Obstructive lung diseases Flashcards
(77 cards)
1
Q
What are the airflow limitations in obstructive lung disease?
A
Peak flow reduced
FEV1 reduced
FVC may or may not be reduced
FEV1/FVC reduced
2
Q
What are the causes of chronic bronchitis?
A
Smoking Atmospheric pollution Occupation Dust Alpha1 antitrypsin deficiency
3
Q
What is chronic bronchitis?
A
Cough productive of sputum most days in at least 3 consecutive months for 2 or more years
4
Q
What are the morphological changes to large airways in chronic bronchitis?
A
Mucous gland hyperplasia
Goblet cell hyperplasia
Minor inflammation and fibrosis
5
Q
What are the morphological changes t small airways in chronic bronchitis?
A
Goblet cells appear
Inflammation and fibrosis in longstanding disease
6
Q
What are the causes of emphysema?
A
Smoking Atmospheric pollution Occupation Dust Alpha1 antitrypsin deficiency
7
Q
What is emphysema?
A
Increase beyond normal in the size of airspaces distal to terminal bronchiole arising from either dilation or destruction of their walls
8
Q
What are the forms of emphysema?
A
Centriacinar
Panacinar
Periacinar
Scar
9
Q
What is centriacinar emphysema?
A
Begins with bronchiolar dilation then alveolar tissue is lost
10
Q
What is panacinar emphysema?
A
Permanent destruction of entire acinus distal to respiratory bronchioles
11
Q
What are emphysemic spaces called?
A
Blebs and bullae
12
Q
What are the mechanisms of airway obstruction in COPD?
A
Large airways- little contribution by glands and mucous
Small airways- smooth muscle tone, inflammation, fibrosis
partial collapse of airway wall on expiration
Loss of alveolar attachments
13
Q
What is COPD?
A
Chronic, slowly progressive disorder characterised by airflow obstruction that does not change markedly over several months
14
Q
What is the prevalence of COPD?
A
1 million in UK diagnosed, but only about 50% of cases diagnosed
6th most common cause of death in UK
15
Q
What are the causes of COPD?
A
SMOKING Chronic asthma Passive smoking Maternal smoking Air pollution Occupation Alpha 1 antitrypsin deficiency
16
Q
What si the typical COPD patient?
A
Over 40
Smoker/ex-smoker
Dyspnoea on exertion
Cough
17
Q
What are the symptoms of COPD?
A
Dyspnoea Cough Wheeze Weight loss Peripheral oedema
18
Q
What is th differential diagnosis for COPD?
A
COPD Asthma Lung cancer LV failure Fibrosing alveoli's Bronchiectasis
19
Q
What PMH may a COPD patient have?
A
Asthma as a child
Respiratory diseases
Ischaemic heart disease
20
Q
What are the signs of COPD?
A
Dyspnoea Pursed lip breathing Breathing using accessory muscles Cyanosis CO2 flap/tremor
21
Q
What are the non respiratory symptoms of COPD?
A
Loss of muscle mass
Weight loss
Cardiac disease
Depression/anxiety
22
Q
How is the severity of COPD assessed?
A
FEV1 real vs predicted >80% mild 50-79% moderate 30-49% severe <30% very severe
23
Q
What are the baseline tests for COPD?
A
Spirometry CXR- hyperinflation, tumours, heart problems FBC BMI- lower BMI=more problems alpha1 antitrysin if patient under 50
24
Q
What are the methods of prevention of progression of COPD?
A
Smoking cessation
25
What are the relieving treatments for COPD?
Inhalers
Short acting bronchiole dilators- SABA and SAMA
Long acting bronchodilators- LABA and LAMA
High dose inhaled corticosteroids- reviler and fostair
26
What are the methods of prevention of COPD exacerbation?
Flu and pneumococcal vaccines
| Pulmonary rehab- programme of exercise, education and support
27
What are the non-pharmacological managements of COPD?
```
Smoking cessation
Vaccinations
Pulmonary rehab
Nutritional assessment
Psychological support
```
28
What is the management of exacerbated COPD?
Short acting bronchodilators
Steroids- 40mg prednisone for 5-7 days
Antibiotics
Hospital admission- tachypnoea, low O2, hypotension
29
What is the treatment of COPD requiring hospital admission?
Nebulised bronchodilators
Corticosteroids
Antibiotics
Non invasive ventilation
30
What is a pulmonary embolism?
