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DS1102 > Week 5 - Respiratory Disorder > Flashcards

Week 5 - Respiratory Disorder Flashcards

1
Q

What are restrictive disorders

A

A disorder caused by decreased lung elasticity or other causes inhibiting lung expansions. This type of disorder affects inspiration

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2
Q

What are obstructive disorders

A

Disorders associated with the narrowing or obstruction of airways.

This obstruction often results from structural changes or inflammation in the air passages, leading to symptoms such as wheezing, coughing, and shortness of breath

This disorder affects expiration.

e.g. COPD, asthma

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3
Q

What is asthma

A

heterogenous disease, usually characterized by chronic airway inflammation and variable expiratory airflow obstruction.

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4
Q

What are asthma attacks

A
  • Unpredictable, disabling attacks of severe dyspnea, coughing and wheezing triggered by sudden episodes of bronchospasms
  • May be virtually asymptomatic between attacks
  • May rarely be fatal in state of unremitting attacks (450 deaths per year in Australia)
  • Significant reduction in forced expiratory volume (FEV) and peak expiratory flow rate (PEFR)
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5
Q

What does asthma cause

A
  • airway inflammation which makes the airways more sensitive to various triggers like allergens, pollution, smoke ect
  • Bronchoconstriction causing the airways to narrow, restricting airflow into and out of the lungs
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6
Q

what are 2 types of asthma

A
  • allergic (atopic)
  • non-allergic (non atopic)
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7
Q

What is allergic (atopic) asthma

A

asthma which is primarily triggered by allergens like pollen, dust mites, pets. It is associated with a hypersensitive immune response

  • Childhood onset
  • Allergic triggers
  • IgE mediated
  • Th2 dependent
  • Mast cells, basophils, eosinophils involved
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8
Q

What are the stages in allergic (atopic) asthma - type 1 hypersensitivity reaction

A
  • exposure to antigen
  • sensitization stage - asymptomatic
  • effect stage - anaphylactic or atopic immune response (early phase, and late phase)
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9
Q

what is the sensitisation stage occur

A

During the initial encounter to an allergen the allergen is processed by the immune cells as a foreign invader but no allergic symptoms occur at this stage

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10
Q

When does the early phase of the effect stage occur

A

First 15min

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11
Q

What occurs in the early phase of the effect stage

A

mast cell degranulation
- bronchoconstriction and wheezing, increased mucus production, variable degrees of vasodilation and increased vascular permeability
- Mediators produced by mast cells and basophils trigger bronchoconstriction by direct stimulation or subepithelial vagal (parasympathetic) receptors

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12
Q

When does the late phase of the effect stage occur

A

4-6 hours after exposure

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13
Q

what occurs in the late phase of the effect stage

A
  • Cellular inflammation
  • recruitment of leukocytes, notably eosinophils, neutrophils, and T cells
  • Cellular infiltration, fibrin deposition, and tissue destruction resulting from the sustained allergic response cause increased bronchial reactivity, oedema and further inflammatory cell recruitment
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14
Q

What are non allergic asthma

A

not related to allergies, it is instead triggered by factors like respiratory infections (e.g. colds, flu), cold air, exercise, stress or exposure to irritants (smoke,)

  • Adult onset
  • Triggers often unknown
  • Non-IgE mediated
  • T cell dependence unclear
  • neutrophils involved
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15
Q

What are drugs which can induce non allergic asthma

A
  • aspirin
  • codeine and morphine
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16
Q

what are treatments for asthma

A
  • B2-adrenoceptor agonist e.g. Salbutamol (ventolin)
  • Methylxanthines e.g. theophylline
  • Inhaled corticosteroids (preventers)
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17
Q

what do B2-adrenoceptor agonist e.g. Salbutamol (ventolin) do

A

Bronchodilators - which relaxes airway smooth muscle

This mimics the actions of adrenaline - allows deeper breathing

May be used in all patients with asthma

Longer term can decrease saliva production (xerostomia —> increased risk of caries)

