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Respiratory - Week 2 > Respiratory: Obstructive Airway Disease > Flashcards

Respiratory: Obstructive Airway Disease Flashcards

1
Q

What does an obstructive disease affect?

A

The airways

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2
Q

What does a restive disease affect?

A

The lungs

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3
Q

What the the obstructive airway syndromes?

A

o Asthma
o Chronic bronchitis
o Emphysema
o COPD/ asthma overlap syndrome (i.e. smokers with features of both asthma and COPD – aka COPD with reversibility

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4
Q

What is the aetiology of airways obstruction in COPD?

A
  • Bronchi are invaginated into the lung tissue
  • Alveolar walls (or attachments) connect to lung
  • Inflammation causes mucosa to become engorged causing obstruction
  • Circular smooth muscle constricts causing narrowing of airway
  • Cutting alveolar ‘guy ropes’ will collapse airway integrity
  • Interthoracic pressure (as in emphysema) causes collapse
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5
Q

What does extrinsic asthma mean?

A

The trigger has been identified

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6
Q

What does atopic asthma mean?

A

It is allergic related with an IgE mediated response

Non-atopic, is non-allergic

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7
Q

What are the three main factors in asthma that characterise the disease?

A
  • Reversible airflow obstruction
  • airway inflammation
  • Airways Hyper-responsiveness
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8
Q

What is the dynamic evolution of asthma?

A
  • Bronchoconstriction – brief symptoms
  • Chronic airway inflammation – exacerbations AHR
  • Airway remodelling – fixed airway obstruction
    o scar tissue is laid down permanently which is irreversible
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9
Q

What is the remodelling effects in asthma?

A
  • basement membrane thickening
  • collagen deposition
  • smooth muscle; there can be hypertrophy
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10
Q

What will trigger asthmatic inflammation?

A

Genetic disposition in combination with a particular trigger

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11
Q

Describe airway inflammation

A
  • Epithelial is detached

- Generally disordered mess

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12
Q

How can airways inflammation be investigated?

A

Bronchial biopsy

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13
Q

What drug can be used to normalise abnormal asthmatic airways?

A

Glucocorticoids

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14
Q

What are the clinical symptoms of asthma?

A
  • Episodic symptoms and signs
  • Diurnal variability – nocturnal/ early morning
  • Non-productive cough, wheeze
  • Triggers
  • Associated atopy (rhinitis, conjunctivitis, eczema)
  • Family history of asthma
  • Wheezing due to turbulent airflow
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15
Q

How is Asthma diagnosed?

A
  • History is primary diagnosis tool, examination would only really be useful (to hear wheeze, if examined early in the morning)
  • Diurnal variation of peak flow rate
  • Reduced forced expiratory ratio (FEV1, FVC 15%)
  • Provocation testing leads to bronchospasm
    o Exercise
    o Histamine/ allergen
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16
Q

What are the components in COPD that lead to obstruction and ongoing disease progression?

A

Mucociliary dysfunction
Inflammation
Tissue damage

17
Q

Describe the cellular signs that characterises chronic bronchitis?

A

o Chronic neutrophilic inflammation
o Mucous hypersecretion
o Smooth muscle spasm and hypertrophy
o Partially reversible

18
Q

Describe the cellular signs that characterises Emphysema?

A 
o	Alveolar destruction
o	Impaired gas exchange 
o	Loss of bronchial support
o	Irreversible
o     Protease imbalance
19
Q

Describe the protease imbalance in emphysema?

A
  • Protease production is increased leading to alveolar destruction and therefore emphysema
  • Antiprotease function is a genetic factor which inhibits the action of protease
20
Q

What are the clinical symptoms of COPD?

A
  • Chronic symptoms – non-episodic
  • Smoking
  • Non-atopic
  • Daily productive cough
  • Progressive breathlessness
  • Frequent infective exacerbations
  • Chronic bronchitis – wheezing
  • Emphysema – reduced breath sound
21
Q

What are the chronic affects of COPD?

A
  • Progressive fixed airflow obstruction
  • Impaired alveolar gas exchange failure; decrease of PaO2 increase of PaCO2 4
  • Pulmonary hypertension
  • Right ventricular hypertrophy / failure (i.e. cor pulmonale)
  • Death
22
Q

What are the non-pharmicological treatments for COPD?

A 
o	Smoking cessation
	+/ - nicotine/ bupoprion
o	Immunisation – influenza/ pneumococcal
o	Physical activity
o	Oxygen – domiciliary
o	Venesection
o	Lung volume reduction surgery
o	Stenting
23
Q

What are the pharmicological treatments of COPD?

A 
o	LAMA; tiotropium/ aclidinium
o	LABA; salmeterol/ formeterol
o	LAMA- LABA combo; aclidium/ formeterol
o	LABA-ICS combo; beclometasone- formoterol
o	PDE41 – roflumilast
o	Mucolytic – carbocisteine
o	Antibiotics – azithromycin

Respiratory - Week 2 (8 decks)

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