Asthma/COPD Flashcards Preview

Respiration > Asthma/COPD > Flashcards

Flashcards in Asthma/COPD Deck (106)
Loading flashcards...
1

Patient with COPD who has never smoked

Alpha 1 anti trypsin deficiency

2

what is cor pulmonae

right sided hypertrophy and heart failure due to increased vascular resistance

3

difference between obstructive and restrictive disease

Obstructive-airways
Restrictive- lungs

4

examples of obstructive lung disease

Asthma, COPD (chronic bronchitis, emphysema)

5

what is asthma COPD overlap syndrome

Asthma and COPD

smokers with COPD who are eosinophilic and show reversibility with bronchodilators and are steroid responsive

6

Cause of airway obstruction in COPD

invagination of mucosa
smooth muscle constriction
alveolar wall attachments to bronchioles break away
in emphysema

7

Extrinsic vs Intrinsic asthma

extrinsic-identifiable cause
intrinsic-unknow cause

8

Type II Inflammation - what this involves and what types of asthma is this associated with

TH2 cells, type II lymphoid cells, B cells which produce IgE, type II cytokines (IL4, IL5, IL13)
Effector cells- eosinophils, basophils, mast cells

associated with allergic asthma, exercise induced asthma and late-onset eosinophilic asthma

9

Asthma triad

T2 airway inflammation (eosinophils)
Airway Hypersensitivity (twitchiness)
Reversible airflow obstruction

10

Dynamic evolution of asthma

1. Bronchoconstriction
2. Chronic airway inflammation
3. Airway remodelling

11

Hallmarks of asthma remodelling

BM thickening, collagen deposition in the submucosa and smooth muscle hypertrophy

12

key cytokines in asthma

IL4, IL5, IL13

13

Influence of Leukotriene D4

attracts eosinophils, makes goblet cells secrete mucous

14

Endotypes which indicate type II high asthma

present cytokines IL4, IL5, IL13
raised total or specific IgE
Eos >300
Raised FeNO

15

why should asthmatics never be treated with B2 agonists alone

Doesn't get rid of problem

16

how do we measure airflow obstruction

peak flow or spirometry

17

how do we measure bronchiole hypersensitivity

challenge testing

18

how do we measure airway inflammation

invasive bronchoscopy

19

Presentation of asthma

Episodic S+S i.e. there is a trigger
Diurnal variability-worse at night and early morning
non-productive cough
wheeze
TH2 comorbidities
Responsiveness to steroids and beta2 agonists
FHX of asthma

20

Presentation of asthma

Episodic S+S i.e. there is a trigger
may be atopic
Diurnal variability-worse at night and early morning
non-productive cough
wheeze
TH2 comorbidities
Responsiveness to steroids and beta2 agonists
FHX of asthma

21

Investigations in Diagnosis of asthma

the diagnosis of asthma is a clinical one
should have at least 1 of the 4 symptoms and have variable airflow obstruction
History and examination
Diurnal variability of peak flow rate
Spirometry/peak flow-reduced FER OF <0.75
Reversibility to inhaled salbutamol of >0.15
Provocation testing- exercise, histamine, methacholine, mannitol
FeNO
Blood eosinophils
Blood IgE

22

Signs and Symptoms of COPD

Usually smoker
Chronic, not episodic
non-atopic
FER <0.7
usually no reversibility to bronchodilators
Respiratory failure (paO2 down, PaCO2 up)
pulmonary hypertension
RV failure

Productive cough, wheeze, Breathlessness
Exacerbations
Reduced breathing sounds (emphysema)

23

Treatment of asthma (SIGN GUIDELINES)

1. Low dose ICS with SABA
2. Add LABA
3. stop LABA, increase ICS or just increase ICS or add LTRA, theophylline or LAMA
4. increase ICS or add on 4th drug (LTRA, theo, LAMA)
5. low dose oral steroid

Step 4 and 5-refer to specialist care

24

Treatment of COPD

Non-Pharmacological

exercise, smoking cessation, vaccines (flu, pneumococcal), pulmonary rehab, o2

Pharmacological

LABA/LAMA (non-eosinophilic)
ICS/LABA
ICS/LABA/LAMA

PDE4 inhibitors- Roflumilast
Mucolytics- Carbocisteine
Antibiotics

25

What type of inflammation is asthma associated with

eosinophilic

26

Two conditions that make up COPD and their features

Neutrophils release protease which cause alveolar wall destruction (emphysema) and mucus hypersecretion (bronchitis)

Emphysema- alveolar wall destruction therefore a loss of bronchiole support, impaired gas exchange (irreversible)

chronic bronchitis- chronic neutrophilic inflammation, mucus hypersecretion, impaired mucocilary function, change in lung microbiome (more G-), smooth muscle spasm and hypertrophy (partially reversible)

27

Diagnosis of COPD

Assess symptoms
Spirometry-FER <0.75
assess risk of exacerbations assess comorbidities

28

Which COPD patients are 'high risk'

2 or more exacerbations in 1 year, FEV1 <0.5

29

how stop further decline in COPD

smoking cessation

30

What does spirometry measure

forced expiratory volumes, rates