Am embolus that lodges in the lungs and normally originates in the deep veins of the legs
31
What are the risk factors for pulmonary embolism?
```
Recent major trauma or surgery
Cancer
Cardiopulmonary disease
Pregnancy
Inherited thrombophilia
Oral contraceptive
```
32
What are the signs and symptoms of a small isolated peripheral pulmonary embolus?
```
Pleuritic chest pain
Cough
Haemoptysis
Pyrexia
Pleural rub
Stony dullness to perfusion at base
```
33
What are the signs and symptoms of a large PE blocking perfusion?
Breathlessness
Tachycardia
Tachypnoea
Hypoxia
34
What are the signs of a massive central PE?
```
Syncope
Reduced cardiac output
Acute loss of blood flow to brain
Cardiac arrest
Tachycardia
Tachypnoea
Hypoxia
Hypertension
```
35
How is PE diagnosed?
```
Small= CT pulmonary angiogram
Large= radiography
```
36
What investigations are done fro PE?
```
FBC, biochemistry, blood gases
CXR
ECG
D dimer
CT pulmonary angio
V/Q scan
Echo
```
37
What is the prognosis of PE?
Small with anticoagulant treatment- good prognosis
Mortality 0-25% at 1 month
PESI score predicts mortality
38
What is the treatment for PE?
Oxygen if hypoxic
Low molecular weight heparin while awaiting tests
Warfarin once diagnosis confirmed
Direct oral anticoagulants
Thrombolysis
Pulmonary embolectomy
Treated for 3 months but lifelong treatment recommended if high risk of recurring
39
What is pulmonary hypertension?
Elevated blood pressure in pulmonary arterial tree >25 mmHg
40
What are the causes of pulmonary hypertension?
Idiopathic
Secondary to chronic respiratory disease or left heart disease
Chronic thromboembolic PH
Micellanious- collagen vascular disease, portal hypertension, congenital heart disease, HIV
41
What are the symptoms of pulmonary hypertension?
Exertional dyspnoea
Chest tightness
Exertional syncope/presyncope
42
What are the signs of pulmonary hypertension?
```
High JVP
RV heave
Loud pulmonary second heart sound
Hepatomegaly
Ankle oedema
```
43
What investigations should be carried out for pulmonary hypertension?
```
ECG
Lung function tests
CXR
Echo
V/Q scan
Right heart catheterisation
```
44
What does right heart catheterisation allow for in pulmonary hypertension?
Allows direct measurement of pulmonary artery pressure
| Measurement of wedge pressure and cardiac output
45
What are the general treatment measures of pulmonary hypertension?
Treat underlying condition
Oxygen
Anticpagulation
Diuretics
46
What are the specific treatment measures for pulmonary hypertension?
```
Calcium channel antagonist
Prostacyclin
Endothelium receptor antagonists
Phosphodiesterase inhibitors
Thromboendarectomy
Lung/heart transplant
```
47
What is the gene and disease prevalence for cystic fibrosis?
1 in 25
| 1 in 2500
48
What are the clinical features of cystic fibrosis in infants and young children?
Recurrent chest infections
| Failure to thrive
49
What are the clinical features of cystic fibrosis in older children and adults?
Recurrent chest infections
Nasal polyps and sinusitis
Male infertility
50
How is cystic fibrosis diagnosed?
Immunoreactive trypsinogen screening at 5 days
If positive, mutation analysis performed
Sweat test to check chloride levels- >60 indicative of CF
51
What are the cardinal features of cystic fibrosis?
```
Lungs= recurrent bronchopulmonary infection- pneumonia, bronchiectasis, scarring, abscesses
Pancreatic= abnormal stools- pale/orange, greasy, oily, very offensive-, failure to thrive- may do well on great milk, deficiencies of fat soluble vitamins, ADEK.
```
52
How are infections prevented in cystic fibrosis patients?
```
Segregation
Airway clearance and adjuncts
Mucolytics
Prophylactic antibiotics
Annual influenza vaccine
```
53
What are the most common pathogens that infect those with cystic fibrosis?
In early life- staph aureus, H. influenzae
| Later- pseudomonas aeruginosa
54
How is chronic infection dealt with in patients with cystic fibrosis?
