Asthma and COPD: Aetiologies, Symptoms and Aids to Diagnose Flashcards
(129 cards)
1
Q
What is obstructive airway disease?
A
- narrowing of the airways
- large, medium and small airways affects
- inhale but difficult to exhale
2
Q
In obstructive lung disease we can see hyperinflammation and trapping of air, why is this?
A
- air becomes trapped in <2cm sized airways
- increased mucus causing mucus plugs
- ⬇️ elastic recoil
- forced vital capacity may appear normal
3
Q
What type of hypersensitivity is asthma?
A
- type I hypersensitivity
- hyper responsive to stimuli
4
Q
Is asthma reversible or permanent?
A
- reversible
5
Q
What is atopy?
A
- genetic susceptibility
- susceptible to allergic reactions
6
Q
What as the 4 basic symptoms of asthma?
A
1 - wheezing
2 - breathlessness
3 - cough
4 - chest tightness
7
Q
Do patients with asthma always have symptoms?
A
- no
- can have acute attacks or be normal
8
Q
What does the British Thoracic Society (SIGN) say about the symptoms of asthma, to be diagnosed with asthma?
A
- must have 1 or more of the common symptoms
- wheezing, breathlessness, cough or chest tightness
9
Q
What does the British Thoracic Society (SIGN) say about the reversibility of asthma?
A
- diagnosis of asthma must show its reversible
- variable air flow improves with treatment
10
Q
Roughly how many people a year die due to asthma?
A
- 3-5 people
- poor asthma management and education
11
Q
Is asthma more common in adults of children?
A
- children
- more likely to develop allergies
12
Q
What is the prevalence of asthma in UK adults and children?
A
- adults = 8%
- children = 20%
13
Q
In patients with atopy (genetic susceptibility) what antibody do they produce a lot of that triggers the hypersensitivity?
A
- IgE
14
Q
Is asthma caused by one thing?
A
- no
- multifactorial, but needs a stimulus
15
Q
In patients with atopy, are they likely to have other allergies?
A
- yes
- hayfever, rhinitis, eczema and urticaria (hives)
16
Q
In patients with atopy, why is it important to ask them about family history?
A
- genetic
- may run in family
17
Q
What is skin prick testing?
A
- patients will receive small prick on arm
- then exposed to multiple common allergans
- positive test = raised skin
- IgE can then be measured in blood if positive
18
Q
Patients with atopy and asthma have polygenic inheritance, what does that mean?
A
- multiple genes cause traits - traits may be asthma or allergies
19
Q
What is a common chromosome where atopy and asthma have been shown?
A
- 11q13
20
Q
What is Dermatophagoides pteronyssinus more commonly known as?
A
- dust mite
21
Q
Generally what are the 2 common things that need to occur for someone to have an asthma attack?
A
1 - sensitisation of atopic patient
2 - inhalation of allergen
22
Q
Asthma can be divided into a 2 stage process, how long does each phase last?
A
1 - phase 1 = 20 minutes
- IgE binds to mast cells and degranulate.
2 - phase 2 = 6-12 hours
- T cells, mast, basoinophil and esionphils cells all migrate to lungs and induce bronchoconstriction and inflammation
23
Q
Which lymphocytes regulate the inflammatory response in asthma?
A
- T lymphocytes
- specifically T helper cells
24
Q
T1 and T2 are classes of T helper cells, which is inflammatory and which is anti-inflammatory?
A
- T1 = anti-inflammatory
- T2 = inflammatory
25
Once IgE has been produced by B cells, what does IgE generally bind with in an asthma attack?
- mast cells
- basophils and eosinophils also involved
26
What is the process mast cells undergo to release inflammatory stiumulus?
- degranulation
27
What is the initial compound released from mast cells during an asthma attack?
- histamine
28
In addition to histamine release, what else is released during an asthma attack that is able to stimulate inflammation further?
- leukotrienes
- prostaglandins
29
Why do anti-histamines not work in asthma?
- other inflammatory mediators involved
- such leukotrienes and prostoglandins
30
In an asthma attack what is the main problem histamines, leukotrienes and prostaglandins cause?
- bronchospasm
- bronchoconstriction
- followed by inflammation
31
In asthma attacks, why do treatments target histamines, leukotrienes and prostaglandins?
- target inflammation - target bronchospasm
32
In the late phase response of an asthma attack, vasodilation occurs in addition to bronchoconstriction. What does this encourage?
- ⬆️ permeability
- same as in acute inflammation
33
In an asthma attack increase permeability leads to infiltration of the smooth muscle by what immune cells?
