Respiratory pathology Flashcards
What does COPD stand for ?
Chronic obstructive pulmonary disease
What is the basic problem for people with COPD?
They struggle to get air out of there lungs.
What are the names of the two conditions which combine to produce COPD?
Chronic bronchitis and emphysema
What is the largest risk factor for COPD ?
Smoking
What are some other risk factors for COPD ?
Pollution Dust Older age Genetics Socioeconomics
What is Alpha-1 Antitrypsin deficiency?
An inherited condition which causes early onset COPD and COPD lower in the lung than normal
Why does maternal smoking effect the risk of COPD ?
If a mother or grandmother smoked in pregnancy then the babies lungs will be smaller which causes an increased risk of COPD
What is the prognosis of COPD?
it is incurable and irreversible
What is Alpha 1 Antiprotease deficiency ?
It is a genetic condition which causes emphysema without chronic bronchitis
What is chronic bronchitis ?
It is a cough which produces sputum most days for three consecutive months for two or more consecutive years.
What condition does chronic bronchitis sometimes look like ?
Chronic bronchial asthma
What does Chronic bronchitis do to the large airways ?
Causes hyperplasia in the mucous glands and goblet cells
Minor inflammation
Fibrosis
What does chronic bronchitis do to the small airways ?
It causes the appearance of goblet cells
Long standing inflammation.
Fibrosis
What happens to complicate chronic bronchitis ?
Infection occurs and the FEV1 falls
What is emphysema ?
An increase beyond the normal size in the size of the airspaces distal to the terminal bronchioles arising as a result of dilation or destruction of walls.
i.e. loss of alveolar surface area
What is an acinus ?
The region of the lung distal to the bronchioles
What are the names of the different types of emphysema
Centriacinar emphysema
Scar emphysema
Panacinar emphysema
Periacinar emphysema
What is centriacinar emphysema ?
Emphysema which starts with the bronchiolar dilation and then alveolar tissue is lost. it is found at the top of the lobes
What s scar emphysema ?
No clinical effect but is the formation of emphysema next to scars
What is panacinar emphysema ?
Infects all the alveoli in a whole area of lung
What is periacinar emphysema ?
Causes loss of tissue at the edge of the acini and if it leaks air into the pleura cavity then it causes an pneumothorax to develop
What % of smokers will develop emphysema ?
Less than 50%
How does emphysema develop ?
In our healthy lungs we have neutrophils and macrophages that help protect us. These cells however produce elastase (protease) enzymes which if lets to build up in cause tissue destruction and emphysema in the lung. Therefore we also have anti-elastase (anti-proteases) which prevent elastases from causing tissue destruction. Note that the lung is not very good at repairing itself.
If there is a alpha 1 antitrypsin deficiency then there is a lack of anti-elastases which cause a build up of elastases and therefore tissue destruction. Smocking causes an decrease in anti-elastases as well as knocking out any repair mechanisms that the lungs did have and increasing the immune cell action which in tern produces more elastase. All of which result in an increase in tissue destruction.
Describe what happens to blood vessels when emphysema develops.
In Emphysemic lungs there is a reduced ability to perform effective gas exchange. This causes vasoconstriction of the blood vessels diverting blood to a better functioning alveoli. If the damage in the lungs is great this extensive construction in the lungs increases the pressure at which the heart must pump the blood to get it through the lungs therefore resulting in high blood pressure. It also causes cor pulmonale which causes hypertrophy of the right ventricle and can cause oedema. Long term vasoconstriction causes fibrosis which constricts vessels even further, loss of capillary’s which adds to the hypoxic state of the body, and production of red blood cells which makes the blood more viscous and harder to pump (known as secondary polycythaemia).
What is the main effect of emphysema ?
Hypoxia throughout the body
What does COPD present with ?
Cough breathlessness Production of sputum Chest infections Wheezing Weight loos Loos of muscle mas Fatigue Swollen ankles Continues worsening of symptoms Cyanosis Raised JVP
How is COPD diagnosed ?
Diagnosed based on a combination of symptoms, history and spirometry.
