Respiratory Diseases Flashcards
What is COPD?
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma.
What is asthma?
Long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm.
What are the characteristics of COPD?
- Slowly progressive
- Increasing breathlessness
- Airflow obstruction
- Little or no reversibility
- Does not change much over several months
- Predominantly caused by smoking
Which structures are affected in COPD?
-Small and large airways (inflammation)
What is emphysema?
Condition characterised by abnormal, permanent enlargement of airspaces distal to the terminal bronchiole accompanied by the destruction of their walls. Associated with COPD
What is FEV1?
Forced expiratory volume in 1 second:
-Volume of air that can be expelled from maximum
inspiration in the first second.
-Time dependent and reflects airway caliber
What is FVC?
Forced vital capacity (FVC) of the lung:
-The volume of air that can be forcibly expelled from the lung from the maximum inspiration to the maximum
expiration.
-Volume dependent and reflects lung volume
Is COPD likely to have airway reversibility?
No
What are the symptoms of COPD?
-Breathlessness
-Cough
Sputum production
-Purulence during exacerbations
-Wheeze
What causes alpha1 antitrypsin deficiency?
Autosomal recessive disorder of chromosome 14 with 40+ different phenotypes.
Co-dominant alleles.
Proteinase inhibitor.
What are the risk factors for COPD/Emphysema?
- Smoking
- Pollution
- Alpha1-antitrypsin
How do you calculate pack years?
20 cigs/day for 1 year = 1 pack year
What are the characteristics of asthma?
- Chronic inflammatory disorder of the airways
- Airways hyper-responsiveness
- Recurrent episodes of wheezing and breathlessness
- Chest tightness and coughing particularly in the morning and night
- Variable airflow obstruction
- Chest pain and vomiting
What factors increase risk of asthma?
- Genes
- First degree relative - 10x
- Maternal smoking
- Obesity
What factors can be protective against asthma?
- Breast feeding
- Early exposure to animals and allergens
What are the characteristics of extrinsic asthma?
- Family history
- Starts in childhood
- Eczema/rhinitis
- Precipitating factors
- Positive skin tests
- Episodic
What are the characteristics of intrinsic asthma?
- Adulthood
- Negative skin tests
- Persistent symptoms
- No clear precipitating factors
- Exacerbated by infections
- Aspirin sensitive group
What is the pathology of asthma?
- Adulthood
- Negative skin tests
- Persistent symptoms
- No clear precipitating factors
- Exacerbated by infections
- Aspirin sensitive group
What are the warning signs of asthma deteriorating?
- Nocturnal cough and wheeze
- Eczema deteriorated
- Bad chest symptoms in the morning
- Provoked by triggers
How can asthma be monitored?
Peak Flow
What is a paradoxical pulse?
An abnormally large decrease in stroke volume, systolic blood pressure and pulse wave amplitude during inspiration
What is tachypnoea?
Abnormally rapid breathing
How does a Beta2 Adrenoceptor agonist asthma reliever work?
Action: Stimulation of airway β2 adrenoceptors
Result: Relaxation of bronchial smooth muscle
What are some examples of Beta2 Adrenoceptor agonist asthma relievers?
- Salbutamol
- Terbutaline
- Salmeterol
- Efomoterol
How does an Antimuscarinic asthma reliever work?
Action: Inhibit muscarinic receptors on smooth muscle
Result: Relaxation of bronchial smooth muscle
What are some examples of Antimuscarinic asthma relievers?
- Ipratropium bromide
- Tiotropium
How does a Glucocorticoid asthma preventer work?
Action: binding to cytosolic receptors and affects gene transcription/translation
Result: potent anti-inflammatory agents
and reducing airway hyper-responsiveness
What are some examples of Glucocorticoids asthma preventers?
- Hydrocortisone
- Prednisolone
- Beclomethasone
- Budesonide
- Fluticasone
What is the immediate treatment for an acute severe asthma attack?
- O2 maintain SpO2 94-98%
- Salbutamol 5mg via O2 driven nebuliser
- Ipratropium bromide 0.5mg vie O2-driven nebuliser
- Prednisolone tablets tablets 40-50mg or IV hydrocortisone 100mg
- No sedatives
- Chest X-Ray if suspected pneumothorax/consolidation. Or pt needs ventilation
Management if asthma attack presents life-threatening features?
- Discuss with senior clinician and ICU team
- Consider IV MgSO4 1.2-2g over 20mins
- Nebulised Beta2 agonist more frequently (eg, salbutamol 5mg every 15-30mins)
What is the subsequent management if pt is improving after treatment of acute asthma attack?
