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CR2 > Obstructive Lung Diseases > Flashcards

Obstructive Lung Diseases Flashcards

1
Q

What causes asthma

A

Chronic inflammation

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2
Q

Is airflow limitation variable in asthma or COPD

A

Asthma

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3
Q

Asthma symptoms

A

Wheeze
Shortness of breath
Chest tightness
Cough

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4
Q

What limits airflow in asthma

A

Narrowed airways from chronic inflammation

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5
Q

How does chronic inflammation impact airways

A

Thickening basement membrane
Airway smooth muscle hypertrophy
Leukocyte infiltration
Goblet cell hyperplasia
Mucus hypersecretion

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6
Q

Which type of cells are central in asthma pathology

A

TH2

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7
Q

What molecules do allergens activate in asthma pathology

A

Sensitised mast cells

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8
Q

Which bronchoconstrictor mediators are released by sensitised mast cells when allergens bind to them

A

Histamine
Cysteinyl leukotrienes
Prostaglandin D2

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9
Q

What do TH2 cells do in asthma pathology

A

Release inflammatory mediators

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10
Q

What inflammatory mediators are released by TH2 cells in asthma pathology

A

IL-4
IL-5
IL-9
IL-13

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11
Q

Types of asthma

A

Allergic asthma
Exercise induced asthma
Late onset eosinophilic asthma
Very late onset asthma
Obesity associated asthma
Smoking related neutrophilic asthma
Smooth muscle mediated paucigranulocytic asthma

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12
Q

Does T2 type asthma usually appear in childhood or adulthood

A

Childhood

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13
Q

Does non t2 type asthma usually appear in childhood or adulthood

A

Adulthood

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14
Q

What can cause variation in asthma symptoms

A

Time of day
Season
Environment

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15
Q

Why is predictive value of isolated asthma signs and symptoms poor

A

Symptoms are not specific to asthma

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16
Q

Wheeze

A

Continuous high pitch musical sound coming from chest

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17
Q

What is involved in asthma diagnosis

A

Previous medical history
Current medical history
Lung function tests

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18
Q

What symptoms on assessment suggest possible asthma

A

Wheeze
Cough
Breathlessness
Chest tightness

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19
Q

What characteristics from history suggest possible asthma

A

Recurrent symptom episodes
Symptom variability
Absence of alternative diagnosis symptoms
Recorded observation of wheeze
History of atopy
Historical variable PEF or FEV1

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20
Q

Which patients would be sent for tests to confirm asthma

A

Intermediate probability patients

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21
Q

How does badly managed asthma effect spirometry

A

Decr FEV1 and FVC

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22
Q

Does the upper portion of a flow volume graph show inspiration or expiration

A

Expiration

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23
Q

How does the flow volume graph of an asthma patient and person without asthma differ

A

Asthma causes scalloped line during expiration due to reduced flow rate

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24
Q

Why does asthma decrease flow rate

A

Small airways collapse

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25
Q

What spirometry result indicates asthma

A

Obstructive spirometry with positive bronchodilator reversibility, although spirometry may be normal in asymptomatic patients

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26
Q

How many PEF attempts are used to calculate a value

A

3

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27
Q

How much variability in PEF and FEV1 suggests asthma

A

20%+ PEF
12%FEV1

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28
Q

How does PEF change in asthma exacerbation

A

Decrease

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29
Q

Asthma management goals

A

Control disease
No daytime symptoms
No night wakening
No need for rescue medication
No daily activity limitation
Norma, lung function
Minimal drug side effects
Invariable PEF

