Why is studying Lung disease important

Question 1

What does a healthy lung look like

Answer 1

Pink

Clearly defined edges

Question 2

What does an unhealthy lung look like

Answer 2

Ragged edges

Degradation due to proteolytic enzymes

Question 3

Are all symptoms specific to lung disease

Answer 3

NO

Question 4

Why is the data not always extrapable

Answer 4

Different burdens in different areas

Question 5

What is meant by endentulism

Answer 5

No teeth

Question 6

What is the respiratory system/disease concerned with

Answer 6

Concerned with function and dysfunction of the lungs and structures around the lungs (pleura, chest wall and respiratory muscles), and the pulmonary vasculature

Question 7

Which parameters are used to measure the burden of lung disease

Answer 7

Mortality
Morbidity: Hospital admissions, GP consultation rates, time off work or school
Morbidity: Years lived with disability (YLDs)
and relative rankings, depends upon the parameter studied and the population studied

Question 8

What is meant by ‘Winter Pressures’

Answer 8

Respiratory disease- massive peak in winter for burden on health services due to exacerbations of asthma, COPD and infections

Question 9

When is COPD often diagnosed

Answer 9

COPD often diagnosed with severe acute episodes- unnecessary morbidity- could have been picked up or intervened earlier

Question 10

What can flow-volume loops be used for

Answer 10

To diagnose different lung diseases

Question 11

How much does lung disease in the UK cost society

Answer 11

Lung disease in UK costs society £11 billion per annum

Question 12

Describe the scale of the problem associated with lung disease

Answer 12

Lung conditions, including lung cancer, are estimated to cost wider society around £9.9 billion each year.
Respiratory disease affects one in five people in England and is the third biggest cause of death
Hospital admissions for lung disease have risen over the past seven years at three times the rate of all admissions

Question 13

How many people present with a COPD exacerbation but have not been diagnosed previously

Answer 13

Currently around a third of people with a first hospital admission for a COPD exacerbation have not been previously diagnosed

Question 14

What does NHS England says needs doing

Answer 14

From 2019 we will build on the existing NHS RightCare programme to reduce variation in the quality of spirometry testing across the country. More staff in primary care will be trained and accredited to provide the specialist input required to interpret spirometry results.
Over the next ten years we will be targeting investment in improved treatment and support for those with respiratory disease, with an ambition to transform our outcomes to be equal, or better, than our international counterparts.

Question 15

What increases the burden of lung disease

Answer 15

60% of patients with obstructive airways disease received no bronchodilators
only a minority of people with mild obstructive lung disease are detected- no treatment given- increasing the burden

Question 16

Describe some trends associated with lung disease

Answer 16

Decline in respiratory mortality not seen in females

uk not producing better outcomes compared to similar EU countries (less steep decreases in death)

Question 17

List the most common numbers of lung disease (in terms of people living with a diagnosis in Jan 2013)

Answer 17

1. Asthma
2. COPD
3. Bronchiectasis
4. Obstructive sleep Apnea
5. Sarcoidosis
6. Lung cancer
7. IPF

Question 18

Describe the deaths from different cancers

Answer 18

Lung cancer is the biggest cancer killer in the UK

Lung cancer kills more women in the UK than breast cancer

Question 19

Describe the 5 year cancer survival rates associated with lung cancer

Answer 19

2nd lowest- to pancreas

Question 20

Describe lung cancer in the UK

Answer 20

46,000 new cases per year in the UK
Over 35,900 deaths per year in the UK
ie 98 deaths every day
Less than 5% of patients with lung cancer survive more than 10 years
rate identical to rate in 1970
86% preventable

Question 21

Describe the improvements associated with lung cancer

Answer 21

One and two year survival rates are improving

Mortality rates for lung cancer are projected to fall by 21% in the UK between 2014 and 2035, to 58 deaths per 100,000 people by 2035.

Reflecting reduced rates of smoking, earlier diagnosis, better treatments

Question 22

Describe the trends associated with smoking

Answer 22

In 2014, 19% of adults in Great Britain currently smoked, down from a peak of 46% in 1974. Average consumption among smokers was 11 cigarettes a day – the lowest daily cigarette consumption for years

Question 23

Describe the classifications of lung diseases

Answer 23

Spirometry distinguishes between airway diseases and small lung disorders
Restrictive- small lung diseases
once spirometry confirms this- is it disease inside or outside the lung

Question 24

What are the different types of airway diseases

Answer 24

localised obstruction

generalised obstruction

Question 25

Give some examples of diseases due to localised obstruction

Answer 25

``` Obstructive sleep apnoea syndrome Upper airway tumours Thyroid enlargement Vocal cord dysfunction Relapsing Polychondritis Tumours (eg Lung Cancer) Post tracheostomy stenosis Foreign bodies Bronchopulmonary dysplasia ```

Question 26

Give some diseases due to generalised obstruction

Answer 26

