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01. Respiratory System - HP > Obstructive Lung Disease > Flashcards

Obstructive Lung Disease Flashcards

1
Q

What is characteristic about obstructive lung disease?

A

Airflow limitation

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2
Q

What is FEV1?

A

The forced expiratory volume of air exiting the lung in the first second

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3
Q

What is FVC?

A

The final total expired

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4
Q

What is normal FEV1?

A

3.5-4 litres

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5
Q

What is normal FVC?

A

About 5L

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6
Q

What happens to FEV1 in obstructive lung disease?

A

It is reduced

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7
Q

What happens to FVC in obstructive lung disease?

A

It may be reduced

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8
Q

What are the most common obstructive airway diseases?

A

Asthma
Chronic Bronchitis
Emphysema

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9
Q

What happens in peak expiratory flow in obstructive lung diseases?

A

It may also be reduced

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10
Q

What is emphysema?

A

A destruction of the alveolar wall
An increase in the alveolar space causing exhalation to be more difficult
Loss of elasticity

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11
Q

Is the mechanism of obstruction for chronic bronchitis, emphysema and asthma the same?

A

No they all have different mechanisms

Although all of their most component is airway obstruction

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12
Q

What does COPD stand for?

A

Chronic Obstructive Pulmonary Disease

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13
Q

What does the person physically have to do to measure FEV1 and FVC?

A

Take in a deep breath and blow out their lungs as much air as fast as possible

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14
Q

What is the predicted FVC based on?

A

Age
Sex
Height

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15
Q

What is normal range of PERF?

A

80-100% normal

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16
Q

What is a moderate fall in PERF?

A

50-80%

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17
Q

What is a marked fall in PERF?

A

<50%

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18
Q

In bronchial asthma what Type of hypersensitivity is present?

A

Type 1

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19
Q

What are the most common causes of both emphysema and chronic bronchitis?

A

Smoking
Atmospheric Pollution
Occupation: exposure to dust

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20
Q

Which gender is more affected by chronic bronchitis and emphysema?

A

Male

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21
Q

What is chronic bronchitis defined clinically as?

A

Cough productive of sputum most days in at least 3 consecutive months for 2 or more consecutive years

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22
Q

What are the 3 forms of emphysema?

A

Centriacinar
Panacinar
Periacinar

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23
Q

What does pan-acinar wipe out surface area by?

A

By area

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24
Q

What does centri-acinar wipe out surface area by?

A

By number

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25
Q

What is a bulla?

A

An emphysematous space greater than 1cm

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26
Q

Is COPD reversible?

A

No generally considered to be irreversible

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27
Q

What is ‘ura bleb’?

A

Term used to describe bulla spaces underneath the plura

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28
Q

What can ‘bleb’ lead to?

A

Spontaneous pneumothorax

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29
Q

How does smoking contribute to COPD?

A

Contributes to a protease-antiprotease imbalance by inducing anti-elastase deficiency and negatviely affecting elastin synthesis repair mechanisms

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30
Q

What do neutrophils and macrophages release that can cause lung damage?

A

Enzymes (elastases) which can lead to the degradation of lung tissue

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31
Q

How is the maintenance of alveolar tissue maintained in a healthy individual?

A

Repair mechanisms of anti elastases and elastin synthesis

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32
Q

What is there a loss of in emphysema? (think guy ropes)

A

Alveolar attachments

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33
Q

What are the normal values of pulmonary gas exchange of oxygen?

A

Normal PaO2 - 10.5 -13.5 kPa

34
Q

What are the normal values of pulmonary gas exchange of carbon dioxide?

A

Normal PaCO2 4.8 - 6.0 kPa

35
Q

What are the values in Type 1 respiratory failure?

A

PaO2 , 8 kPa (PaCO2 normal or low)

36
Q

What are the values in Type 2 respiratory failure?

A

PaCO2 > 6.5 kPa

37
Q

What are the 4 normal states associated with HYPOXAEMIA?

A

Ventilation/Perfusion imbalance
Diffusion impairment
Alveolar hypoventilation ( not enough air getting in)
Shunt

38
Q

What can the obstruction of airways be made worse by?

A

Inflammation

Mucous

39
Q

In the UK how many people are diagnosed with COPD?

A

900,000

40
Q

How common a cause of death is COPD in UK?

A

6th

41
Q

How common a cause of death is COPD in the world?

A

5th

42
Q

How can COPD affect the daily lives of those that live with it?

