lecture 4 (respiratory)

Question 1

what are the structures found in respiratory system?

Answer 1

• upper airway (oesophagus, nasal cavity, pharynx, larynx)
• trachea
• bronchi
• bronchioles
• alveoli
• respiratory muscles
• connective tissue
• capillary bed

Question 2

what are the two categories of respiratory diseases?

Answer 2

• obstructive airways disease
  -restrictive lung disease

Question 3

what occurs in obstructive airways disease?

Answer 3

• narrowing of airways

Question 4

what are examples of obstructive airway diseases?

Answer 4

• asthma
• COPD
• chronic bronchitis
• emphysema
• bronchiectasis
• cystic fibrosis

Question 5

what occurs in restrictive lung diseases?

Answer 5

• affect respiratory system outside of the airways
• lungs not expanding and contracting as they should

Question 6

what are some examples of restrictive lung diseases?

Answer 6

• interstitial lung disease
• musculoskeletal diseases
• neuromuscular disease
• diaphragmatic weakness/paralysis
• obesity

Question 7

what occurs during an asthma attack?

Answer 7

• smooth muscle in the airways becomes swollen and inflamed
• excessive mucus secretion
• blockage of airways
• reversible obstruction

Question 8

what occurs in bronchiectasis?

Answer 8

• excess mucus secretion so blockage of airways
• damage airways and they become larger but more blocked with secretions

Question 9

what is spirometry?

Answer 9

• physiological test to measure airflow through airways

Question 10

what does spirometry assess and test?

Answer 10

• assesses respiratory health
• diagnoses respiratory diseases

Question 11

what does spirometry measure?

Answer 11

• effect of respiratory disease on how well the lungs work
• responsiveness of airways to medication
• severity of airway disease and use for prognosis
• monitors disease progression over time

Question 12

how do you prepare a spirometer?

Answer 12

• know your equipment so results are comparable
• calibration (check against known standard) and verification
• infection control (single use nose clips, ppe)

Question 13

what patient checks are needed before participating in spirometry?

Answer 13

• haemoptysis (coughing up blood)
• pneumothorax (collapsed lung)
• recent heart attack
• recent pulmonary embolism
• thoracic, cerebral or abdominal aneurysms
• eye surgery
• nausea and vomiting
• recent thoracic surgery
• recent abdominal surgery

Question 14

how is the patient prepared before the test?

Answer 14

• pre test: avoid smoking, alcohol, vigorous excersize, inhaler, large meal
• explain positioning and procedure
• age, height, birth sex, ethnicity
• type/dose/time of last medication
• smoker, non smoker, ex smoker

Question 15

why is the procedure taken seated?

Answer 15

• safety so dont faint
• comparable rest values
• viable for everyone

Question 16

how is the test performed?

Answer 16

1. nose clip on, tidal breathing
2. inhale to maximal Inspiration
3. forced expiration to residual volume
4. minimum of 2 attempts

Question 17

what could occur if fast breathing was forced straight away?

Answer 17

• could trigger bronchoconstriction
• smooth muscle contraction and airway narrowing
• hard to breathe fast in respiratory diseases

Question 18

what does spirometry measure?

Answer 18

• resting vital capacity (big breath in)
• peak expiratory flow
• forced expiratory volume (FEV1)
• forced vital capacity (FVC)

Question 19

what is forced vital capacity?

Answer 19

• maximum volume of air exhaled with maximal forced effort from maximum inspiration

Question 20

how are the results shown?

Answer 20

• volume time graph
• flow volume loop

Question 21

what is in flow volume loop with normal conditions?

Answer 21

• sharp peak to top
• steady decline down
• round smooth curve at bottom

Question 22

what does a flow volume loop look like in restrictive diseases?

Answer 22

• PEF normal/reduced (airways ok, disease elsewhere)
• FEV1 reduced
• FVC reduced
• raised FEV1:FVC ratio
• graph smaller than should be (smaller volume of air able to move)

Question 23

what does a flow volume loop look like in obstructive diseases?

Answer 23

• scooped shape, no smooth decline (airway obstruction)
• PEF reduced
• FEV1 reduced
• FVC reduced (takes longer to expire)
• FEV1:FVC ratio reduced

Question 24

what is dynamic airway compression?

Answer 24

-pressure surrounding airway exceeds pressure within airway lumen

Question 25

what are the errors that could occur?

Answer 25

- hesitation/ not maximal expiration = flat peak - cough = wiggle in line - partially obstructed mouthpiece - spirometry induced bronchoconstriction = each attempt decreases

Question 26

what should FEV1/FVC be to be classed as obstructive?

Answer 26

- below LLN - z score of less than -1.645