``` Asthma C.O.P.D. Bronchiectasis Cystic Fibrosis Obliterative Bronchiolitis Long term effects of prematurity ```

Question 27

Give some small lung diseases within the lungs

Answer 27

``` Idiopathic Pulmonary Fibrosis Sarcoidosis Hypersensitvity Pneumonitis Langerhans Cell Histiocytosis Lymphangioleiomyomatosis Alveolar Proteinosis Asbestosis Extrinsic Allergic Alveolitis Eosinophilic pneumonia ```

Question 28

Give some small lung diseases outside the lungs

Answer 28

``` Pleural effusions Mesothelioma Pneumothorax Scoliosis Respiratory muscle weakness Obesity- restricts the size of the lungs- increased risk of sleep apnoea syndrome and asthma ```

Question 29

Give some diseases due to infections

Answer 29

Tuberculosis Infective bronchitis Pneumonia / Empyema

Question 30

Give some diseases due to pulmonary vascular disorders

Answer 30

Pulmonary emboli | Pulmonary hypertension

Question 31

Describe the trends associated with asbestos

Answer 31

Deaths due to asbestos related lung disease increasing significantly (mesothelioma)

Question 32

Describe pulmonary emboli

Answer 32

Clots in the lung may complicate immobility and be fatal and for example remain single biggest cause of maternal death associated with childbirth

Question 33

Describe the impact of obesity

Answer 33

Increasing prevalence of obesity causes both increased respiratory workload, but also respiratory dysfunction and associated with increased risk of asthma and sleep related breathing disorders

Question 34

Describe idiopathic pulmonary fibrosis

Answer 34

35% Increase in diagnosis between 2000 and 2008. | Median survival 3 years from diagnosis (Poorer prognosis than cancer of the colon, breast or ovary)

Question 35

Describe sleep apnoea

Answer 35

Obstructive Sleep apnoea syndrome: Leads to a six times normal risk of having a road traffic crash

Question 36

List some typical symptoms that reflect lung disease

Answer 36

``` Breathlessness Cough Sputum production Haemoptysis Chest discomfort Wheeze or musical breathing Stridor Hoarseness Snoring history /Daytime sleepiness (Weight loss. Anorexia, Fever) ```

Question 37

What is breathlessness?

Answer 37

Breathlessness or dyspnoea is a sensation of difficult, laboured or uncomfortable breathing.

Question 38

What are the potential causes of breathlessness

Answer 38

Lung Disease Heart Disease Pulmonary Vascular Disease Neuromuscular disease (eg diaphragm weakness) Systemic Disorders (eg anaemia, hyperthyroidism, obesity) need to consider them all

Question 39

What can motor neurone disease or M.D present with

Answer 39

Diaphragm weakness- even once they have been diagnosed

Question 40

What is the key function of the lung

Answer 40

The function of the lung is to get oxygen into the body and carbon dioxide out

Question 41

Why can large animals not meed their demands by oxygen alone

Answer 41

A resting adult needs 250 ml oxygen/minute | This is much more than can be acquired by simple diffusion

Question 42

Describe gas exchange

Answer 42

The action of breathing delivers warmed, humidified air to specialised gas exchange surfaces The heart delivers deoxygenated blood to the pulmonary capillaries Gas exchange between air and blood occurs by diffusion

Question 43

List some scilliotoxic agents

Answer 43

Pollution Smoke Damage the cilia

Question 44

How does COPD interfere with the process of gas exchange

Answer 44

Over production of mucus Due to overstimulation by particulate matter Excess mucous obstructs the airways Damaged respiratory mucosa

Question 45

What happens to the mucous glands in COPD

Answer 45

Mucous gland hyperplasia occurs Increase in thickness as it is cartilaginous Can't expand outwards and so it narrows the airways

Question 46

What else can narrow the airways

Answer 46

poor elasticity of alveolar tissue- we need to elucidate the mechanism

Question 47

What happens in pneumonia

Answer 47

neutrophils fill the alveoli- unable to take part in gas exchange

Question 48

What happens in P.E

Answer 48

No deoxygenated blood delivered to the heart for oxygenation

Question 49

Describe a systematic approach for diagnosing lung diseases

Answer 49

First question if result of infection or vascular disorders If not, then must be airways or small lung disorder Use spirometry to distinguish airways and small lung (restrictive) disease When determined, ask if localised/generalised for airways and due to disease inside/outside lungs if restrictive