- neutrophils, basophils and eosinophils (granular)
- monocytes and dendritic cells
34
In an asthma attack increase permeability leads to infiltration of the smooth muscle of immune cells, what can this do to the epithelial cells?
- desquamation (shedding of cells)
35
In a late phase asthma attack what happens to goblet cells?
- hyperplasia - ⬆️ mucus production - ⬆️ plugging and blocking of airways
36
In a late phase asthma attack what happens to smooth muscle cells?
- hypertrophy and hyperplasia
37
What causes smooth muscles to contract during a late phase asthma attack?
- cytokines
38
What is polyphonic wheezing?
- lots of different whistling/wheezing sounds - caused by different size airways
39
Patients with asthma can experience dynamic hyperinflammation, how small do bronchi generally have to become for air to be trapped and for dynamic hyperinflammation to occur?
- \<2cm
40
Although asthma is generally reversible, what can happen if not managed and asthma becomes chronic?
- remodelling of airways due to chronic inflammation
- collagen deposition
- fibrotic tissue replaces parenchymal tissue
- fixed narrowing
41
Are eosinophils in asthma attacks generally associated with acute or chronic asthma?
- acute - inflammation and airway obstruction
42
Are neutrophils in asthma attacks generally associated with acute or chronic asthma?
- chronic
- inflammation and steroid dependent asthma
- just like in COPD, chronic marker in WBCs
43
What is the main cell in an asthma attack that causes bronchospams?
- mast cells
44
What are a few environmental triggers for asthma?
- animal hair, pollen, mould
- infections (viral/bacterial)
- pollution
- perfumes and sprays
- smoking
- chlorine
- temperature changes
45
What are some common drugs that may contribute to an asthma attack?
- aspirin and NSAIDs (some anti-inflammatory pathways are ⬇️)
- B-blockers (off target effects, B1 and 2 can be affected)
46
What are some basic physiological, non disease specific aspects that may cause asthma?
- pregnancy
- premenstrual (pre period)
- exercise
47
Can peoples jobs contribute to asthma?
- yes
- occupational asthma is main occupational lung disease
48
What is diurnal variability?
- variation in peak expiratory flow
- measured over 24 hours
- \>20% variation is a diagnosis of diurnal variability
49
During an acute exacerbation of asthma, what may happen to respiratory rate?
- ⬆️ respiratory rate
- body attempts to ⬆️ O2
- tachypnoea (abnormal rapid breathing)
50
During an acute exacerbation of asthma, what may happen to heart rate?
- ⬆️ heart rate - tachycardia
51
In severe asthma, what can happen to the colour of finger tips and skin?
- cyanosis - blue skin
52
What is normal respiratory rate and what might you expect in asthma?
- normal = 12-16 breaths/min - asthma = \>20 breathes/min
53
What is a silent chest?
- no sound heard from chest
- RED FLAG
- VERY dangerous
54
What is also common in silent chests?
- bradycardia
- body is shutting down
55
In patients with suspected asthma, why would a full blood count be helpful?
- measure eosinophils as part of WBCs
- eosinophils associated with acute asthma
56
In patients with suspected asthma, in addition to a full blood count, what other protein in blood can be useful to measure that may have contributed to the asthma attack?
- IgE
- identify atopy
57
Why might PEF and a PEF diary be useful in patients with suspected asthma?
- diurnal relates top variation in a day
- non asthmatics have very small variability in PEF
- asthmatics are likely to have variation throughout day
58
What are the 2 main scans that will be performed on the chest if a patient is suspected with asthma?
- chest X-ray - high sensitivity CT may be performed
59
In a patient with suspected asthma why might a spirometry test and/or full lung function test be useful?
- identify if symptoms are reversible - distinguish between obstructive and restrictive
60
In asthma is FEV1 or FVC reduced more?
- FEV1
61
In asthma what would the FEV1/FVC ratio be expected to be?
- \<70%
- due to reduction in FEV1
62
To determine if the asthma is reversible what may patients be given, and how long would this take to take effect?
- short acting B agonist (salbutamol) - over 20 minutes
63
To determine if the asthma is reversible patients can be given a short acting B agonist (Salbutamol), what improvement in FEV1 is needed to determine if the asthma is reversible?
- \>15%
64
In patients with asthma, why might the patients total lung capacity increase and their residual lung volumes increase?
- due to hyperventilation and air trapping
65
In patients with asthma, would DLCO/TLCO be low or normal?
- normal as interstium and alveoli are not generally affected
- if air reaches alveoli it will perfuse
- ventilation is low though
66
What can be seen in X-rays in some patients with asthma?
- hyperinflammation
67
In patients with hyperinflammation due to asthma, how may ribs will be evident posteriorly and anteriorly?
