ALS Lecture 5 - The Nature of Airways Obstructions DONE Flashcards
(106 cards)
1
Q
airway obstruction
A
blockage of any part of airway
2
Q
common obstructive airway diseases (3)
A
asthma, COPD, bronchiectasis
3
Q
to diagnose airflow obstruction we must use
A
spirometry
4
Q
label the spirometry diagram (A)
A
done
5
Q
FEV1
A
forced expiratory capacity in 1 second (amount of air blown out in 1sec)
6
Q
FVC
A
forced vital capacity, total amount of air you can blow out
7
Q
FEV1:FVC ratio should be
A
> 70%
8
Q
FEV1:FVC ratio <70% =
A
diagnosed obstruction
9
Q
if FEV1 and FVC are symmetrically decreased (ratio is still normal) then =
A
diagnosed restriction
10
Q
label the diagrams of mechanisms of airflow obstructions (B)
A
done
11
Q
3 mechanisms of airflow obstruction
A
mucus, constricted smooth muscle, supporting structure damage
12
Q
increased secretions/mucus in airways obstruction
A
cough may clear
13
Q
constricted smooth muscle obstruction
A
asthma, bronchitis
14
Q
supporting structure damage obstruction
A
alveoli collapse in emphysema
15
Q
bronchial hyper reactivity is a measure of airway
A
‘twitchiness’
16
Q
the ‘twitchier’ the airways, the
A
harder to control
17
Q
asthmatic airways are very
A
sensitive
18
Q
label the flowchart (C)
A
done
19
Q
bronchial hyperactivity can be assessed with a
A
bronchial challenge test
20
Q
most often used products in bronchial challenge test (2)
A
methacholine, histamine
21
Q
chemicals used in bronchial challenge test trigger a bronchospasm in normal individuals but people with _____ ___ ______ have a ____ ____
A
bronchial hyper responsiveness, lower threshold
22
Q
bronchial hyper responsiveness is usually found in (2)
A
asthma, COPD
23
Q
PC20 =
A
point where FEV1 drops by 20%
24
Q
lower PC20 =
A
worse asthma
25
look at the diagrams of bronchial challenge testing (D)
done
26
asthma is usually characterised by (3)
reversible airflow obstruction, chronic airway inflammation, increased airway responsiveness
27
chronic airway inflammation is mostly
eosinophilic
28
asthma is commonly divided into 2 types
atopic (extrinsic), non-allergic (intrinsic
29
atopic/extrinsic asthma is characterised by symptoms that are triggered by an
allergic reaction
30
non-allergic/intrinsic asthma is triggered by factors not related to
allergens
31
how many children get asthma?
1/6
32
how many children grow out of asthma?
50%
33
variable airflow obstruction
>50% increase of FEV1 following bronchodilator use
34
2 types of T lymphocytes in asthma
T helper 1, T helper 2
35
T helper 1 promote cell immunity by (2)
IgG production, gamma interferon
36
T helper 2 promote immunity by (3)
enhancing mast cells and eosinophils, IgE synthesis
37
in asthma there is more __ activity than __
more Th2 than Th1
38
label the diagram of asthma (E)
done
39
mechanism of atopic asthma (7 steps)
1. APC present antigen to T cell
2. Th2 cells produce IL-4, IL-5, IL-13
3. interleukins signal B cells to produce IgE
4. IgE recognises allergen, binds to mast cells in airway
5. with antigen, IgE causes mast cell degranulation
6. degranulation of mast cells release inflammatory mediators like histamine, leukotrienes that promote bronchospasm
7. cytokines attract eosinophils (more inflammation)
40
IL-4 in asthma
stimulates IgE production
41
IL-5 in asthma
activates recruited eosinophils
42
IL-13 in asthma
activates mucus secretion, promotes IgE
43
4 main asthma phenotypes
atopic, non-allergic, obesity, persistent airflow limitation
44
atopic asthma (3)
childhood, eosinophils, identifiable triggers
45
non-allergic asthma (2)
eosinophilic, neutrophilic?
46
persistent airflow limitation asthma (2)
fixed obstruction or incompletely reverses
47
asthma and obesity (2)
prominent respiratory symptoms, little evidence of eosinophils
48
asthma triggers (6)
pets, dust, mould, pollen, occupational, food
49
atopy pathophysiology (4 steps)
1. first allergen exposure, IgE antibodies bind to mast cells and basophils
2. same allergen reenters, attaches to IgE
3. mast cells and basophils release histamines
4. more smooth muscle contraction and mucus
50
objective evidence of atopy (3)
total IgE blood, specific IgE to aeroallergens (RAST) blood, skin prick
51
acute asthma airway changes (5)
smooth muscle contraction, mucus, plasma leak, oedema, sensory nerve activation
52
chronic asthma airway changes (2)
subepithelial fibrosis, smooth muscle hypertrophy
53
diagnosis of asthma (3)
variable airway narrowing, bronchodilator reversibility study, peak flow
54
look at the diagram of asthma flow chart (F)
done
55
PEFR monitoring (2)
depends on meter, effort
56
reversibility testing (2)
pre- and post- bronchodilator spirometry
57
when is reversibility testing considered positive?
