Respiratory: Obstructive Airway disease

Question 1

What are key histological markers of airway remodelling in asthma?

Answer 1

Thickened basement membrane
Collagen deposition in the submucosa
Smooth muscle hypertrophy

Question 2

Which drugs in asthma act to reduce the eosonophillic inflammation?

Answer 2

Corticosteroids
Cromones
Theophylline

Question 3

Which drugs in asthma target the hyperactivity of the airways?

Answer 3

Bronchodilators (Beta agonist and muscarinin antagonist)

Question 4

Which drugs in asthma target inflammatory mediators and Th2 cytokines?

Answer 4

Antileukotrienes
Monoclonal antibodies
Anti IgE
Anti interleukin5

Question 5

What antibody is raised with atopic disease?

Answer 5

IgE

Question 6

What are the two components of COPD?

Answer 6

Chronic bronchitis and emphysema

Question 7

What is chronic bronchitis?

Answer 7

Inflammation of the bronchi (large and medium sized airways)

• Chronic neutrophil inflammation
• Mucus hypersectretion
• Mucociliary dysfunction
• Smooth muscle spasm and hypertrophy

Question 8

What is emphysema?

Answer 8

Alveolar destruction resulting in impaired gas exchange and loss of bronchial support.

Question 9

What vaccinations are people with COPD given?

Answer 9

Influenza yearly

Pneumococcal

Question 10

What are the treatment stages in asthma?

Answer 10

SABA
SABA + ICS
SABA + ICS + LABA
SABA + ICS + LABA + Montelukast

Question 11

Why might inhaled steroids (esp fluticasone) cause pnemonia in COPD?

Answer 11

Local immune supression and impared mucociliary clearance. Fluticasone has a prolonged period of lunge retention

Question 12

When are inhlaed corticosteroids used in obstructive lung disease?

Answer 12

As monotherapy in asthma

With a LABA in COPD.

Question 13

How is montelukast given?

Answer 13

Oral tablet, once daily

Question 14

What is omalizumab and when is it used in obstructive lung disease?

Answer 14

Anti IgE monoclonal antibody.
Inhibits the binding to the high affinity IgE receptors. This inhibits the TH2 response and associated mediator release from basophils and mast cells. It is given as an injection eveery 2 - 4 weeks for patients with severe persistent allergic asthma

Question 15

What is aminophylline?

Answer 15

IV methylxanthine used in acute attacks. Acts as a phosphodiesterase inhibitor

Question 16

What is theophylline?

Answer 16

Oral methylxanthine used for maintainence therapy in COPD and asthma.

Question 17

What is roflumilast?

Answer 17

A PDE4 inhibitor used in OPD where there are frequent exacarbations. It is rarely used due to severe GI side effects.

Question 18

What is carbocisteine?

Answer 18

A mucolytic used in COPD to reduce sputum viscosity.

Question 19

What is the treatment for acute COPD?

Answer 19

Nebulised salbutamol + Ipratropium 
Oral prednisolone 
24 - 28 % Oxygen (titrated with SATs) 
Antibiotics (amoxicillin/doxycyline)
IV theophyllines if there is a poor response to neubulised bronchodilators

Question 20

What investigations are required if you have an infective axacerbation of COPD?

Answer 20

• ABG
• CXR
• ECG
• Theophylline level if on theophylline
• Sputum culture
• Blood cultures

Question 21

What patients with COPD should be assessed for long term oxygen therapy? What does the assessment comprise?

Answer 21

FEV1 less than 30% predicted 
Cyanosis 
Polycythaemia
Peripheral oedema 
Raised JVP
Oxygen sats less than 92%

Assessment is measurement of ABG on 2 ocassions at least 3 weeks apart. Offer oxugen therapy to those with a p02 of less than 7.3 or less than 8 with

1. Polycythemia
2. Nocturnal hypoxia
3. Peripheral oedema
4. Pulmonary hypertension

Question 22

What is the most common causitive organism for an infective exacarbation of COPD?

Answer 22

Haemophilus influenzae
Strep pneumonia
Moraxells catarrhalis

Question 23

Where is the gene for alpha 1 anti trypsin found?

Answer 23

Chromosome 14

Question 24

How is alpha 1 anti trypsin inherited?

Answer 24

Autosomal recessive/Co domiannt

Question 25

What is the management for alpha 1 anti trypsin deficiency?

Answer 25

Supportive - bronchodilators
IV alpha 1 anti trypsin deficiency
Surgery - volume reduction or lung transplant