Why is studying Lung disease important Flashcards
What does a healthy lung look like
Pink
Clearly defined edges
What does an unhealthy lung look like
Ragged edges
Degradation due to proteolytic enzymes
Are all symptoms specific to lung disease
NO
Why is the data not always extrapable
Different burdens in different areas
What is meant by endentulism
No teeth
What is the respiratory system/disease concerned with
Concerned with function and dysfunction of the lungs and structures around the lungs (pleura, chest wall and respiratory muscles), and the pulmonary vasculature
Which parameters are used to measure the burden of lung disease
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
What is meant by ‘Winter Pressures’
Respiratory disease- massive peak in winter for burden on health services due to exacerbations of asthma, COPD and infections
When is COPD often diagnosed
COPD often diagnosed with severe acute episodes- unnecessary morbidity- could have been picked up or intervened earlier
What can flow-volume loops be used for
To diagnose different lung diseases
How much does lung disease in the UK cost society
Lung disease in UK costs society £11 billion per annum
Describe the scale of the problem associated with lung disease
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
How many people present with a COPD exacerbation but have not been diagnosed previously
Currently around a third of people with a first hospital admission for a COPD exacerbation have not been previously diagnosed
What does NHS England says needs doing
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.
What increases the burden of lung disease
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
Describe some trends associated with lung disease
Decline in respiratory mortality not seen in females
uk not producing better outcomes compared to similar EU countries (less steep decreases in death)
List the most common numbers of lung disease (in terms of people living with a diagnosis in Jan 2013)
- Asthma
- COPD
- Bronchiectasis
- Obstructive sleep Apnea
- Sarcoidosis
- Lung cancer
- IPF
Describe the deaths from different cancers
Lung cancer is the biggest cancer killer in the UK
Lung cancer kills more women in the UK than breast cancer
Describe the 5 year cancer survival rates associated with lung cancer
2nd lowest- to pancreas
Describe lung cancer in the UK
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
Describe the improvements associated with lung cancer
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
Describe the trends associated with smoking
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
Describe the classifications of lung diseases
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
What are the different types of airway diseases
localised obstruction
generalised obstruction
Give some examples of diseases due to localised obstruction
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
Give some diseases due to generalised obstruction
Asthma C.O.P.D. Bronchiectasis Cystic Fibrosis Obliterative Bronchiolitis Long term effects of prematurity
Give some small lung diseases within the lungs
Idiopathic Pulmonary Fibrosis Sarcoidosis Hypersensitvity Pneumonitis Langerhans Cell Histiocytosis Lymphangioleiomyomatosis Alveolar Proteinosis Asbestosis Extrinsic Allergic Alveolitis Eosinophilic pneumonia
Give some small lung diseases outside the lungs
Pleural effusions Mesothelioma Pneumothorax Scoliosis Respiratory muscle weakness Obesity- restricts the size of the lungs- increased risk of sleep apnoea syndrome and asthma
Give some diseases due to infections
Tuberculosis
Infective bronchitis
Pneumonia / Empyema
Give some diseases due to pulmonary vascular disorders
Pulmonary emboli
Pulmonary hypertension
Describe the trends associated with asbestos
Deaths due to asbestos related lung disease increasing significantly (mesothelioma)
Describe pulmonary emboli
Clots in the lung may complicate immobility and be fatal and for example remain single biggest cause of maternal death associated with childbirth
Describe the impact of obesity
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
Describe idiopathic pulmonary fibrosis
35% Increase in diagnosis between 2000 and 2008.
Median survival 3 years from diagnosis (Poorer prognosis than cancer of the colon, breast or ovary)
Describe sleep apnoea
Obstructive Sleep apnoea syndrome:
Leads to a six times normal
risk of having a road traffic crash
List some typical symptoms that reflect lung disease
Breathlessness Cough Sputum production Haemoptysis Chest discomfort Wheeze or musical breathing Stridor Hoarseness Snoring history /Daytime sleepiness (Weight loss. Anorexia, Fever)
What is breathlessness?
Breathlessness or dyspnoea is a sensation of difficult, laboured or uncomfortable breathing.
What are the potential causes of breathlessness
Lung Disease
Heart Disease
Pulmonary Vascular Disease
Neuromuscular disease (eg diaphragm weakness)
Systemic Disorders (eg anaemia, hyperthyroidism, obesity)
need to consider them all
What can motor neurone disease or M.D present with
Diaphragm weakness- even once they have been diagnosed
What is the key function of the lung
The function of the lung is to get oxygen into the body and carbon dioxide out
Why can large animals not meed their demands by oxygen alone
A resting adult needs 250 ml oxygen/minute
This is much more than can be acquired by simple diffusion
Describe gas exchange
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
List some scilliotoxic agents
Pollution
Smoke
Damage the cilia
How does COPD interfere with the process of gas exchange
Over production of mucus
Due to overstimulation by particulate matter
Excess mucous obstructs the airways
Damaged respiratory mucosa
What happens to the mucous glands in COPD
Mucous gland hyperplasia occurs
Increase in thickness as it is cartilaginous
Can’t expand outwards and so it narrows the airways
What else can narrow the airways
poor elasticity of alveolar tissue- we need to elucidate the mechanism
What happens in pneumonia
neutrophils fill the alveoli- unable to take part in gas exchange
What happens in P.E
No deoxygenated blood delivered to the heart for oxygenation
Describe a systematic approach for diagnosing lung diseases
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