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18
Q

What do Methylxanthines do

A

Bronchodilator - relaxes the airway smooth muscle

Bronchodilators which can only be given oral ( or through IV)

Weak anti-inflammatory actions

  • Bronchodilators may exacerbate gastro-esophageal reflux and can contribute to enamel erosion
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19
Q

What do inhaled corticosteroids (preventer) do

A

preventative treatment for asthma
- useful anti-inflammatory agents for acute severe asthma (beclomethasone, budesonide)
- Reduces inflammatory cell numbers and decreases airway hyper-responsiveness to non-specific stimuli and antigens
- Directly inhibitory effect on T-cells, eosinophils,
- Increases the risk of oral candidiasis - advise patient to rinse mouth with water after using their preventer inhaler

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20
Q

How do dental environments influence asthma

A
  • Create an environment with an increased risk of an asthmatic attack through dental materials and products which may exacerbate asthma - dentifrices, sealants, acrylics, tooth enamel dust and aerosols etc.
  • Medications: Aspirin and other NSAIDS, some opioid analgesics (codeine)
  • Anxiety and stress which can trigger asthma
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21
Q

What is chronic obstructive pulmonary disease

A

Chronic Obstructive Pulmonary Disease (COPD) is a group of progressive lung diseases that cause airflow blockage and breathing-related problems.
- caused by an overreaction of the immune system

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22
Q

What are the 2 conditions which make up chronic obstructive pulmonary disease COPD

A
  • Chronic Bronchitis
  • Emphysema
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23
Q

What are the main caused of Chronic obstructive pulmonary disease

A
  • Smoking (main cause)
  • Environmental factors - long term exposure to lung irritants - chemical vapors, pollutants, and dust from grain or wood
  • Genetic - a disorder known as alpha-1-antitrypsin deficiency can trigger emphysema, even if no other risk factors are present
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24
Q

What is chronic bronchitis

A

a persistent cough with sputum production for at least 3 months in at least 2 consecutive years in the absence of any other identifiable cause. - is caused as the bronchial tube has an increased amount of mucus

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25
Q

What does chronic bronchitis do to the body

A

Mucus hypersecretion due to enlarged submucosal glands and an increase in goblet cells which secrete mucus. This causes airways to narrow by the thickness of the mucosa

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26
Q

Progression of chronic bronchitis (what chronic bronchitis can cause in the heart)

A
  • reduced flow of air and hence reduced oxygen levels in the blood (hypozemia)
  • pulmonary hypertension
  • increased right ventricular load - to overcome the increased resistance in the pulmonary arteries
  • right ventricular hypertrophy - where the right ventricle becomes thickened as it tried to pump blood against the high pressure in the lungs
  • Right sided heart failure
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27
Q

What is emphysema

A

the irreversible enlargement of airspaces distal to terminal bronchioles with destruction to their walls.
Reduces elastic recoil of the lungs, causing a reduced pressure for expiratory flow

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28
Q

What are the 2 types of emphysema which cause significant air flow obstruction

A
  • Centriacinar*
  • Panacinar*
29
Q

What is an acinus

A

the functional unit of the lung: a respiratory bronchiole and its alveolar ducts and alveolar sacs

30
Q

What is centriacina emphysema

A
  • where damage is primarily in the central or proximal parts of the acini, particularly the respiratory bronchioles (the distal alveoli are spared)
  • Predominantly affects the upper lobes of the lungs
  • predominantly in heavy smokers
  • most common type
31
Q

What is panacinar emphysema

A

In panacinar emphysema, the damage involves the entire acinus uniformly, including the respiratory bronchioles, alveolar ducts, sacs, and alveoli.

This type of emphysema generally affects the lower lobes of the lungs and is more evenly distributed throughout the lung parenchyma.