- anterior = \>6 ribs
- posterior = 10 ribs in mid clavicular line
68
What is COPD?
- restrictive lung disease
- progressive airflow obstruction
- not fully reversible
- symptoms always present
69
The risk of COPD increases with age, at what age does the risk generally start to increase?
- \>35 years
70
In addition to the natural progression of COPD, what is the main cause that accentuates COPD?
- smoking
- 90% of COPD is caused by smoking
71
How much FEV1 generally decline each year in COPD patients?
- 30ml/year
72
What % of the UK is diagnosed with COPD?
- 2%
73
How many deaths in the UK are caused by COPD?
- 30,000
74
How many GP and hospital admissions are due to COPD?
- 1.4 million GP appointments - 12.5% (1/8) of acute hospital admissions
75
Are respiratory inhalers expensive for the NHS?
- yes - top 5 costliest drug - 29% of respiratory disease costs
76
What is the formula for calculating pack years in COPD?
- (no. cigs per day x years) / 20
- divide by 20 as packs contain 20 cigarettes
- e.g 10 cigs for 10 years = (10x10)/20 = 5 pack years
77
Why are pack years calculated in COPD?
- ⬆️ pack years = ⬆️ risk of COPD
- main risk factor for COPD
78
Can pipes and cigars increase the risk of COPD?
- yes - less than smoking though
79
Can passive smoke increase risk of COPD?
- yes
80
In patients who smoke, what % go on to develop COPD?
- aprox 15-25%
81
Can occupational exposure (coal, dust etc.) and air pollution increase the risk of COPD?
- yes
82
Why is the inverse care law important in COPD?
- ⬇️ socio-economic = ⬆️ risk of COPD
83
What is trypsin?
- enzyme that digests proteins
84
What is alpha-1 antitrypsin?
- protease inhibitor
- inhibits elastase in lungs following pathogen death
- elastin cannot be broken down
85
Why does alpha-1 antitrypsin deficiency cause COPD?
- elastaste destroy pathogens, but also degrade elastin
- alpha-1 antitrypsin inhibits elastate following pathogen death
- in pathients with deficiency, such as in COPD, lungs elastin ⬇️
- lungs lose elastic properties and cannot exhale
- can cause emphysema
86
What forms of COPD can alpha-1 antitrypsin deficiency cause?
- causes emphysema (damaged alveoli)
- chronic bronchitis (damaged bronchi, main airways)
- bronchieltasis (smaller airways)
87
What is chronic bronchitis as a form of COPD?
- affects upper airways
- hyperplasia of goblet cells
- ⬆️ mucus production blocking airways
- ⬆️ risk of infection
88
What is the diagnosis of chronic bronchitis as a form of COPD?
- sputum production \>3 months/year - 2 consecutive years
89
Chronic bronchitis is a form of COPD, what symptoms can patients present with?
- breathlessness, mainly on exertion - gets worse over time - thick creamy sputum
90
What is emphysema as a form of COPD?
- destruction of alveoli distal to terminal bronchiole
- ⬇️ in elastic properties
- ⬇️ surface area
- interstitium becomes fibrotic and ⬇️ perfusion
91
If the interstium is damaged or blocked in COPD, what happens to the TLCO/DLCO?
- reduced - CO cannot diffuse
92
How can smoking increase risk of COPD?
- smoke activates neutrophils in lungs
- neutrophils release elastase to clear damaged tissue
- chronic smoking = chronic neutrophils and inflammation
93
What is a large bullae?
- damaged alveolar sacs - small alveoli form one large sac called a bullae
94
In emphysema what happens to surface area and perfusion?
- ⬇️ surface area - ⬇️ perfusion
95
In COPD there is hyperplasia of goblet cells, which increases mucus production. What can this lead to in the lung of a patient with chronic bronchitis?
- ⬆️ viscous mucus - ⬆️ infection as mucus acts as a medium - damaged cilia - fixed airway obstructions
96
In COPD there is a reduction in elastic properties, how does this cause an increase in air trapping?
- following inspiration airways collapse
- elastic recoil of lungs forces air out, but not possible in COPD
- air becomes trapped
97
Why can trapped air and reduced elastic properties of the lungs increase work of breathing?
- expiration is generally passive due to elastic recoil
- accessory muscles need to be used to exhale causing fatigue
- pursed lip breathing helps
- both require more energy
98
When trying to diagnosis a patient with suspected COPD, what are the 2 most important risk factors to consider?
- age (\>35 years)
- smoking duration
99
What are the most common symptoms in COPD?
