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BDS2 BAMS Respiratory Tract > Asthma & COPD > Flashcards

Asthma & COPD Flashcards

1
Q

what are the respiratory symptoms

A 
cough
wheeze
stridor
dyspnea 
pain
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2
Q

what are factors to consider with a cough

A

whether it is productive or dry
what color is the sputum
is there blood

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3
Q

what is a wheeze

A

a wheeze is a noise you make when you breathe out. It is an organ sounding noise and means there is a problem with the airway whether it be tightened, blocked or inflamed

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4
Q

what is stridor

A

this is a noise you make when you breathe in. It is due to a blockage in the airway

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5
Q

what is dyspnea

A

shortness of breath

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6
Q

what are the diff types of pain

A

can be general or inspiratory

possible due to inflammatory changes in the chest wall

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7
Q

what are respiratory signs

A 
chest movements with respiration 
rate of respiration 
air entry
vocal resonance
percussion note
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8
Q

Why does respiratory rate increase in asthma

A

There is an increase in respiratory rate in asthma due to bad ventilation

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9
Q

how can air entry be assessed

A

look to see if reduced or symmetrical

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10
Q

what is assessed in vocal resonance

A

is there solid/liquid inside the lungs?

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11
Q

what is percussion note

A

tap to see the noise. If it is a resonant noise then it is hollow. If it is a dull noise it isnt hollow.

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12
Q

what are respiratory investigations

A 
sputum examination 
chest radiograph 
pulmonary function 
bronchoscopy 
VQ scan - ventilation/perfusion mismatch
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13
Q

how is pulmonary function tested

A

PEFR - max flow rate
FEV1 - forced expiratory volume in one second
FEV1/VC - measure of respiratory function

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14
Q

what is ventilation/perfusion mismatch

A

o Condition in which one or more areas of the lung receive oxygen but no blood flow or they receive blood flow but no oxygen due to some diseases and disorders

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15
Q

what is the normal respiratory rate

A

12-15

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16
Q

what are respiratory diseases

A

infections
airflow obstruction
gas exchange failure
tumors

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17
Q

what are examples of respiratory infections

A

pneumonia

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18
Q

what are examples of airflow obstructive diseases

A

asthma
chronic obstructive pulmonary disease
restrictive pulmonary change

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19
Q

what can gas exchange failure be due to

A

reduced surface area, fibrosis, fluid

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20
Q

what are common triggers for exacerbations for chronic airflow obstruction

A

infections
exercise
cold air

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21
Q

what is asthma

A

reversible airflow obstruction

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22
Q

what us asthma due to

A

bronchial hypersensitivtiy

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23
Q

what is bronchial hypersensitivity

A

it is the immune system’s overreaction to minor stimulation. Something happens and triggers a disproportionate immune response

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24
Q

describe the immune response in asthma

A

The mast cells degranulate triggering the immune response causing constriction, inflammation of the airway lining and oedema of the inside of the tube making the diameter smaller. The mucous glands also go into hypersecretion adding to this narrowing