30
Q

What medication is used as rescue medication for symptomatic asthma

A

Inhaled short acting beta 2 agonist

31
Q

What drugs are used in asthma management

A

Inhaled short acting beta 2 agonist
Inhaled corticosteroids

32
Q

What is SMART

A

combined maintenance and reliever therapy

33
Q

In What age children should spacers be considered for inhalers

A

5-12yrs

34
Q

Should aerosol inhalers be inhaled slow and steady or quick and deep

A

Slow and steady

35
Q

Should dry powder inhalers be inhaled slow and steady or quick and depo

A

Quick and deep

36
Q

Corticosteroids

A

Broad spectrum anti inflammatory drugs

37
Q

What receptors do ICSs bind to in the cytoplasm

A

Glucocorticoid receptor

38
Q

What does the corticosteroid-glucocorticoid receptor complex bind to

A

Glucocorticoid response element on DNA

39
Q

What is released as a result of glucocorticoids binding to DNA

A

CXCL8
IL-6
TNF-alpha

40
Q

Why should corticosteroid use be limited

A

Can block other immune pathways

41
Q

What do beta 2 agonists cause

A

Airway smooth muscle relaxation

42
Q

What do beta 2 agonists bind to

A

Beta 2 adrenergic receptors on smooth muscle

43
Q

What medications are used in asthma combination therapy

A

Beta 2 agonists
ICS

44
Q

What does COPD cause

A

Progressive airflow limitation

45
Q

COPD risk factors

A

Smoking
Genetics
Occupational chemicals
Frequent lung infections as child
Indoor smoke
Occupational Dust

46
Q

What causes COPD

A

Chronic inflammation
Small airway disorders
Emphysema
Systemic effects

47
Q

Emphysema

A

Bronchoconstriction and alveoli destruction

48
Q

How does cigarette smoke cause COOD

A

Irritated and activates epithelial cells + macrophages -> inflammatory mediators -> inflammatory cascade

49
Q

What proteases are released by TC1 and neutrophils in COPD and what do they do

A

Metalloproteinase 9 - elastin degradation
Neutrophil elastase - mucus hypersecretion

50
Q

Which cells secrete transforming growth factor beta in COPD

A

epithelial cells
Macrophages

51
Q

What is the role of transforming growth factor beta in COPD

A

Stimulates fibroblast proliferation causing fibrosis in small airways

52
Q

How do asthma and COPD respond to steroids

A

Asthma - good
COPD - poor

53
Q

What is the difference between asthma and COPD airflow limitation

A

Asthma - variable
COPD - progressive

54
Q

Is atopy a characteristic of asthma or COPD

A

Asthma

55
Q

COPD symptoms

A

Shortness of breath
Dyspnoea - progressive, worse w exercise
Chronic cough
Phlegm
Wheezing
Chest tightness
Recurrent lower Respiratory infection

56
Q

What is involved in COPD diagnosis

A

Previous history
Current history
Lung function tests
Spirometry
Age >40

57
Q

What 3 things are involved in COPD assessment

A

Symptom severity
Extent of lung function decline
Exacerbations

58
Q

What expiratory ratio indicates COPD

A

<0.7

59
Q

How does COPD affect FEV1 and FVC

A

Decrease

60
Q

What framework is used for deciding COPD treatment

A

ABCD tool

61
Q

What decides where a COPD patient is placed on the ABCD tool

A

Annual moderate exacerbations with or without hospital admission
Breathlessness questionnaire and COPD assessment test

62
Q

What is the first line maintainable treatment for COPD

A

Long acting bronchodilator

63
Q

What drugs are used in COPD treatment

A

LAMA
LABA
ICS
bronchodilator

64
Q

LAMA

A

Long acting muscarinic antagonist

65
Q

LABA

A

long acting beta 2 agonist

66
Q

Which group on the COPD ABCD tool has elevated bloody eosinophils and may need triple therapy

A

Group D

67
Q

What drugs make up COPD triple therapy

A

LAMA
LABA
ICS

68
Q

How do LAMAs inhibit smooth muscle contraction

A

Block ACh binding to M3 muscarinic receptors

69
Q

What do LAMAs do

A

Inhibit smooth muscle contraction

70
Q

Asthma first line therapy

A

ICS

CR2 (33 decks)

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