- O2 maintained at SpO2 94-98%
- Prednisolone 40-50mg daily or IV hydrocortisone 100mg 6 hourly
- Nebulised Beta2 agonist and ipratropium 4-6 hourly
What is the subsequent management if pt is not improving 15-30mins after treatment of acute asthma attack?
- Continue O2 and steroids
- Continuous nebulisation of salbutamol at 5-10mg/hour (or nabulised salbutamol 5mg every 15-30mins)
- Continue ipratropium o.5 mg 4-6 hourly until pt improves
What measures can be taken to prevent future exacerbations in an asthma patient?
- Check compliance with existing therapies
- Check inhaler technique
- Education on asthma plan/medication
- Monitor (PF)
- Check for triggers (new pt)
- Eliminate trigger factors
What are the two main types of lung cancer?
Small cell and Non-small cell
What are the potential symptoms of lung cancer?
- Cough
- Breathlessness
- Wheeze
- Stridor
- Haemoptysis
- Dysphagia
- Hoarse voice
- Chest pain
- Bone pain
- Neurology
- Anorexia
- Weight loss
What is a stridor?
A high-pitched, wheezing sound caused by disrupted airflow.
What is haemoptysis?
The medical term for coughing up blood that comes from the lungs or bronchial tubes
What is dysphagia?
Medical term for swallowing differences
What are the potential signs of lung cancer?
- Anorexia/weight loss
- Clubbing
- Tachypnoea
- Signs of collapse/consolidation/effusion
- Lymphadenopathy
- SVC obstruction
- Horner’s syndrome
- Signs of metastatic spread
What is Lymphadenopathy?
Disease of the lymph nodes, in which they are abnormal in size, number, or consistency
What is Horner’s syndrome?
A rare condition characterized by miosis (constriction of the pupil), ptosis (drooping of the upper eyelid), and anhidrosis (absence of sweating of the face). It is caused by damage to the sympathetic nerves of the face.
What does clubbing look like?
-Tissue at the base of the nails is thickened and the normal angle between the
nail base and adjacent ski is obliterated:
1. Fluctuation and softening of the nail bed (Boggy)
2. Loss of angle between nail bed and the fold
3. Increased convexity of the nail fold
What investigations would be done on a pt with suspected lung cancer?
- CXR
- CT/PET scan
- Bronchoscopy
- Percutaneous fine needle aspiration/biopsy
- Mediastinoscopy
- VATS
- Bone scan/CT head
- Endobronchial ultrasound
What is a PET scan?
Positron Emission Tomography:
- The system detects gamma rays emitted by a positronemitting radionuclide (tracer)
- Fluorodeoxyglucose (FDG), an analogue of glucose
- Indicate tissue metabolic activity
What is a CXR?
A chest radiograph, is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures
What is a mediastinoscopy?
A procedure that enables visualization of the contents of the mediastinum, usually for the purpose of obtaining a biopsy
What are the treatments for small cell lung cancer?
- Chemotherapy
- Radiotherapy
What are the treatments for Non-small cell lung cancer?
- Surgery
- Radiotherapy
- Chemotherapy (?)
How much does smoking increase the risk of lung cancer?
- 8-20x
- Risk falls 2 fold after 10-20 years after stopping
What are the risk factors/causes for lung cancer?
- Smoking
- Asbestos exposure
- Radioactive materials/radon gas
- Pyrene, arsenic, nickel, napthalenes
- Family history
What is thromboembolism?
Formation in a blood vessel of a clot (thrombus) that breaks loose and is carried by the blood stream to plug another vessel. The clot may plug a vessel in the lungs (pulmonary embolism), brain (stroke), gastrointestinal tract, kidneys, or leg
What is pleural effusion?
The build-up of excess fluid between the layers of the pleura outside the lungs.
In pleural effusion if >30g/l of exudate is present, what is this a sign of?
- Malignancy
- Infection
In pleural effusion if <30g/l of exudate is present, what is this a sign of?
- Heart failure
- Nephrotic syndrome
What is exudate?
A mass of cells and fluid that has seeped out of blood vessels or an organ, especially in inflammation.
How common is Cystic Fibrosis in the UK?
- Carrier frequency of 1 in 25
- CF incidence 1 in 2000-2500
- Autosomal recessive
Which mutation is responsible for cystic fibrosis?
DF508 mutation - Deletion of three nucleotides spanning
positions 507 and 508 of the CFTR gene resulting in the loss of a
single codon for the amino acid phenylalanine. Chromosome 7. 2000+ mutations.
