Respiratory Disorders Flashcards
(36 cards)
What are the key characteristics of asthma?
A chronic inflammatory disease of the airways characterized by:
- Variable respiratory symptoms (wheeze, shortness of breath, chest tightness, cough)
- Variable expiratory airflow limitation
Associated with bronchial hyperresponsiveness and airway inflammation. Cause often involves genetic + environmental factors.
What happens in the airways during asthma?
- Bronchoconstriction: Airway smooth muscle tightens.
- Airway Edema/Swelling: Due to inflammation.
- Mucus Hypersecretion: Increased mucus clogs airways.
- Airway Remodeling: Long-term structural changes (can occur).
- Inflammation: Primarily eosinophilic (in many types).
List common triggers for asthma symptoms/exacerbations.
- Allergens (pollen, dust mites, pet dander, mold)
- Irritants (smoke, pollution, strong smells, chemicals)
- Respiratory infections (viral > bacterial)
- Exercise (EIB)
- Cold air / Weather changes
- Certain medications (NSAIDs, beta-blockers)
- Stress / Laughter
How is asthma diagnosis typically confirmed?
- History: Pattern of typical respiratory symptoms.
- Evidence of Variable Expiratory Airflow Limitation: Demonstrated by lung function tests (spirometry) showing:
- Reduced FEV1/FVC ratio (obstruction)
- Significant reversibility (increase in FEV1 ≥12% AND ≥200mL post-bronchodilator) OR excessive variability in PEF over time.
What do the Green, Yellow, and Red zones on a peak flow meter indicate?
- Green (80-100% of personal best): All clear / Good control. Follow routine plan.
- Yellow (50-80% of personal best): Caution / Asthma worsening. Follow action plan (may need increased reliever/controller).
- Red (<50% of personal best): Medical Alert! Use reliever, seek medical attention immediately.
What are the two main goals of asthma management according to GINA?
- Symptom Control: Achieve good control of symptoms to maintain normal activity levels.
- Risk Reduction: Minimize future risk of exacerbations, fixed airflow limitation, and medication side-effects.
How does GINA classify asthma control?
- Well-controlled: Symptoms ≤2 times/week, no nighttime waking, reliever needed ≤2 times/week, no activity limitation.
- Partly controlled: Presence of any features > well-controlled level in any week.
- Uncontrolled: ≥3 features of partly controlled asthma present in any week, or exacerbation in the last week. (Simplified from slide 30 for clarity - focus on frequency)
List key non-pharmacological strategies for asthma.
- Smoking cessation (active & passive)
- Physical activity (encouraged, manage EIB)
- Allergen/Irritant avoidance (if relevant)
- Weight management (if obese)
- Vaccinations (Influenza, Pneumococcal)
- Breathing exercises (e.g., Buteyko - adjunctive)
- Patient education & self-management (action plan)
What is the main difference between reliever and controller medications in asthma?
- Relievers (Quick Relief): Used “as needed” for acute symptom relief. Primarily bronchodilators (e.g., SABA).
- Controllers (Prophylactic/Maintenance): Taken regularly (daily) to reduce airway inflammation, control symptoms, and reduce future risks. Primarily contain Inhaled Corticosteroids (ICS).
What fundamental change did GINA introduce regarding SABA use?
SABA-only treatment is NO LONGER RECOMMENDED for asthma in adults and adolescents. This is due to the risks associated with treating symptoms without addressing the underlying inflammation (increased risk of exacerbations, mortality).
Describe GINA 2024 Track 1 (Preferred) approach for adults/adolescents.
Uses low-dose ICS-Formoterol as the single inhaler for both:
Reliever: As-needed for symptom relief.
Controller:
Steps 1-2: As-needed use only.
Steps 3-5: Regular daily maintenance dose(s) PLUS as-needed use for relief.
(Dose adjusted stepwise based on control)
Describe GINA 2024 Track 2 (Alternative) approach.
Uses separate inhalers:
Reliever: As-needed SABA.
Controller: Regular daily ICS-containing medication.
Step 1: Take ICS whenever SABA is taken (not daily).
Step 2 onwards: Regular daily maintenance ICS (or ICS/LABA). Dose/combination adjusted stepwise.
(Considered if Track 1 not possible/preferred, or adherence concerns with Track 1 as-needed strategy)
What are the three components of the ongoing asthma management cycle?
