Obstructive Airway Overview

Question 1

What general class of disease involves the lungs?

Answer 1

Restrictive disease

Question 2

Name three obstructive airway syndromes

Answer 2

Asthma
Chronic bronchitis
Emphysema

Question 3

What is the asthma triad?

Answer 3

Reversible airflow obstruction
Airway inflammation
Airway hyperresponsiveness

Question 4

Dynamic evolution of asthma: What does bronchoconstriction lead to?

Answer 4

Brief symptoms

Question 5

Dynamic evolution of asthma: What does chronic airway inflammation lead to?

Answer 5

Exacerbations of airway hyperresponsivness

Question 6

Dynamic evolution of asthma: what does airway remodelling lead to?

Answer 6

Fixed airway obstruction

Question 7

In relation to the hallmarks of remodelling in asthma, what happens to the basement membrane, submucosa and smooth muscle?

Answer 7

Basement membrane - thickening
Submucosa - collagen deposition
Smooth muscle - hypertrophy

Question 8

Describe the stages in the inflammatory cascade.

Answer 8

1. Genetic predisposition + trigger factor (viral, allergen, chemical)
2. Airway inflammation
3. Mediators/TH2 Cytoklines (e.g. histamine, leukotriene)
4. Twitchy smooth muscle (hyper-reactivity)

Question 9

What can be used to manage airway inflammation in the inflammatory cascade?

Answer 9

Anti-inflammatory corticosteroid

Question 10

What can be used to control the mediators in the inflammatory cascade?

Answer 10

Anti-leukotriene
Anti-IgE
Anti-IL4/5/13

Question 11

What can be used to manage twichy smooth muscle (hyper-reactivity) in the inflammatory cascade?

Answer 11

Bronchodilators (beta-2-agonists)

Question 12

What happens to asthma symptoms when the patient is related to drugs (NSAIDs, B-blockers), chemicals, cold, smoke, viral infection and exercise?

Answer 12

Symptoms worsen

Question 13

What can be said about the timing of asthma symptoms?

Answer 13

Episodic and dirurinal variability (nocturnal/early morning)

Question 14

What type of cough is present in asthma, and what symptoms alongside it?

Answer 14

Non-productive cough and wheeze

Question 15

Name three associated atopy with asthma

Answer 15

Rhinitis
Conjunctivitis
Eczema

Question 16

What is the wheezing due to in asthma?

Answer 16

Turbulent airflow

Question 17

What would a diurinal variation of peak flow rate indicate about the diagnosis of asthma?

Answer 17

Confirm it

Question 18

What would the forced expiratory ratio be like in an asthmatic?

Answer 18

Reduced

FEV1/FVC

Question 19

What two methods can be used for provocation testing for bronchospasm in suspected asthma patients?

Answer 19

Exercise

Histamine/allergen inhalation

Question 20

In COPD, what leads to mucociliary dysfunction, inflammation and tissue damage?

Answer 20

Noxious particles or gases e.g. smoking

Question 21

In COPD, what do mucociliary dysfunction, inflammation and tissue damage all lead to?

Answer 21

Development of obstruction and ongoing disease progression

Question 22

What are two characteristics of COPD?

Answer 22

Exacerbations

Reduced lung function

Question 23

In COPD, what is the subtype called where there are disrupted alveolar attachments?

Answer 23

Emphysema

Question 24

What is the subtype of COPD, where mucosal and peribronchial inflammation and fibrosis occur?

Answer 24

Bronchiolitis

Question 25

In COPD, when cigarette smoke encounters alveolar macrophages, what 4 things do the cells release?

Answer 25

Neutrophil chemotatic factors Cytokines (IL-8) Mediators (LTB4) Oxygen radicals

Question 26

In COPD, what do proteases lead to?

Answer 26

``` Alveolar wall destruction (emphysema) Mucus hypersecretion (chronic bronchitis) ```

Question 27

What type of COPD has chronic neutrophilic inflammation, mucus hypersecretion, smooth muscle spasm and hypertrophy and is partially reversible?

Answer 27

Chronic bronchitis

Question 28

What type of COPD has alveolar destruction, imparied gas exchange, loss of bronchial support and is irreversible?

Answer 28

Emphysema

Question 29

What sort of imbalance is present in emphysema?

Answer 29

Protease imbalance

Question 30

What 3 things must you assess in the assessment of COPD?

Answer 30

1. Assess symptoms 2. Assess degree of airflow limitation using spirometry 3. Assess risk of exacerbations

Question 31

Relating to exacerbations and spirometry, what features are indicators of high risk COPD?

Answer 31

Two exacerbations or more within the last year | FEV1

Question 32

What can be said about the timing of symptoms in COPD?

Answer 32

Chronic symptoms not episodic

Question 33

Is COPD atopic?

Answer 33

No

Question 34

What is the cough like in COPD?

Answer 34

Daily and productive

Question 35

Is the breathlessness reversible or progressive in COPD?

Answer 35

Progressive

Question 36

What occurs frequently in COPD patients?

Answer 36

Infective exacerbations

Question 37

Which subtype of COPD is characterised by wheezing?

Answer 37

Chronic bronchitis

Question 38

Which subtype of COPD is characterised by reduced breath sounds?

Answer 38

Emphysema

Question 39

What are the 5 steps of the chronic cascade in COPD, before death?

Answer 39

1. Progressive fixed airflow obstruction 2. Impaired alveolar gas exchange 3. Respiratory failure: decreased PaO2, increased PaCO2 4. Pulmonary hypertension 5. Right ventricular hypertrophy/failure (i.e. Cor Pulmonale)

Question 40

What are 6 non-pharmacological management measures of COPD?

Answer 40

1. Smoking cessation 2. Immunisation- infleunza/pneumococcal 3. Physical activity 4. Oxygen - domiciliary 5. Venesection 6. Lung volume reduction surgery

Question 41

Name the 4 pharmacological gold standard COPD managements

Answer 41

1. LAMA: Tiotropium/Aclinidium 2. LABA: Salmeterol/Formoterol 3. LAMA-LABA combo: Alinidium/Formoterol 4. LABA-ICS combo: Beclometasone-Formoterol

Question 42

What are the 3 other pharmacological managements of COPD?

Answer 42

PDE4I - Roflumilast Mucolytic - Carbocisteine Antibiotics - Azithromycin

Question 43

What is the difference between inflammation in asthma and COPD?

Answer 43

Asthma - eosinophilic | COPD - Neutrophilic

Question 44

What is the difference between FVC and TLCO in asthma and COPD?

Answer 44

Asthma - preserved FVC and TLCO | COPD - reduced FVC and TLCO

Question 45

What general class of disease involves the airways?

Answer 45

Obstructive disease

Question 46

What produces IL-13, IL-4 and IL-5?

Answer 46

TH2 cells