  • Associated with a1-antitrypsin deficiency and exacerbated by smoking
  • Acini uniformly enlarged from respiratory bronchiole to terminal alveoli
  • More common in lower zones and anterior margins of the lung and usually most severe at the bases
32
Q

What is the pathogenic triad (the mechanisms of how emphysema occurs)

A
  • Oxidative stress, increased apoptosis and senescence
  • Inflammatory cells, release of inflammatory mediators
  • Protease-antiprotease imbalance (protease destroys alveolar wall while antiprotease protects the wall)
33
Q

What does the pathogenic triad cause

A

alveolar wall destruction

34
Q

What is the COPD link to oral health

A

Association between poor oral health and periodontal disease and development and
progression of COPD
* Possibly linked to immune cell activation mediated by pathogenic bacterial species in dental plaque also found in acute exacerbation of chronic bronchitis
* Periodontal therapy in COPD patients may improve lung function and decrease frequency of COPD exacerbations

35
Q

What is sleep apnoea

A

sleep disorder characterised by interruptions in breathing during sleep. These interruptions are called apneas and can last for several seconds to minutes.

36
Q

What are the different types of sleep apnoea

A
  • Obstructive SA
  • Central SA
  • Complex SA Syndrome
37
Q

What is obstructive SA

A
  • most prevalent form
  • occurs when tongue and throat muscles relax excessively during sleep causing airway to narrow or close
  • results in loud snoring or choking sounds
  • often associated with obesity and more common in men
38
Q

What is central SA

A
  • brain respiratory centres not responding properly to rising CO2 levels - no regular contraction of diaphragm and intercostal muscles
  • often related to medical conditions such as heart failure and pharmacologic agents morphine)
  • more common in older adults
39
Q

What is complex SA syndrome

A
  • combination of obstructive SA and central SA
  • occurs when someone with OSA develops CSA after starting continuous positive airway pressure (CPAP) therapy for their OSA
40
Q

What are symptoms of sleep apnoea

A
  • Loud snoring
  • Choking or gasping for air during
    sleep
  • Excessive daytime sleepiness
  • Morning headaches
  • Difficulty concentrating
  • Irritability
41
Q

What are the treatments for sleep apnoea

A
  • Lifestyle changes e.g. weight loss, avoiding alcohol and sedatives, and side sleeping
  • Continuous positive airway pressure - most common treatment (moderate to severe OSA) it delivers a steady flow of air pressure to keep the airway open during sleep
  • Bilevel Positive airway pressure (BiPAP): Similar to CPAP but offers different pressures for inhaling and exhaling - more comfortable for some individuals
  • Oral appliances (mandibular advancement devices) - prescribed by dentists to reposition lower jaw and tongue to help keep the airway open
  • Medications - addressing the underlying medication condition
42
Q

What is CPAP

A

Continuous positive airway pressure
- most common treatment
- delivers a steady flow of air pressure to keep the airway open during sleep

43
Q

What is BiPAP

A

Bilevel positive airway pressure
- offers different pressures for inhaling and exhaling
- more comfortable for some individuals

44
Q

What is the impact of sleep apnea and oral health

A
  • Can affect the structures of the mouth and throat —> xerostomia
  • Periodontal disease suggested to be associated with OSA
    Use of oral appliances may cause dental issues, e.g. damages in bite or discomfort
  • Regular dental check ups are essential
  • Provide guidance on oral hygiene and help manage any issues that may arise from sleep apnea treatment
45
Q

binding of the allergen to which type of antibody triggers allergen triggered asthma (type 1 hypersensitivity)

A

IgE antibody

46
Q

How do IgE antibodies cause an allergen triggered asthma reaction

A

IgE antibodies are produced during the sensitization phase and are bound to basophile cells. The next time the body is exposed to the allergen the basophils are triggered and release inflammatory signals causing symptoms

47
Q

What is a disadvantage of using inhaled corticosteroids especially in older patients

A

increase risk of oral candidiasis (thrush)

