session 6 Flashcards
patients at risk of exacerbation
previous exacerbation, disease severity, GORD, pulmonary hypertension, resp failure
causes of exacerbations
bacteria (haemophilus influenzae), virus (rhinovirus), pollution, eosinopihils
what COPD therapies improve symptoms
pulmonary rehab, bronchodilators, mucolytics, refractory dysponea management
what COPD therapies improve risk
smoking cessation, oxygen therapy, anti inflammatories. non invasive ventillation
example of proximal bronchodilators
act at muscarinic receptors M3
example of distal bronchodilators
B2 agonists. increase in cAMP, and therefore broncodilation
definition of bronchiectasis
long-term condition where the airways of the lungs become widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection.
symptoms bronchiectasis
cough with sputum, breathlessness, recurrent infections, haemoptysis, weight loss
how is bronchiectasis diagnosed
crackles on auscultation, CXR, CT scan shows signet ring sign
2 red flags for possible mis diagnosed bronchiecstasis
- asthma without reversible airway obstruction on spirometry/inspiratory squeaks and crackles
- COPD but diminished breath sounds, and hearing squeaks and crackles
- recurrent chest/sinus infections
- IBS/RA
differences in location chronic bronchitis, bronchiectasis, asthma and emphysema
chronic bronchitis- broncus
bronchiectasis- bronchus
asthma- bronchus
emphysema- alveoli
differences in pathology chronic bronchitis, bronchiectasis, asthma and emphysema
chronic bronchitis- mucous gland hyperplasia, hypersecretion
bronchiectasis- airway dilation, scarring
asthma- smooth muscle hyperplasia, excess mucus, inflammation
emphysema- airspace enlargment, wall destruction
differences in etiology chronic bronchitis, bronchiectasis, asthma and emphysema
chronic bronchitis- tobacco, pollution
bronchiectasis- severe and persistant infections
asthma- immunological
emphysema- tobacco smoke
main symptoms chronic bronchitis, bronchiectasis, asthma and emphysema
chronic bronchitis- cough, white sputum
bronchiectasis- cough, yellow smelly sputum, fever
asthma- episodic wheezing, cough, dyspnea
emphysema- dysnpnea
most common gene mutation CFTR
Phe50del- defective intracellular production and traffiking, decreased stability
what can a CFTR mutation affect
manufacture protein, transport protein, processsing function, membrane stability
x ray sign CF
tram track sign shows thick walled dilateed bronchi
x ray sign bronchiecstasis
signet ring sign shows dilated bronchus accompyaning pulmonary artery
signs for late diagnosis of CF
recurrent idiopathic pancreatitis, sinusitis and lung infections, infertility
complications CF
bronchiecstasis, pneumothorax, ABPA, haemoptysis, resp failre. chronic sinusitis, nasal polyposis
signs bronchiecstasis
hypoxaemia, fever, haemoptysis, fine crackles, inspiratpry squeaks, clubbing
signs acute severe asthma
cannot complete full sentences, wheeze when ausciltated, peak expiratory flow rate 33-50%,
O2 >92%,
RR > 25,
pulse >110
signs life threatening asthma
acute severe features plus silent chest/starting to tire causing altered consciousness/cyanotic
PEFR < 33%
O2 < 92
RR dropping
management acute severe asthma
oxygen, nebulised salbutamol, steroids, senior
