why study lung disease

Question 1

what is the study of lung disease

Answer 1

concerned with function and dysfunction of lungs and structures around the lungs and pulmonary vasculature

Question 2

parameters of burden

Answer 2

mortality
morbidity - hospital admissions, GP consultation rates, time off
morbidity - years lived with disability (as in a study)
is it generalisable

Question 3

change in levels of diabetes and alzheimers

Answer 3

increase

Question 4

change in level of diarrhoeal illness

Answer 4

decrease

Question 5

burden of lung disease

Answer 5

£11 billion annum
£9.9billion for england alone 
1 in 5 people in England affected 
3rd biggest cause of death 
hospitalisations risen over 7 years 3x rate of all admissions - better at keping people out of hospital for different things

Question 6

cause of increased burden of lung disease in september

Answer 6

asthma

Question 7

cause of increased burden of lung disease in oct-feb

Answer 7

COPD and pneumonia exacpeated

Question 8

how many people with COPD exacerbation have not been previously diagnosed

Answer 8

1/3

missed opportunity for prevention

Question 9

NHS england view

Answer 9

reduce variation in spirometry tetsing across teh country

more staff in primary care trained to provide specialist input to interpret results

Question 10

results of secret spirometry study

Answer 10

only a few people noticed when there was severe obstructive lung disease
60% people with obstructive airways didnt receive bronchodilators
very easy to overlook disase if you dont do the test
1/3 people on drugs found not to have disease - waste of money

Question 11

UK’s respiratory mortality in comparision to other places

Answer 11

worse

Question 12

regional variation of lung disease

Answer 12

different diagnostic rate of sleep apnea

5/6 fold difference in asthma hospitalisation rate - not on optimal treatment

Question 13

commonest lung disease in order

Answer 13

asthma 
COPD 
bronchiolitis 
obstructive sleep apnoea 
sarcoidosis 
lung cancer 
idiopathic pulmonary fibrosis

Question 14

respiratory death in UK

Answer 14

kills 1 in 5 people

Question 15

asthma mortality and prevalence

Answer 15

high prevalence 
low mortality (it should be even lower with the treatment available)

Question 16

mortality of COPD and lung cancer from 1990 to 2020

Answer 16

increasing

Question 17

death from lung cancer

Answer 17

biggest cancer killer
awful 5yr survival rate
even though more people have breast cancer

Question 18

lung cancer in the UK

Answer 18

46000 new cases a year 
35900 deaths yr - 98 daily 
<5% survive 10yrs 
86% preventable 
some have it and dont smoke

Question 19

one and 2 year survival of lung cancer

Answer 19

improving

Question 20

lung cancer prediction for 2035

Answer 20

fall by 21% to 58deaths per 100000 people by 2035

because of reduced rates of smoking, earlier diagnosis and better treatment

Question 21

smoking prevalence

Answer 21

from 46% in 1974 to 19% in 2014

average consumption 11 a day = lowest for years

Question 22

what are restrictive disorders

Answer 22

small lungs

disease in or out of the lung

Question 23

order of thought when suspect lung disease

Answer 23

infection
pul vascular disorder - spirometry distinguish from infections
then is it restrictive disorder or an airway disease (obstruction)

Question 24

what is happening with mesothelioma now

Answer 24

epidemic
asbestos related malignancy terrible prognosis of lining off lungs
reflect exposue to asbestos years ago

Question 25

pulmonary embolism

Answer 25

biggest cause of death in childbirth vessel obstructed complicate immobility

Question 26

obesity

Answer 26

restrict size of the lung | causes increased respiratory workload, respiratory dysfunction, and risk of asthma and sleep related breathing disorders

Question 27

idiopathic pulmonary fibrosis

Answer 27

35% increase in diagnosis between 2000 and 2008 median survival 3 yrs from diagnosis - more people know about it poor prognosis than colon, breast or ovary cancer need more research

Question 28

sleep apnoea

Answer 28

6x normal risk of having car crash public health concern - interfere with the ability to work recession of the ribcage - muscle moves in and causes obstruction of the airways every 45s big tongue, obese, receding jaw - obese are the biggest group

Question 29

symptoms of lung disease

Answer 29

``` breathlessness cough sputum production haemoptysis chest discomfort wheeze or musical breathing stridor hoarseness snoring history/daytime sleepiness weight loss anorexia fever ```

Question 30

what is breathlessness

Answer 30

dyspnoea | sensation of difficult, uncomfortable or laboured breathing

Question 31

cause of breathlessness

Answer 31

lung disease heart disease pulmonary vascular disease neuromuscular disease - eg diaphragm weakness, bowel push up diaphragm - cant breath properly when lying down systemic disorders - anaemia, hyperthyroidism, obesity

Question 32

when do you check the causes of breathlessness

Answer 32

always, even if already have one of these diagnoses- might be a different one this time

Question 33

function of lungs

Answer 33

get O2 into the body and CO2 out

Question 34

why cant we use diffusion

Answer 34

resting adult needs 250ml O2/min | more than can get from diffusion

Question 35

describe gas exchange

Answer 35

the airway branch to gas exchange surfaces action of breathing delivers warm, humidified air to gas exchange surfaces heart delivers deox blood to pul capillaries GE occurs by diffusion

Question 36

effect of COPD on GE

Answer 36

damaged respiratory mucosa ciliotoxic more mucous - it is over produced and because ciliotoxic it cannot be removed as well excess mucous obstruct airways mucous gland hyperplasia - wall is cartilaginous so cant expand so restrict the lumen radial refraction of elastic tissue

Question 37

effect of lung damage on the airways

Answer 37

the walls are thicker - mucous

Question 38

foreign bodies

Answer 38

can cause infection

Question 39

pneumonia

Answer 39

airsacs not available because full of neutrophils, inflammatory cells and bacteria,

Question 40

asbestos

Answer 40

fibrosis | destroys air sacs

Question 41

first steps in diagnosis

Answer 41

take a history and examine the respiratory system

Question 42

bronchiolitis

Answer 42

dilatation of bronchi | infection and suppuration