FEV1 increases by 200mls
58
gold standard in asthma diagnosis testing
sputum eosinophilia
59
treatment for asthma that works in most people (2)
corticosteroids, bronchodilators
60
if an asthmatic is highly atopic (too much IgE we can use drugs such as (1)
Omalizumab
61
in asthma we can also use IL-5 blockers such as (1)
Mepoluzimab
62
label the flow chart of asthma medications (G)
done
63
reasons patient may not be getting better with asthma treatment (3)
poor compliance, poor technique, misdiagnosis
64
COPD is characterised by (3)
slow progression, air trapping, airflow limitation
65
main risk factor for COPD
smoking
66
label the FEV1 COPD diagram (H)
done
67
types of COPD (2)
chronic bronchitis, emphysema
68
obstructive bronchitis
small airway disease
69
emphysema
breakdown of lung tissue
70
chronic bronchitis involves (5)
mucus gland hypertrophy, smooth muscle hypertrophy, goblet cell hyperplasia, inflammatory cell infiltrate, excess mucus
71
in chronic bronchitis inflammatory cell infiltrates are
lymphocytes, neutrophils
72
emphysema involves (3)
enlargement of airspace distal to terminal bronchiole, fibrosis, wall destruction
73
2 major types of emphysema
centrilobular, panlobular
74
centrilobular emphysema (3)
upper lobes, proximal acinus of bronchiole, spared distal alveoli
75
panlobular emphysema (2)
all lung fields, loss of all portions from bronchiole to alveoli
76
label the diagram of emphysema types (I)
done
77
on emphysema scans, lung destruction is more marked in
upper zones
78
emphysema CT scans show (2)
emphysematous bulla, squashes normal lung
79
look at scans of emphysema (J)
done
80
lebel the diagram of the normal airway and airway in emphysema (K)
done
81
how does emphysema cause airflow obstruction (2 steps)
1. alveolar pressure = pleural pressure + elastic recoil
| 2. reduced pressure and traction in emphysema
82
label the flow chart of vicious cycle of inactivity and symptoms (L)
done
83
COPD and inactivity (3 steps)
1. airflow obstruction worsened by exacerbations
2. air trapping
3. hyperinflation, breathlessness
4. limited activity = less fitness = less muscle
5. increased breathing rate
84
causes of COPD (6)
smoking, drugs, chronic asthma, occupations, familial, passive smoking
85
diagnosis of COPD
FEV1:FVC doesn't improve by 20% with bronchodilator
86
2 phenotypes in COPD patients
blue bloaters, pink puffers
87
blue bloater has predominantly
bronchitis
88
blue bloaters symptoms (5)
sputum, oedematous ankles, cyanosed, overweight, sleep apnoea
89
blue bloaters go into ______ ____ early on in natural history of disease
ventilatory failure
90
pink puffer has predominantly
emphysema
91
pink puffer symptoms (3)
thin, pursed lip breathing, accessory muscle use
92
look at the Fletcher-Peto plot and label it (M)
done
93
fill in the table of asthma and COPD (N)
done
94
label the venn diagram of COPD and asthma (O)
done
95
label the diagram of flow through the airway (P)
done
96
resistance =
inversely proportional to radius4
97
airflow obstruction can cause hypoxia due to (2)
ventilation perfusion mismatch, poorly ventilated alveoli due to bronchial narrowing
98
pulmonary hypertension is a bad sign in
COPD
99
pulmonary hypertension is improved by
long term O2 therapy
100
consequence of pulmonary hypertension
cor pulmonale
101
cor pulmonale
right sided heart failure, usually due to chronic lung disease
102
bronchiectasis is a disease in which there is a permanent
enlargement of parts of airways
103
most common cause of bronchiectasis
cystic fibrosis
104
symptoms of bronchiectasis (3)
bronchial dilation, recurrent infection, chronic purulent sputum
105
other causes of bronchiectasis (5)
immunodeficiency, rheumatoid arthritis, colitis, post-measles, idiopathic
106
bronchiectasis CT scan of lungs
signet ring sign, dilated bronchiole