Suppress bacterial load
Treat infective exacerbations
Reduce inflammation- ibuprofen, azythromycin, prednisilone
55
What are non respiratory manifestations of cystic fibrosis?
```
GI= dysmotility- gusto-oesophageal reflux, distal intestinal obstruction, constipation/rectal prolapse
GI= coexistent disease- Crohn's, coeliac
Hepatomegaly
Upper airway polyps and sinusitis
Diabetes
Bones= osteopenia, arthropathy
Heat exhaustion
Bilateral absence of vas deferens
Vaginal candidiasis
Stress incontinence
```
56
What are the respiratory symptoms of cystic fibrosis?
```
Reduced mucociliary clearance
Increased bacterial adherence
Reduced endocytosis of bacteria
Aggressive progressive bronchiectasis
Recurrent LRTI
Progressive airflow obstruction
Respiratory failure
Haemoptysis
Pneumothorax
```
57
What respiratory tract infections are treated with oral antibiotics in CF?
Staph
Haemophilus
Pneumococcus
58
What respiratory tract infections are treated with IV antibiotics in CF?
Pseudomonas
Stenotrophomonas
Burkholderia
59
What are some treatments of CF?
Treatment of infections
Ivacaftor
Lung transplant
60
What is ivacaftor?
Drug that binds to CFTR and improves transport of chloride ions in CF
Only for patients with G551D gene- 5-10%
61
What are indications for lung transplant in a CF patient?
```
Rapidly deteriorating lung function
FEV1 <30% predicted
Life threatening exacerbations
Estimated survival
Increasing weight loss
Hypoxia at rest
Hypercapnia
Recurrent worsening sepsis
```
62
What are the contraindications for lung transplant in CF?
Absolute- other organ failure, malignancy, significant peripheral vascular disease, drugs, nicotine, alcohol, active systemic infection, microbiological issues (Mycobacterium abscessus)
Relative- Other organ dysfunction, non compliance, steroids >20mg daily, abcense of social support, osteoporosis, low BMI, surgical risks (previous thoracic surgery)
63
How is an acute asthma attack managed?
```
Oxygen
Salbutamol (nebuliser)
Prednisilone 40mg/hydrocortisone 100mg
Ipratripium (nebuliser)
IV magnesium sulphate
```
64
What are the cons of metered dose inhalers?
Needs coordinations
50-60% remains in mouth and pharynx
Elderly, young and v unwell can't use
65
What are the pros of using a metered dose inhaler with a spacer?
Low ora-pharyngeal deposition
Reduced speed or aerosol
Reduced risk of oral candidiasis and dysphagia with steroids
66
What are the pros and cons of dry powder inhalers?
Less coordination required
| Lot of ora-pharyngeal deposition
67
What are the aims of asthma treatment?
```
No daytime symptoms
No night awakening due to asthma
No need for rescue medication
No asthma attacks
No limitation on activity
Minimal side effects from medication
```
68
What is the 1st step of asthma treatment?
Short acting B2 agonists- salbutamol, terbutaline
69
What is the 2nd step of asthma treatment and when is this given?
Inhaled corticosteroids- beclomethasone
| When using reliever 3x a week, waking 1 night a week, symptomatic 3x a week
70
What is the 3rd step of asthma treatment?
Long acting B2 agonist and ICS- fostair
71
What is the 4th step of asthma treatment?
Inhaled long acting anti muscarinic- triputaline, relaxes bronchial smooth muscle, causes dry mouth, GI upset, headaches
Leukotrine receptor antagonists
72
What is the 5th step of asthma treatment?
Long term oral steroids- 40mg prednisolone
73
What are some steroid sparing drugs used in treatment of asthma?
Immunisuppressives
| Methotrexate, ciclosporin, oral gold
74
What are some non-pharmacological management options of asthma?
```
Inhaler technique
Smoking cessation
Flu/pneumococcal vaccines
Co-morbidities
Allergen avoidance
```
75
What are the signs of moderate acute asthma?
Increasing symptoms
| PEF 50-75% predicted
76
What are the signs of severe acute asthma?
PEF 33-50%
Resp rate >25
Pulse >110
Inability to complete sentences in one breath
77
What are the signs of life threatening acute asthma?
```
Altered convoys level
Exhaustion
Arrythmia
Hypotension
Cyanosis
Silent chest
Poor resp effort
PEF <33% predicted
SpO2 <92%
PaO2 <8kPa
```
