Asthma And COPD Flashcards
Pathophysiology of asthma7
Characterised by airflow limitation and hyperresponsiveness as well as bronchial inflammation Caused by a combination of atopy and allergy
The chronicity of asthma depends on
Airway inflammation and remodelling
Pathophysiology of COPD
There is an increase in mucous secreting goblet cells especially in larger bronchi.may have inflammation and pus in lumen Chronic inflammatory cells, predominantly CD8 cells. Ulcered epithelial layer and squamous epithelium may replace columnar Scarring and thickening causes airway narrowing
Diagnosis of COPD
Usually clinical and based on breathlessness and sputum production in chronic smoker
Test and criteria for airflow limitation reversibility in COPD
Lung function tests FEV1:FVC ratio is reduced and PEFR low And airflow limitation usually reversible if FEV change is less than 15%
Differences between asthma and COPD
COPD affects the airway and parenchyma while asthma just affects airway Inflammation primarily eosinophils and CD4 while COPD is neutrophils and CD8
Classification of COPD severity
Stage 0: At risk, cough or sputum present but lung function normal. Stage 1: Mild COPD, FEV1/forced vital capacity (FVC) <70%, with an FEV1 ≥80% predicted, with or without chronic symptoms. Stage 2: Moderate COPD, FEV1/FVC <70% and FEV1 % pred>30% and <80%. Stage 2 is split at an FEV1 of 50% pred since the existing data support the value of inhaled corticosteroids below an FEV1 of 50% pred but not above. Stage 3: Severe COPD, FEV1 <30% pred and FEV1/FVC <70%.
Classification of asthma severity
Intermittent Mild persistent Moderate persistent Severe persistent
Intermittent asthma
Symptoms (difficulty breathing, wheezing, chest tightness, and coughing): Occur on fewer than 2 days a week. Do not interfere with normal activities. Nighttime symptoms occur on fewer than 2 days a month. Lung function tests (spirometry and peak expiratory flow[PEF]) are normal when the person is not having an asthma attack. The results of these tests are 80% or more of the expected value and vary little (PEF varies less than 20%) from morning to afternoon.
Mild persistent asthma
Symptoms occur on more than 2 days a week but do not occur every day. Attacks interfere with daily activities. Nighttime symptoms occur 3 to 4 times a month. Lung function tests are normal when the person is not having an asthma attack. The results of these tests are 80% or more of the expected value and may vary a small amount (PEF varies 20% to 30%) from morning to afternoon.
Moderate persistent asthma
Symptoms occur daily. Inhaled short-acting asthma medication is used every day. Symptoms interfere with daily activities. Nighttime symptoms occur more than 1 time a week, but do not happen every day. Lung function tests are abnormal (more than 60% to less than 80% of the expected value), and PEF varies more than 30% from morning to afternoon.
Severe persistent asthma
Symptoms: Occur throughout each day. Severely limit daily physical activities. Nighttime symptoms occur often, sometimes every night. Lung function tests are abnormal (60% or less of expected value), and PEF varies more than 30% from morning to afternoon.
COPD goals of therapy
The GOAL of treatment in COPD is to: reduce symptoms, prevent exacerbations and decrease mortality
Asthma goals of therapy
The GOAL of treatment in ASTHMA is to: reduce inflammation and to achieve¸total control
Role of PEFR monitoring
Objective measure of airflow limitation as correlates with FEV1 Monitoring of PEF may be useful include the acute care of asthma exacerbations in adults, home monitoring of asthma, and assessment of occupational asthma
Role of PEFR monitoring in COPD
greater variability in daily PEFR measurements in patients with severe to very severe COPD (with similar comorbidities, age, medication use, and symptoms) could help to objectively identify patients with more unstable disease with a propensity for greater exacerbation and a higher mortality.
Symptoms when assessing severity
severe airflow obstruction in asthma include tachypnea, tachycardia, prolonged expiratory phase of respiration (decreased I:E ratio), and a seated position with use of extended arms to support the upper chest (“tripod position”) [1,2]. Use of the accessory muscles of breathing (eg, sternocleidomastoid) during inspiration and a pulsus paradoxus (greater than 12 mmHg fall in systolic blood pressure during inspiration) are usually found only during severe asthmatic attacks
Triggers of acute exacerbation of asthma
●Respiratory infections (viruses, bacteria) ●Allergen exposure (inhalant, food, and occupational) ●Inhaled respiratory irritants (including tobacco and cannabis smoke and cold, dry air) ●Temperature and weather ●Physical activity ●Hormonal fluctuations ●Medications ●Emotional factors (eg, anxiety, stress) Comorbidities, such as rhinitis, rhinoviral infection, gastroesophageal reflux, obesity, obstructive sleep apnea, depression, and anxiety can trigger asthma symptoms as well
Triggers of acute exacerbation of COPD
Respiratory infections, most commonly viral (eg, rhinovirus) or bacterial, are estimated to trigger approximately 70 percent of COPD exacerbations Atypical bacteria are a relatively uncommon cause The remaining 30 percent are due to environmental pollution, pulmonary embolism, or have an unknown etiology
Association between COPD and smoking
Most important risk factor Smoking cessation reduces the accelerated decline in lung function that is associated with smoking, which decreases the likelihood that COPD will develop
COPD stepwise treatment