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25
what are the 3 things that contribute to an asthma attack
Muscle constriction, mucosal secretion & oedema are what mainly contribute to the asthma attack.
26
what produces a wheeze in asthma
narrowing of the airway causing airflow differences.
27
what is the function of the cough in asthma
try and bring up the mucous
28
what does asthma experience
diurnal variation - worse int early morning
29
what is the peak expiratory flow rate
This is how fast you can get air out of your lungs can change as the airway narrows the more narrow the airway the slower the PEFR
30
what are asthma atriggers
infection environmental stimuli cold air atopy
31
what are environmental stimuli that can cause asthma
o Dust o Smoke o Chemicals at work
32
how does cold air effect asthma
more of an issue for children, causes a wheeze due to the change in temperature of gas
33
what is atopy
atopy’ – people with asthma often have other conditions related to the immune system. Atopy refers to the genetic tendency to develop allergic diseases
34
why is a skin prick test done for asthmatics
Can do a skin prick test to see whether skin reacts but it is not that efficient as it is testing the sensitivity of the skin not the lungs but it does help narrow the range of possible triggers
35
what type of immune response does asthma show
biphasic
36
describe the biphasic pattern of asthma
hours later it can get worse again. Normal pattern of asthma is that there is an initial problem and then a late problem because some mediators that are released work slowly while some work quickly. This is important as if someone has an asthma attack if they are treated and appear to have recovered it is important to do something else as otherwise the later response will kick in and it will get worse again.
37
what is required for asthma
You need the initial treatment, beta2 agonists but if you do not use steroids then you will not tackle the second phase
38
describe the immunology for asthma
Mast cell degranulates and there is an upregulation of the immune response It is an issue with asthma as this response is occurring to something innocuous
39
describe asthma treatment
Asthma is treated in a strategic way by working out whether they have mild/moderate/severe asthma How they are treated in an emergency differs depending on the severity.
40
what is treatment for mild asthma
usually a blue puffer and a brown inhaled steroid to be used every day
41
what is Tx for severe asthma
More severe may take a high dose inhaled steroid, long acting beta agonists and oral steroids
42
who is classed as a severe asthmatic
If the patient has ever been admitted to hospital or taken steroid tablets more than once a year then they are classed as a severe asthmatic
43
what are the respiratory drugs
``` beta-adrenergic agonists anticholinergic corticosteroids leukotriene inhibitors chromones theophyllines ```
44
what to beta adrenergic agonists do
o Relax bronchial smooth muscle  Reduce bronchoconstriction  Reduce bronchial tone
45
what are the different types of beta adrenergic agonists
short and long acting | protective against stimuli
46
what do anticholinergic drugs to
act on muscarinic receptors reduce basal tone only good in COPD
47
what are corticosteroids
o Has immune cell and epithelial cell action | o They help prevent mucosal oedema/mucosal secretion/bronchial constriction
48
when should you use a corticosteroid
o Use if beta2 agonist is used more than 3 times a week
49
how should steroid be given in a severe attack
injection
50
what is the problem if the corticosteroids are taken everyday
possible adrenal serpression/osteoporosis
51
when is a spacer recommended for corticosteroids
if dose exceeds 800 ug in adults
52
what are theophyllines
good for helping ventilation | used in severe asthma due to potential adverse effects
53
what are the different layers to the pyramid of asthma risk assessment
``` red others LA B2 agonist LD inhaled steroid SA B2 agonist ```
54
what is COPD
MIXED airway reversible obstruction and destructive lung disease
55
what happens in COPD
Airways are inflamed causing them to narrow | Abnormal alveoli means that there is a reduction of surface area for gas exchange and lung function
56
what is emphysema
Emphysema is the destruction of alveoli and the dilation of others to fill the space The remaining alveoli are still lined by gas exchange tissue but the surface area is reduced.
57
what are the classifications of COPD
``` gold 1 or 2 (mild/moderate) gold 3 (severe) gold 4 (very severe) ```
58
what will a gold 4 COPD patient experience
wheeze and cough breathless on mild exertion over inflated lungs cyanosis
59
how can COPD progress to respiratory failure
from: reduced surface area for gas exchange thickening of alveolar mucosal barrier
60
what can poor ventilation occur due to
airway narrowing | restrictive lung defects
61
what are the causes of COPD
smoking environmental lung damage hereditary
62
what is environmental lung damage
these are occupational lung diseases (coal, silica, beryllium, asbestos). Also causes the fibrosis of the lungs not just the tumour
63
what in COPD is hereditary
emphysema | some lack the enzymes required to maintain the integrity of the alveoli
64
what are the two types of occupational lung disease
fibrosis | tumors
65
how does fibrosis from occupation lung disease occur
from coal, silicon, beryllium, asbestos
66
what can asbestos also lead to other than fibrosis
mesothelioma | tumor of the pleural lining
67
describe management of COPD
``` smoking cessation long acting bronchodilator inhaled steroids systemic steroids oxygen support pulmonary rehabiliation therapy ```
68
what is type 1 respiratory failure
alveolar related | oxygen in the gas moves from the gas into the blood - the thicker the barrier the harder it is for it to get through
69
what is type 2 respiratory failure
hypercapnia | happens in ventilation
70
what can type 2 respiratory failure be due to
o Airway blockage or narrowing – maybe from a chest infection or oedema of mucosa lining o Ventilation problems – muscles. Chronic COPD is usually bearable until an infection presents resulting in the o Acute or chronic – infections
71
what is failure of ventilation defined as
When PaCO2 > 6.7kPa It occurs only in acute respiratory failure (type 2) There is a 20% reduction in ventilation needed.
72
What happens due to chronic ventilation failure
renal compensation for acidosis
73
what are contributions to chronic ventilation failure
* Reduced compliance * Airway obstruction * Muscle dysfunction
74
what is normal breathing control
In normal breathing CO2 drive controls ventilation. | Oxygen saturation is usually okay
75
what is breathing control in COPD
In COPD there is a CO2 tolerance and hypoxia drives ventilation.
76
why can giving oxygen in patients with COPD be detrimental
It is important that you consider the fact that oxygen may be detrimental for someone with COPD as hypoxia is the driver for their breathing
77
when is oxygen used in COPD
in the acute stages use oxygen until medical help arises
78
what should you watch in those that use oxygen in COPD
their respiratory rate and SaO2
79
how should oxygen be used in the chronic state of COPD
with care | fixed percentage delivery
80
what are the two ways home oxygen therapy can occur
via cylinder | via oxygen concentrator
81
why should oxygen support be used 24/7
Oxygen support should be used properly otherwise there will not be significant improvements. An acute cardiac event is more likely if good oxygen levels are not maintained most of the time
82
what is COPD relations to dentistry
Their ability to attend for treatment possibly due to their home oxygen Use of inhaled steroids comes with a candida risk as steroid can land in the mouth causing immunosuppression leading to fungal infections. This can be tackled by rinsing the mouth and using a spacer device. Smokers are at risk of oral cancer and COPD patients are largely smokers

BDS2 BAMS Respiratory Tract (4 decks)

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