- Assess: Symptom control, risk factors, lung function, inhaler technique, adherence, patient goals.
- Adjust: Treatment (step up/down), non-pharmacological strategies, treat modifiable risk factors.
- Review: Response to adjustments.
What are potential add-on therapies considered at GINA Step 5?
Referral for expert advice/phenotyping. Consider add-on:
- LAMA (Long-acting muscarinic antagonist)
- Biologics (Anti-IgE, Anti-IL5/5R, Anti-IL4Rα, Anti-TSLP) based on phenotype (e.g., allergic, eosinophilic)
- Low-dose oral corticosteroids (last resort, weigh risks/benefits)
What are the key components of emergency treatment for an asthma exacerbation?
- Oxygen: To maintain SpO2 93-95% (94-98% in children).
- Short-Acting Beta2-Agonists (SABA): Repeated doses, often nebulized or via MDI+spacer (e.g., Salbutamol).
- Systemic Corticosteroids: Oral (prednisolone) or IV (hydrocortisone). Early administration crucial.
- Ipratropium Bromide: Consider adding nebulized SAMA in severe exacerbations.
(Monitor response closely - PEF, SpO2, clinical signs)
What is the key principle for managing asthma during pregnancy?
Maintain good asthma control. Poorly controlled asthma poses a greater risk to mother and baby than asthma medications.
- ICS are considered safe and should be continued.
- Avoid exacerbations.
- Salbutamol is the preferred reliever.
What is Chronic Obstructive Pulmonary Disease (COPD)?
A common, preventable, and treatable disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases (primarily smoking).
What are the two main pathological components often contributing to COPD?
- Chronic Bronchitis: Inflammation and mucus hypersecretion in the airways (clinically: chronic productive cough).
- Emphysema: Destruction of alveoli, leading to loss of elastic recoil and enlarged airspaces.
(Most patients have features of both)
What is the most common cause of COPD? List other risk factors.
Other Risk Factors:
- Environmental exposures (biomass fuel smoke, pollution)
- Occupational dusts and chemicals
- Genetics (e.g., Alpha-1 antitrypsin deficiency - AATD)
- Abnormal lung development / Premature birth
- Recurrent childhood respiratory infections
- Asthma / Airway hyper-responsiveness
What are the hallmark symptoms of COPD?
- Dyspnea: Progressive, persistent, worse with exercise.
- Chronic Cough: May be intermittent or daily, may be productive (sputum).
- Chronic Sputum Production:
- Wheezing and Chest Tightness (can occur)
- Recurrent lower respiratory tract infections.
How is COPD diagnosis confirmed?
Diagnosis confirmed by post-bronchodilator FEV1/FVC < 0.70.
This indicates persistent airflow limitation that is not fully reversible.
How does GOLD classify the severity of airflow limitation in COPD (based on FEV1)?
Based on post-bronchodilator FEV1 % predicted (in patients with FEV1/FVC < 0.7):
- GOLD 1 (Mild): FEV1 ≥ 80%
- GOLD 2 (Moderate): 50% ≤ FEV1 < 80%
- GOLD 3 (Severe): 30% ≤ FEV1 < 50%
- GOLD 4 (Very Severe): FEV1 < 30%
What tools are used to assess symptom burden in COPD according to GOLD?
a. Modified Medical Research Council (mMRC) Dyspnea Scale: Assesses breathlessness related to activity (Score 0-4).
- Cut-off: mMRC 0-1 = Less symptoms; mMRC ≥ 2 = More symptoms.
b. COPD Assessment Test (CAT): 8-item patient questionnaire assessing broader impact (Score 0-40).
- Cut-off: CAT < 10 = Less symptoms; CAT ≥ 10 = More symptoms.
How are patients classified using the GOLD ‘ABE’ assessment tool?
Combines symptom burden (mMRC or CAT) and exacerbation history (moderate/severe in past year):
Group A: Low Symptoms (mMRC 0-1 or CAT < 10) AND 0 or 1 moderate exacerbation (not leading to hospital admission).
Group B: High Symptoms (mMRC ≥ 2 or CAT ≥ 10) AND 0 or 1 moderate exacerbation (not leading to hospital admission).
Group E: ANY symptom level AND ≥ 2 moderate exacerbations OR ≥ 1 exacerbation leading to hospitalization.