A 
Climbing stairs 
Gardening 
housework 
Dressing 
Sleep disturbance 
Can all be affected
43
Q

What is the main cause of COPD?

A

Smoking

44
Q

What % of smokers develop COPD?

A

20%

45
Q

Is weight loss a bad symptom?

A

Yes - often indicates severe disease

46
Q

What are the specific features that should be included in the past medical history of a COPD patient?

A

Asthma as a child
Respiratory diseases
Ischaemic heart disease

47
Q

What are the specific features that should be included in the drug history of a COPD patient?

A

List of current inhales, doses

Previous medications and effects on breathing

48
Q

What are the specific features that should be included in the personal and social history of a COPD patient?

A

Occupation

Smoking history, age started, stopped smoking, cigarettes/day, pack years

49
Q

Does COPD change markedly over several months?

A

No

50
Q

In obstructive lung disease why is FEV1 reduced?

A

Because in 1 second the amount of air getting out is more affected due to the obstructed airways

51
Q

Is the mechanism for all obstructive airway diseases the same?

A

No the mechanism for obstruction is different in each case

52
Q

Where is there inflammation in chronic bronchitis?

A

Inflammation of the bronchial tubes

53
Q

Alot of what is produced in chronic bronchitis?

A

Mucous

54
Q

In chronic bronchitis what are the morphological changes in the large airways?

A

Mucous gland hyperplasia
Goblet cell hyperplasia
Inflammation and fibrosis is a minor component

55
Q

In chronic bronchitis what are the morphological changes in the small airways?

A

Goblet cells appear

Inflammation and fibrosis in long standing disease

56
Q

What is goblet cell hyperplasia?

A

Increased numbers of goblet cells

57
Q

What is fibrosis?

A

The thickening and scarring of connective tissue

58
Q

What is the most common form of emphysema?

A

Centriacinar

59
Q

What part of the lung is predominantly destroyed in centriacinar emphysema?

A

Upper half of the lungs

60
Q

What part of the lung is predominantly destroyed in panacinar emphysema?

A

The lower half of the lungs

61
Q

What is ventilation?

A

The amount of air moved in and out of the lungs

62
Q

What is chronic (hypoxic) Cor Pulmonale?

A

Pulmonary heart disease
Enlargement and failure of the right ventricle as a response to increased vascular resistance or high blood pressure i the lungs
i.e the heart has to work harder to get blood through the pulmonary circulation

63
Q

In the UK how many are diagnosed with COPD?

A

900,000

64
Q

What % of COPD patients are diagnosed?

A

50%

65
Q

What is 85% of COPD causation due to?

A

Tobacco smoke

66
Q

What is the other 15% of COPD causation due to?

A 
Passive smoking 
Chronic asthma 
Maternal smoking 
Air pollution 
Occupation
67
Q

What is FEV1 in mild COPD?

A

<80%

68
Q

What is FEV1 in moderate COPD?

A

50-80%

30-50%

69
Q

What is FEV1 in severe COPD?

A

<30%

70
Q

When might you start suspecting COPD?

A 
Age 35 or over 
Current or former smoker 
Chronic cough 
Exertional Breathlessness 
Sputum production 
Frequent winter bronchitis
Wheezing  
Chest tightness
71
Q

When examining what might be noticed in a COPD patient?

A

Reduced chest expansion
Prolonged expiraiton/wheeze
Hyperinflated chest

72
Q

What are the signs of respiratory failure?

A

Cyanosis
Use of accessory muscles of expiration
Pursed lip breathing
Peripheral Oedema

73
Q

What confirms the diagnosis for COPD?

A

Spirometry

74
Q

What are the baseline tests for COPD?

A 
Spirometry 
CXR
ECG
Full blood count 
BMI
75
Q

What is the management treatment for COPD?

A

Smoking cessation
Inhalers
Long term Oxygen Therapy

76
Q

What treatment is given to extreme COPD patients?

A

Long term O2 therapy

77
Q

Why is smoking cessation advisable for COPD patients?

A

Because smoking highly contributes to COPD

78
Q

What inhaled therapy is available for COPD patients?

A

Short acting Bronchodilators
Long Acting Bronchodilators
High Dose inhaled corticosteroids

79
Q

When is long term oxygen given?

A

When PaO2 <7.3 kPa

80
Q

When is long term oxygen given if the patients has nocturnal hypoxia, peripheral oedema or pulmonary hypertension?

A

7.3-8kPa

01. Respiratory System - HP (82 decks)

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