Lecture 19 - Chronic Airflow limitation Flashcards Preview

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Flashcards in Lecture 19 - Chronic Airflow limitation Deck (29):
1

what is asthma?

Chronic infalmmatory disorder of the airways

often associated with atopy

SymptomsL recurrent episodes of wheezing, breathlessness, chest tightness and coughing

Widespread, variable, usually reversible airfow limitations

2

The allergen can stimilate which two cells in asthama pathophysiology?

mast cell (usually) or macrophage cell

causes mucos production and vasodilation and angiogenesis

3

What happens to the subepitheliual collagen layer in asthmatics?

Remodelling causes it to thicken

in addition, the infiltration of inflammatory cells causes an increase in mucosal vascularity

4

What happens to smooth muscle volume in asthamatic remodelling?

increases a lot. - augments the airway hyperresponsiveness

5

The narrower a luminal diameter..

the high the airflow resistance (der)

6

FEV1 is affected ___ than FVC in patients with obstructive lung disease

more - FVC can be fully preserved in cases

7

Why do patients feel breathless with obstructed airways?

here is a change in the "work of breathing" - change in the load

Breathlessness is a recognition of an inappropriate degree of respiratory work for body workload

8

What are the factors that exacerbate asthma?

Allergens
resp. infections
pollutants
Exercise and hyperventilation
weather changes
food, additives, drugs
emotion

9

How do you make a diagnosis of asthma?

appropriate clinical setting

need to demonstrate reversible airflow obstruction (peak flow, spirometry - reduced FEV1)

Bronchoprovocation test - measures hyper-reactivity

10

Targetting the inflammation that causes airway hyperresponsiveness is due using...

anti-inflammatory steroids (usually)

sometimes monoclonal antibodies

11

Remember asthma treatment is more than just ...

pharmacotherapy (although its important)

12

Asthma medication tries to minimise the underlying pathophysiology - what are all the medication options?

beta 2 agonists

inhaled corticosteroids (preventer)

oral corticosteroids - only for severe asthmatics

combination inhalers

leukotriene receptor antagonists

anti-IgE

13

clinical effect for corticosteroids is at what dosage?

a very modest amount - point of difference with COPD which needs higher doses

14

What is COPD

group of disorders characterised by airway inflammation and airflow limitation that is not fully reversible

A progressive condition associated with an abnormal inflammatory response to noxious stimuli (almost always cigarettes)

fully reversible asthma is not COPD

15

What are the two broad categories of COPD?

Emphysema - loss of airway tissue

Chronic bronchitis - inflammation and speutum production

16

What are the COPD stats in Australia

3rd leading cause of disease burden in Australia

Fourth leading cause of death in Australian men & 6th in women

nearly 500,000 people in Aus with moderate to severe COPD

mortality of COPD 10-times higher in indigenous Australians

Among principal causes of death, only COPD continues to have a growing death rate

17

COPD is currently what (in terms of diagnosis)

under-diagnosed
under-recognised
under-treated

COPD is preventable and treatable but largely unknown to health care professionals

18

smoking is responsible for __ -__% of COPD cases

smoking is responsible for 80-90% of COPD cases

19

Up to ___% of long-term smokers develop COPD

50%

15-20% develop severe airflow limitation

20

Inflammation , caused by noxious agents acts in two parts of the lungs, what are they?

Small airway disease - Airway inflammation, airway remodelling

Parenchymal destruction - loss of alveolar attachments, loss of elastic recoil

21

What are the inflammation damages from COPD?

Mucociliary dysfunction
strutural changes
Airway inflammation
systemic component

22

Around one thurd of pateints with COPD grow _____from respiratory specimen during stable state

bacteria

23

Bong hits are bad because?

Temperature of air is much hotter and there are fungi in the (pure) form

24

There is alot of shared genetic predispositions between COPD and ___ ___

lung cancer - comorbid

25

What are the non-pharm. and pharm. smoking cessation strategies?

non-pharmacologic:

will power
doctor's advice
self-help material
councelling
courses

Pharmacologic:

Nicotine replacement therapy
bupropion (partial agonists of nicotine receptor)
varenicline (partial agonists of nicotine receptor)

26

true or False

b2 agonists (long-acting) are standard treatment

true

27

Long-acting anticholinergics are demonstrated to achieve

less dyspnoea
better exercise tolerance
less exacerbations
less mortaility

28

The only patients that will benefit from inhaled corticosteriods is...

those with frequent exacerbations

higher doses needed than in athsma

risk of pneumonia is increased

29

Other are other treatment options for COPD?

Theophylline

long erm antibiotics

pulmonary rehabilitation

vaccinations (particularly influenza)

oxygen (only for those with significant resting hypoxia)