- breathlessness on exertion (important distinction with asthma)
- chronic cough
- chronic sputum production
- winter bronchitis
- wheeze
- frequent infections
- peripheral oedema (end stage COPD)
100
When performing a spirometry test on a patient with COPD, would there be a \>15% improvement in FEV1, and what would the FEV1/FVC ratio be?
- no improvement in FEV1 - FEV1/FVC ratio is \<70%
101
In patients with suspected COPD due to their symptoms, but also present with significant weight loss is a red flag for what?
- lung cancer
102
What is haemoptysis?
- coughing up blood - red flag for lung cancer
103
What is the respiratory rate of a patient with COPD expected to be?
- tachypnoea - \>20 breaths/min
104
Why might patients with COPD experience flapping or muscle tremors?
- due to CO2 build up
- chronic use of B2 agonist activate B2 receptors in skeletal muscle
105
Why might we see an increase in jugular venous pressure in patients with COPD?
- increased pressure in lungs moves back through pulmonary artery and into right side of the heart
- pressure in right side of heart increases
- right heart failure increases pressure
106
Would patients with COPD be more likely to develop type 1 or 2 respiratory failure?
- type 2 respirator failure - ⬇️ PaO2 and ⬆️ PaCO2
107
Breathing difficulty is associated with severity of COPD, what is the method for classifying breathlessness?
- mMRC - modified Medical Research Council Scale
108
When defining the severity of COPD, what method defines the severity of COPD and in spirometry values, what would we expect the FEV1/FVC to be lower than?
- GOLD initiative
- in patients with FEV1/FVC \<70%
109
In COPD will pulse oximetry always be low?
- no - but can \<92% during exertion
110
Why would polycythaemia, which is high RBCs, be common in patients with COPD?
- patients with COPD have low PaO2
- bone marrow increases RBCs to increase haemoglobin and increase O2 saturation
- attempt to increase PO2
111
If cor pulmonale is suspected in patients with COPD, what are the 2 most common cardiac assessments?
- ECG - electrocardiogram - right ventricle failure and hypertrophy
112
What are 2 common assessments of quality of life in patients with COPD?
- COPD Assessment Test (CAT) - St. Georges Respiratory Questionnaire (SGRQ)
113
What are predominant cells in asthma and COPD?
- asthma = eosinophils
- COPD = neutrophils (N is closer to C than A in COPD and Asthma)
114
In asthma and COPD what is the major difference in FEV1/FVC ratio?
- both have a FEV1/FVC \<70% - asthma = reversible - COPD = non reversible
115
In asthma and COPD what is the major difference in DLCO/TLCO?
- asthma = normal TLCO/DLCO
- COPD = ⬇️ TLCO/DLCO
116
In asthma and COPD what is the major difference in lung structure?
- asthma = normal structure - COPD = remodelled structure
117
What is sleep apnea?
- cessation of breathing when asleep
118
What is obstructive sleep apnea?
- cessation of breathing due to obstructive lung problem
119
What is hyponea?
- slow breathing
120
How common is obstructive sleep apnea in men and women?
- male = 3-7% - female = 2-5%
121
Which part of the airway is most commonly affected in obstructive sleep apnea?
- upper airways collapsing
122
What are common symptoms for patients with obstructive sleep apnea/hyponea?
- snoring
- apnoeic (means without breath) episodes (\>10 secs)
- excessive daytime sleepiness (Epworth Sleepiness Scale)
- nocturnal choking
- morning headaches
- unrefreshed upon waking
- nocturia (urinating at night)
- ⬇️ concentration, libido, memory
123
What is the Epworth Sleepiness Score?
- diagnostic test for obstructive sleep apnea
124
What can obstructive sleep apnea/hyponea cause?
- hypoxia as not breathing - sleep fragmentation
125
What are some common risk factors for obstructive sleep apnea/hyponea?
- obesity
- ⬆️ collar size
- enlarged tongue/tonsils
- long uvular
- nasal pathology
- down syndrome
126
What are the 3 most common methods for diagnosing obstructive sleep apnea/hyponea?
1 - overnight oximetry 2 - full polysomnography 3 - Epworth Sleepiness Score
127
What are the common treatment options for obstructive sleep apnea/hyponea?
- weight loss - surgery - mouth guards - continuous airway pressure (CPAP)
128
What are some red flags in lung disease that may suggest serious lung disease such as cancer?
- haemoptysis (coughing up blood)
- persistent unexplained fever
- persistent unexplained night sweats
- weight loss
- stridor (high pitched wheezing)
129
Which is the main myeloid lineage cell that is associated with COPD and asthma?
- asthma = esinophils
- COPD = nurtrophils