What will the FEV1/FVC of a COPD patient be
<0.7
What tools can be used in order to diagnose someone with COPD?
Chest X-ray mMRC breathlessness scale results Lung volume Transfer factor tests CT scans
What does a COPD exacerbation look like ?
Worsening symptoms Chest tightness Temperature Fatigue Systemic upset
Should all patients with a COPD exacerbation be brought into the hospital ?
No
What will the hospital do to a patient with a COPD exacerbation ?
Establish the trigger (i.e. is it bacterial or viral) CXR Blood gases RBC U&E Sputum culture VTS Check for other conditions such as a heart attack
What is respiratory failure ?
COPD can be fatal when there is a reduction in ventilation and perfusion.
What sign does respiratory failure cause in a patient ?
Flapping tremor due to CO2 retention
What is it called when there is a build up of CO2 in the blood ?
Hypercapnic
What is type 1 respiratory failure?
Decrease in O2
What is type 2 respiratory failure ?
Decrease in O2 and increase in CO2
What is the GOLD scale used for ?
Determining the severity of COPD
What is the most effective treatment for COPD?
Non - pharmacological management
What are examples of non-pharmacological management ?
Smoking cessation
Pulmonary rehabilitation
Vaccination
What are pharmacological treatments for COPD?
- SABA
- LAMA
- ICS
- LABA
What is used to treat COPD patients who are in an acute exacerbation of symptoms ?
SABS
Steroids
Antibiotics
What is your treatment pathway for a patient with COPD and breathlessness
SABA (patient is requiring it every day) SABA + LAMA (Still so breathless normal life is restricted) SABA + LAMA/LABA (Still no response) No benefit or further treatment
What is your treatment pathway for a patient with COPD who is experiences exacerbations?
SABA + LAMA (Duel therpay) (Continued exacerbations) SABA + LAMA/LABA (duel therapy) (Continued exacerbations) SABA + LAMA/LABA/ICS
How do you remember what Alpha 1 Antiprotease deficiency and Alpha 1 Antitrypsin deficiency is
Trypsin = 'Trip'ing and falling into early onset COPD Protease = 'Pro'duct of bad genes and gives you emphysema
Alpha 1 Antitrypsin deficiency causes early on set COPD and …
COPD which is further down in the lung
What is Asthma ?
An obstructive pulmonary disease resulting from type 1 hypersensitivity. Where people have an increased reactivity which causes an increased reactivity to stimuli.
What causes narrow airways in asthma ?
Inflammation and smooth muscle contraction
What are the most common asthma triggers in children ?
Upper respiratory tract infections
Pollen
Smoke
Pets
What is the course of Asthma like ?
Relapsing and remission throughout the patients life
What % of children are effected by asthma ?
10-15%
What % of adults are effected by asthma ?
5-10%
What are the main risk factors for asthma ?
Genetics - i.e. Atropy
Smoking
Occupation
What is the atopic gene ?
Predisposes a person to a family of conditions which include eczema, hay fever, asthma etc
How does smoking cause asthma ?
Causes smaller lungs and activation of genes which cause asthma in offspring
What occupations can increase the risk of asthma ?
Bakers
Painters
What is the hygiene hypothesis ?
Decreased exposure to bacteria increases the chance of asthma.
How is asthma diagnosed?
It is hard because there is no clear test. Key things are variability of symptoms, cough, wheeze, dyspnoea, chest tightness
What is is good to investigate in the history when trying to diagnose asthma ?
Childhood asthma Bronchitis Wheeze in infancy Eczema Hay fever Any current inhalers family history
What investigations are done to diagnose asthma ?
- Spirometry
- Reversibility test
- Peak flow monitoring
- CXR
- Skin allergen test
Differential diagnosis of asthma ?
COPD Bronchiectasis Cystic fibrosis Tumour or foreign body Cardiac Lung cancer Infection
What is the aim of Asthma medication ?
To have no daytime symptoms and no night time wakening’s, no rescues mediation, no attacks and no limit on activity.