48
Q

What is the primary symptoms noticeable in patients with emphysema

A

reduced expiratory flow rate

reduction in the recoil pressure hence can’t expel as much air in the first second

49
Q

What capacities would be affected in a patient with emphysema

A

Forced expiratory volume in 1 second/forced vital capacity

50
Q

What is cystic fibrosis

A

A monogenic disorder that is inherited in an autosomal recessive manner

It is caused by mutations in the CFTR (cystic fibrosis transmembrane conductance regulator) gene, which is responsible for the formation of a chloride channel in the epithelial cells membranes

51
Q

What does cystic fibrosis result in the body

A

defective CFTR protein leads to thick, sticky mucus production affecting various organs especially the lungs and digestive system

52
Q

What are symptoms of cystic fibrosis

A

respiratory systems
-Persistent cough with thick mucus
- Wheezing or difficulty breathing
- Exercise intolerance
- Repeated lung infections
- Inflamed nasal passages or stuffy nose
- recurrent sinusitis and pneumonia

Other symptoms

  • salty sweat
  • tiredness, lethargy or reduced ability to exercise
  • Poor growth or weight gain
  • frequent visits to the toilet
  • poor appetite
  • CF related diabetes
  • infertility in males
53
Q

Can cystic fibrosis be cured

A

no
but it can be treated to manage

54
Q

What is the management of cystic fibrosis

A
  • medication - antibiotics, anti inflammatory drug, mucus thinners and bronchodilators
  • nutrition
  • therapies
  • procedures
  • specialist
55
Q

What are the oral health implications of cystic fibrosis

A
  • dry mouth
  • increased risk of dental caries and periodontal disease
  • enamel defects due to genetic disease background
  • difficulty maintaining oral hygiene
  • regular dental check ups are crucial for Cf patients
56
Q

What are dental considerations for patient with cystic fibrosis

A
  • Appointment allocation to minimise patient to patient contact e.g. first appointment of the day to reduce chance of them getting a lung infection
  • Limiting treatment to a single allocated surgery
  • Ensuring that all staff members don’t have any transmissible illness e.g. colds, coughs
  • Enforcing cross infection control and waterline disinfection
  • Shorter appointment times and regular breaks
  • Providing treatment with patient in an upright or semi upright position in the chair to facilitate clearance of airway secretions and mucus
57
Q

What causes tuberculosis

A

infection of bacteria Mycobacterium tuberculosis
transmitted through inhalation of airborne droplets containing the bacterium or direct contact

58
Q

What are symptoms of tuberculosis

A
  • persistent cough (often with blood)
  • fatigue
  • weight loss
  • night sweats
59
Q

What are oral manifestations of tuberculosis

A

oral manifestations are rare
- ulcerations
- granulomas
- swollen lymph nodes in the neck (oral tuberculosis)

60
Q

What is the treatment of tuberculosis

A
  • antibiotics (isoniazid, rifampin)
  • Patients with active TB are infectious and require specialised medical treatment
  • For Patients with active TB standard precautions are insufficient to prevent transmission
  • Patients with latent tuberculosis are not infectious can be treated under standard infection control precautions
61
Q

what are the primary mechanism of action for inhaled corticosteroids in asthma

A

anti-inflammatory effect

62
Q

Which lung function parameter is typically reduced in both asthma and COPD

A

FEV1 - forced expiratory volume in the first second

63
Q

What’s hypoxia

A

low level of oxygen in the blood

64
Q

What’s hypercapnia

A

abnormally elevated carbon dioxide levels in the blood

65
Q

what is hypocapnia

A

decrease in alveolar and blood carbon dioxide levels below the normal reference range

66
Q

what is hypoxia

A

absence of enough oxygen in the tissues to sustain bodily functions

67
Q
A
68
Q

What medication increases the risk of candidiasis (thrush)

A

Inhailed corticosteroid’s

68
Q

What is linked to a a1-antitrypsin deficiency

A

panacinar emphysema

DS1102 (30 decks)

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