Respiratory Medicine - 2 Flashcards
What are the two diseases that cause COPD?
Bronchiectasis & emphysema component - non-reversible
What causes bronchiectasis and what happens to the lungs?
recurrent infections
causing consistent damage to the bronchial walls
increased mucus
thickened walls due to scarring
What is the main symptom of bronchiectasis?
productive cough with green sputum
What causes emphysema and what happens to the lungs?
smoking and exposure to toxic chemicals
* Destruction of alveoli - less alveoli
* dilatation of some sacs to ‘fill space’
less surface area, increased cardiac load
What are the causes of COPD?
smoking
air pollutants
genes (AAT deficiency)
age
asthma
chemical exposure
What are the symptoms of COPD?
chronic cough
production of mucus
fatigue
shortness of breath
chest tightness
What is the biggest preventative cause of COPD?
smoking
What medications can be used to treat COPD?
long acting beta agonists = for reversible patients
steriods
oxygen support
What can excerbate COPD?
environmental factors
noncompliance with medications
bacterial pathogens
viral infections
atypical bacteria
What can COPD lead to without management?
progress to respiratory failure - type 1/2
Type 1 VS Type 2 respiratory failure?
Type 1 - hypoxemia
Impaired gas exchange
Normal CO2
Caused by V/Q mismatch, alveoli descruction/ thickening
Treat with oxygen
Type 2 - hypercapnia
Hypoventilation
Normal O2
Caused by muscle disorders, increased airway resistance
Treat with ventilatory support (bronchodilators)
Symptoms of Type 1 VS Type 2
Type 1 (blue bloaters)
- cyanosis
- confusion
Type 2 (pink puffers)
- pink skin
- barrel chest
- pursed lips
When should oxygen be used and what should be done during?
- In the acute stage use Oxygen until medical help arises
Watch - under medical supervision
respiratory rate
SaO2 - In the CHRONIC stage, use oxygen with care – fixed percentage delivery
What is a risk of home oxygen therapy?
oxygen can suppress the respiratory drive, leading to lower ventilatory effort and inability to exhale CO2 efficiently
What is the risk of inhaled steriods dentally and what can be used to prevent this?
Use of inhaled steroids - candida risk
* rinse mouth after device use
* use spacer device for MDI ‘puffers’
What increased risk do smokers have?
oral cancer
In dental surgery, what may a patient that requires home oxygen need?
supplemental oxygen during treatment
What type of disease is cystic fibrosis?
genetic disease
What is the systemic failure in cystic fibrosis?
inherited defect in cell chloride channels
produces excess mucous in all body systems
Which organs are mostly affected by cystic fibrosis?
lung and pancreas
What gene does the cystic fibrosis mutation occur in?
CFTR gene (cystic fibrosis transmembrane conductance regulator)
chromosome 7
What type of gene is the CFTR mutation?
recessive
both parents need to have the gene
What mutation is the commnest defect?
F508del
How is cystic fibrosis diagnosed?
- Prenatal screening - sibling has it
- Perinatal testing - ALL children now screened at day 5 – blood spot test
- ‘Sweat test - greater salt in CF patients
- CTFR Gene testing
Why is diabetes a symptom of CF?
build up causes inflammation and damage to B cells in pancreas
What are the main symptoms of CF in children?
- Troublesome cough
- Repeated Chest infections
- Pseudomonas, Staphylococci
- Prolonged Diarrhoea
- Poor weight gain
What are the consequences of CF?
- Liver dysfunction in some
- Prone to osteoporosis
- Diabetes symptoms
- Prolonged pancreas disease
- Reduced fertility (mainly male)
How is physiotherapy used to treat CF?
- Used to help remove the mucous secretions from the lungs
- Performed at home by parents
What medications are used to treat CF in lungs?
- Bronchodilators to open the airways
- Antibiotics to reduce Chest infection frequency
- Steroids to reduce airway inflammation
What can resistance to antibiotics cause?
pneumonia leading to respiratory failure (1)
What medications are used to treat CF in the digestive system?
- Pancreatic Enzyme replacement
- Nutritional Supplements
What full body system medications can also be used to treat CF?
- CFTR Modulators
- Stem Cell treatments
What are example of CFTR moedulators and what mutation are they used for?
for F508del patients
- ivacaftor, tezacaftor and elexacaftor
- triple-combination therapy
What can taking CFTR modulators from an early age do?
allows patient to produce a more normal secretion for a larger part of their life avoiding much damage
How is stem cell therapy used to treat CR and what is the different between adult and immature stem cells?
- Replace the bad gene with a new copy
- If given to stable cells (‘adult’ cells) the therapy needs repeated every time the cells are replaced
- If given to Stem Cells then ‘adult’ cells will all be made with the correct gene = cure
Why is exercise important for CF?
- Necessary to keep lung function optimal
- Necessary to build physical bulk & strength
What is tranplantation used for in CF?
- Not a cure!
- End stage lung disease
- Also affects heart (cor pulmonale)
- Heart-lung transplant
- Not much survival after due to immunosuppressive drugs
What is the location of a visible mass in the lungs usually?
periphery
What happens if the mass is more central and blocks the bronchus?
allows secretions to build up leading to infection such as pneumonia causing occlusion of the lung
What is the biggest cause of lung cancer?
smoking
What are causes of lung cancer? (not smoking)
radon
workplace chemicals (asbestos, arsenic, nickel)
air pollution
genetics
radiation therapy
other lung diseases (COPD, fiborosis)
What are the two groups of lung tumours?
small cell (25%)
non-small cell (75%)
What are the 3 types of non-small cell lung tumors?
- Squamous Cell carcinoma - most common, central location
- Large cell
- Adenocarcinoma
What are the signs and symptoms of lung tumours?
- Cough
- Haemoptysis (blood stained sputum)
- Pneumonia
- Obstruction of structures near lungs
What are biomarkers and what do they allow?
genetic mutations the tumour has
they allow physicians to classify patients by their probable diseases, prognosis and their response to treatment
In locally advanced NSCLC, what are the treatment steps?
chemoradiation
watch and wait
What is the role of the dentist in cancer?
ask about smoking
advise on quitting
act on patient’s response (refer, build confidence)
What is sleep apnoea?
- Airway obstruction whilst asleep (blocked preventing patient from breathing normally)
- 10 secs or more duration
- Airway muscle tone drops (causes tongue to fall back and occlude the airway)
What can sleep apnoea cause?
Daytime sleepiness/drowsiness (dangerous while driving)
Higher risk of heart disease/stroke due to low oxygen
What are the two types of sleep apnoea?
obstructive sleep apnoea (most common)
central sleep apnoea
How is the severity of sleep apnoea measured?
via apnoea/hypopnoea index (AHI)
What score and less indicates few problems in AHI?
<10
What are the two treatments for OSA and how do they work?
Mandibular Advancement Devices
Oral appliance that pulls jaw forward to open airway
Continuous Positive Airway Pressure (CPAP)
Machine providing constant air pressure to splint airway open
What is positional therapy used for in sleep apnoea?
prevent patient sleeping on their back
