why study lung disease Flashcards
what is the study of lung disease
concerned with function and dysfunction of lungs and structures around the lungs and pulmonary vasculature
parameters of burden
mortality
morbidity - hospital admissions, GP consultation rates, time off
morbidity - years lived with disability (as in a study)
is it generalisable
change in levels of diabetes and alzheimers
increase
change in level of diarrhoeal illness
decrease
burden of lung disease
£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
cause of increased burden of lung disease in september
asthma
cause of increased burden of lung disease in oct-feb
COPD and pneumonia exacpeated
how many people with COPD exacerbation have not been previously diagnosed
1/3
missed opportunity for prevention
NHS england view
reduce variation in spirometry tetsing across teh country
more staff in primary care trained to provide specialist input to interpret results
results of secret spirometry study
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
UK’s respiratory mortality in comparision to other places
worse
regional variation of lung disease
different diagnostic rate of sleep apnea
5/6 fold difference in asthma hospitalisation rate - not on optimal treatment
commonest lung disease in order
asthma COPD bronchiolitis obstructive sleep apnoea sarcoidosis lung cancer idiopathic pulmonary fibrosis
respiratory death in UK
kills 1 in 5 people
asthma mortality and prevalence
high prevalence low mortality (it should be even lower with the treatment available)
mortality of COPD and lung cancer from 1990 to 2020
increasing
death from lung cancer
biggest cancer killer
awful 5yr survival rate
even though more people have breast cancer
lung cancer in the UK
46000 new cases a year 35900 deaths yr - 98 daily <5% survive 10yrs 86% preventable some have it and dont smoke
one and 2 year survival of lung cancer
improving
lung cancer prediction for 2035
fall by 21% to 58deaths per 100000 people by 2035
because of reduced rates of smoking, earlier diagnosis and better treatment
smoking prevalence
from 46% in 1974 to 19% in 2014
average consumption 11 a day = lowest for years
what are restrictive disorders
small lungs
disease in or out of the lung
order of thought when suspect lung disease
infection
pul vascular disorder - spirometry distinguish from infections
then is it restrictive disorder or an airway disease (obstruction)
what is happening with mesothelioma now
epidemic
asbestos related malignancy terrible prognosis of lining off lungs
reflect exposue to asbestos years ago
pulmonary embolism
biggest cause of death in childbirth
vessel obstructed
complicate immobility
obesity
restrict size of the lung
causes increased respiratory workload, respiratory dysfunction, and risk of asthma and sleep related breathing disorders
idiopathic pulmonary fibrosis
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
sleep apnoea
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
symptoms of 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
dyspnoea
sensation of difficult, uncomfortable or laboured breathing
cause of breathlessness
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
when do you check the causes of breathlessness
always, even if already have one of these diagnoses- might be a different one this time
function of lungs
get O2 into the body and CO2 out
why cant we use diffusion
resting adult needs 250ml O2/min
more than can get from diffusion
describe gas exchange
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
effect of COPD on GE
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
effect of lung damage on the airways
the walls are thicker - mucous
foreign bodies
can cause infection
pneumonia
airsacs not available because full of neutrophils, inflammatory cells and bacteria,
asbestos
fibrosis
destroys air sacs
first steps in diagnosis
take a history and examine the respiratory system
bronchiolitis
dilatation of bronchi
infection and suppuration
