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Flashcards in Obstructive Airway Disease Deck (112)
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1

what are the 3 conditions which fit into obstructive airway syndrome?

asthma
chronic bronchitis
emphysema

2

what is COPD/asthma overlap syndromes?

(generally smokers) with features of both asthma and COPD aka COPD with reversibility

3

what are the 3 parts of 'the asthma triad'?

reversible airflow obstruction
airway inflammation
airway hyperresponsiveness

4

what is the dynamic progression of asthma?

1. bronchoconstriction
2. chronic airway inflammation
3. airway remodelling

5

what is involved in the bronchoconstriction stage of asthma?

brief symtpoms

6

what is involved in the chronic airway inflammation stage of asthma?

exacerbations and airway hyper-reactivity

7

what is involved in the airway remodeling stage of asthma?

fixed airway obstruction

8

what are the 3 hallmarks of airway remodeling?

1. thickening of basement membrane
2. collagen deposition in submucosa
3. hypertrophy of smooth musce

9

what are the main type of immune cell infiltrate in asthma?

eosinophils

10

what are the 7 key features of the clinical syndrome of asthma/.

1. episodic symptoms and signs
2. wheezing
3. non productive cough, wheeze
4. triggers
5. diurinal variability in episodes
6. associated atopy
7. family history of asthm

11

what is wheezing in asthma due to?

turbulent airflow in bronchioles

12

in an asthmatic patient what is the forced expiratory ratio?

FEV1/FVC below 75%

13

what is a bronchial challenge test?

a method of diagnosis asthma where the patient breathes in either nebulised methacholine (muscarinic agonist) or histamine and the resultant narrowing of airways is detected by spirometry.

14

how can you tell the difference between a patient without asthma and a patient with asthma on a bronchial challenge test?

patient with asthma will react to much lower doses of the nebulised spasmogens/bronchoconstrictors due to hyperreactivity of the airways

15

describe the diurnal variability in asthmatic episodes.

increased episodes in the morning morning
(PEFR markedly lower at this times)

16

how can use use a bronchial challenge test to distinguish between COPD and asthma?

by repeating bronchial challenge test after administration of salbutamol. if there is a reversibility to inhaled salbutamol >15%: asthma

17

what are the 3 factors involved in the development of obstruction and ongoing disease progression of COPD?
and what are they all caused by?

mucociliary dysfunction inflammation
tissue damage

caused by noxious particles or gases eg smoking

18

what are the 2 major symtpoms of COPD

SOB
worsening QoL

19

what are the 2 major characteristics of the COPD?

reduced lung function
exacerbations

20

what is the main pathology behind emphysema?

disrupted alveolar attachments

21

what is the main immune cell involved in the infiltrate within airways in COPD?

neutrophils

22

what is the main pathology behind chronic bronchitis?

mucus hypersecretion

23

what causes emphysema and chronic bronchitis to occur?

proteases released from stimulated neutrophils causing proteolysis

24

what are the 4 features of chronic bronchitis?

chronic neutrophilic inflammation
mucus hypersecretion
smooth muscle spasm and hypertrophy
partially reversible

25

what are the 4 features of emphysema?

alveolar destruction
impaired gas exchange
loss of bronchial support
irreversible

26

usually there are protease inhibitors which regulate the proteases produced by stimulated neutrophils, in COPD what happens to these protease inhibitors?

down-regulation causing increase proteolysis

27

what is the genetic element to acquiring COPD?

deficiency of protease inhibitors

28

what 3 things must you assess during the assessment of COPD?

assess symtpoms
assess degree of airflow limitation using spirometry
assess risk of exacerbations

29

what is an indicator of high risk COPD?

2 + exacerbations in 1 year
or
FEV1/FVC below 50%

30

what are the 7 key features of the clinical syndrome of COPD?

1. chronic symptoms (not episodic)
2. daily productive cough
3. increasing breathlessness
4. wheezing
5. reduced breath sounds
6. smoking
7. non-atopic