD what is the term obstruction meant by?
There is difficulty in expiration resulting in increased residual volume and increased pressures thus affecting the inspiration.
How might emphysema affect the oxygen diffusion?
Reduction in surface area - due to inflation of the acinar, caused by destruction in elastin.
remodelling increasing thickness of the membranes resulting in slower diffusion
How would a obstruction disease such as COPD by diagnosed?
FEV1 <70%
Why would patients with COPD have barrel chests, hyper percussion and Hemi - diaphragms?
The loss of elastin allows the chest wall to pull the lung further as compliance is increased. This creates large areas of lung which poorly ventilated by still increased in size.
In terms of the emphysema present, what treatment can be given?
Supplemental oxygen
What variables can affected your FEV1?
Age
Gender
Height
Potentially ethnicity
Potentially weight
What treatments would be given to someone with COPD?
To stop smoking - biggest
Bronchioles:
- B2 agonists
- Muscurinic antagonists
- Inhalant corticosteriods
Acinar:
- Oxygen
When would FVC be reduced in obstructive pulmonary disease?
If the FVC is reduced what would be increased?
If there is air trapping
Increased in Residual volume
What is the more common diagnosis of reduced FVC?
Restrictive lung disease
In peak expiratory flow rate measurements, if a patient has a variable forced expiration, what can this be a suggestion of? and why?
Asthma
- because it is reversible.
commonly see “morning dipping”
What is Atelectasis? and causes?
Collapse/ loss of volume in the lung, lobe or segment.
usually due to obstruction to the conduction zone supplying that area i.e. tumour
What is the definitions of Chronic Bronchitis?
Presence of cough and sputum produced most days produced for 3 months of 2 years
What changes occur to the colmnar and cubodial epithelium in the ariways in COPD?
Metaplastic changes where the epithelium is changed to simple squamous
increased in goblet cells.
Outwith pharmacological treatments for COPD, what else may be used to help?
Pulmonary rehabilitation
Name a long acting anticholinergic
Tiotropium
What are some of the common reasons for poor prognosis of asthma treatment?
- poor inhaler techniques
- poor compliance
- smoking - inhibits steroid ability
List the stages of treatment for asthma?
stage 1. Low does ICS + SABA
Stage 2. Add LABA - usually a combo with ICS inhaler
Stage 3. Increased dose of ICS or add LAMA
Stage 4. [Referral to specialist care]. Increased dose of ICS
Stage 5. Add steriod tablet and up dose of ICS
What would promote you do move up a stage of therapy for asthma?
SABA use > 3 doses a week
What are common side effects of using ICS?
Dysphonia
oral candida infections
What technique is used to assess pulmonary circulation. or Ventilation perfusion?
The ventilation pulmonary scan is a nuclear medicine scan that is to assess for any PE.
A radioactive isotope is breathed in followed by the injection of another radioactive isotope which allows the assessment of ventilation perfusion.
What is a PET scan?
Position Emission tomography.
analyses the uptake of radioactive glucose which is rapidly taken up by tumour tissue. The substance can’t be broken down further and as such remain in the cell providing imaging.
When would ultrasound be used to examine the chest?
For detection of plural fluid.
May also be useful for guided therapy of empyema drainage.
Describe bronchoscopy
This is where a small camera is used to assess the airways - performed under local anesthesia with some mild sedation.
this can assess for obstruction and disorientation.
small samples of tissue may be taken
