WEEK 3 - SPUTUM Flashcards
Asthma
RESTRICTIVE RESP CONDITION
## DESCRIPTION
Causes chronic inflammation in the airways, narrowing them and making breathing difficult. Asthma exacerbations are caused by irritation from the environment in the lungs.
Th2 cells are an immune cell subtype, and are excessively stimulated by environmental irritants causing asthma. Irritants such as smoke are received by dendritic cells and processed by Th2 cells, releasing cytokines such as Interleukin-4 and IL-5. These cytokines promote an inflammatory response.
This hypersensitive inflammatory response leads to spasming contractions of the smooth muscles in the bronchioles and increased mucus secretion, narrowing the airways. These changes are reversible.
Overtime, some irreversible changes can occur. Edema, scarring and fibrosis can occur in the bronchioles, resulting in thickening basement membranes, permanently narrowing the airways.
TYPES OF ASTHMA
- Intermittent asthma —>
- mild persistent asthma —>
- moderate persistent asthma —>
- severe persistent asthma
CAUSES/RISK FACTORS
- genetic - family history leads to increased risk of having asthma (childhood asthma)
- environmental factors - hygiene hypothesis (later onset of asthma)
SYMPTOMS
- coughing
- chest pain/tightness
- wheezing
- dyspnea (difficulty breathing)
TREATMENT
- avoid contact with triggering substances
- medication - bronchodilators, corticosteroids
Acute Bronchitis
RESTRICTIVE
DESCRIPTION
Inflammation of the bronchial tubes. Causes a cough that often brings up mucus, as well as shortness of breath, wheezing and chest tightness.
Often brought on by exposure to causing viruses (most common) and bacteria, and can be irritated by known irritants (smoke, dust, mold, vapours)
SYMPTOMS
- coughing up mucus
- wheezing
- shortness of breath
- chest tightness
CAUSES/RISK FACTORS
- caused by viral infection, like flu or the cold
- smoking
- exposure to polluted areas
- prior history of asthma
TREATMENT
- use of antibiotics
- increase fluid intake, orally or IV
- humidifiers
Chronic Bronchitis
OBSTRUCTIVE
Inflammation of the bronchial tubes. Is classified as chronic when there is a productive cough for 3 or more months of the years for 2+ years.
Chronic Bronchitis and Emphysema fall underneath Chronic Obstructive Pulmonary Disease (COPD). CB and Emphysema commonly co-exist, as they are often brought on by their major risk factor, smoking. CB is defined by clinical features like a productive cough, well as Emphysema is defined by structural changes like change in air spaces in the lungs.
CAUSES/RISK FACTORS
- Smoking
- air pollutants
- dust and cilia
- genetic factors (family history)
SYMPTOMS
- Wheezing
- Crackles
- Hypoxemia - low O2 in blood
- Hypercapina - high CO2 in blood
- Cyanosis - blue discolouration of the skin
- Pulmonary hypertension - large amount of pulmonary vasoconstriction due to innefective gaseous exchange leads to increased pulmonary resistance, increasing BP.
- Lung infection
RELEVANT DIAGNOSIS
- FEV1/FVC ratio is a metric that can recognise COPD. A normal ratio is 80%, but can drop to around 50% in COPD patients.
- REID INDEX - Thickness of Glands / Thickness of Wall
TREATMENT
- reducing risk factors
- managing associated illnesses
- supplemental O2
- medication
- bronchodilators
- inhaled steroids
- antibiotics
Bronchiectasis
DESCRIPTION
Obstructive
Bronchial-dilation
Characterised by airways that have been abnormally enlarged. More susceptible to successive infections, as it allows an increase in bacterial colonisation in the bronchi/oles. The ongoing inflammation of the airways overtime leads to airway remodelling.
The symptoms of BE disrupt vital processes that occur in the respiratory system. Including
- mucociliary elevator
- cough reflex
- antibody production (IgA)
- antimicrobial peptides
Airway Neutrophilia is the hallmark of BE. Excessive presence of neutrophils are present in BE as the injured epithelial in the walls of the airways release cytokines (IL1, IL8) that attract neutrophils to the airways.
CAUSES/RISK FACTORS
These factors trigger the initial insult, which initially dilates the airways.
- Bacterial Infection
- A1 Antitrypsin Deficiency
- Asthma
- Bronchial Obstruction (aspiration, tumour obstruction, lymph node swelling)
- Cystic Fibrosis
- COPD
SYMPTOMS
- excessive sputum production - Purulent (off white, yellowy sputum) in 2/3 of patients
- Haemoptysis (coughing up blood) - 60% of patients
- Infections
- Tenacious cough - Chronic
- Weight Loss
- Respiratory comprimise
- Dyspnoea (SOB)
- Wheezing
- Yellow Nail syndrome
RELEVANT DIAGNOSIS
- High-resolution CT - measures Bronchial diameter
- Airway diameter > accompanying blood vessel = BE
- X-ray, visible enlarged airways cystic shadows
- Bronchoscopy
- Spirometry
TREATMENT
- Haemoptysis - embolisation or Lobectomy
- Exacerbations - Antibiotics, long term macrolides, steroids, bronchodilators
- Lifestyle - Smoking cessation, vaccines, exercise
- Postural Drainage x2 a day
-
Chest physiotherapy
- breathing techniques
- Inhaled bronchodilators
Cystic Fibrosis
DESCRIPTION
An inherited disorder characterised by a defective CFTR gene that results in impairment in the ability to produce normal body secretions (sweat, mucus).
Life shortening
Thick, stickier mucus is produced, which is more difficult to remove from the lungs. This causes dysfunctional cilia, creating a breeding ground in the respiratory tracts for recurring respiratory infections. This leads to Bronchiectasis.
CAUSE/RISK FACTORS
- Genetically inherited disorder
SYMPTOMS
- secretions thicker and cause obstruction
- Increased salt in sweat - dehydration risk (salt crystal formation on skin) - CFTR assists in moving Chloride, an element of salt, through cells. Stuck in sweat ducts.
- stickier mucus
- Infertility in males - 98% of male CF patients are infertile due to poor development of Vas Deferens. 15-30% infertile females.
- coughing, wheezing
- SOB
- Poor growth
- Vomiting
RELEVANT DIAGNOSIS
- Newborn screening - Heel prick
- Sweat testing
- Genetic testing (CFTR gene)
TREATMENT
- vaccines
- airway clearance measures (chest physio)
- aerobic exercise
- CFTR modulators
- antibiotics
- bronchodilators
- NSAIDS (ibrupofren)
- nutritional supports (vitamins, 50% calorie surplus)
Sputum matching (purulent, serous, rusty, mucoid, bloody)
purulent - green/yellow - broncho-pulmonary infection
serous - watery thin, pink and frothy - pulmonary oedema
rusty - brick/rusty red or golden yellow - pneumococcal pneumonia
mucoid - thick, white/grey - inflammatory exudate from chronic bronchitis, emphysema, asthma
bloody - bright red - lung tumour, tuberculosis
define shunting
Shunting: the right ventricle is forced to work harder to pump blood through vasoconstricted blood vessels. This excess stress leads to hypertrophy of the right ventricle and increases the risk of heart failure.
Ventilation vs perfusion
Ventilation (V) refers to the flow of air into and out of the alveoli, while perfusion (Q) refers to the flow of blood to alveolar capillaries