Respiratory: Obstructive Airway disease Flashcards Preview

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Flashcards in Respiratory: Obstructive Airway disease Deck (25):
1

What are key histological markers of airway remodelling in asthma?

Thickened basement membrane
Collagen deposition in the submucosa
Smooth muscle hypertrophy

2

Which drugs in asthma act to reduce the eosonophillic inflammation?

Corticosteroids
Cromones
Theophylline

3

Which drugs in asthma target the hyperactivity of the airways?

Bronchodilators (Beta agonist and muscarinin antagonist)

4

Which drugs in asthma target inflammatory mediators and Th2 cytokines?

Antileukotrienes
Monoclonal antibodies
Anti IgE
Anti interleukin5

5

What antibody is raised with atopic disease?

IgE

6

What are the two components of COPD?

Chronic bronchitis and emphysema

7

What is chronic bronchitis?

Inflammation of the bronchi (large and medium sized airways)
- Chronic neutrophil inflammation
- Mucus hypersectretion
- Mucociliary dysfunction
- Smooth muscle spasm and hypertrophy

8

What is emphysema?

Alveolar destruction resulting in impaired gas exchange and loss of bronchial support.

9

What vaccinations are people with COPD given?

Influenza yearly
Pneumococcal

10

What are the treatment stages in asthma?

SABA
SABA + ICS
SABA + ICS + LABA
SABA + ICS + LABA + Montelukast

11

Why might inhaled steroids (esp fluticasone) cause pnemonia in COPD?

Local immune supression and impared mucociliary clearance. Fluticasone has a prolonged period of lunge retention

12

When are inhlaed corticosteroids used in obstructive lung disease?

As monotherapy in asthma
With a LABA in COPD.

13

How is montelukast given?

Oral tablet, once daily

14

What is omalizumab and when is it used in obstructive lung disease?

Anti IgE monoclonal antibody.
Inhibits the binding to the high affinity IgE receptors. This inhibits the TH2 response and associated mediator release from basophils and mast cells. It is given as an injection eveery 2 - 4 weeks for patients with severe persistent allergic asthma

15

What is aminophylline?

IV methylxanthine used in acute attacks. Acts as a phosphodiesterase inhibitor

16

What is theophylline?

Oral methylxanthine used for maintainence therapy in COPD and asthma.

17

What is roflumilast?

A PDE4 inhibitor used in OPD where there are frequent exacarbations. It is rarely used due to severe GI side effects.

18

What is carbocisteine?

A mucolytic used in COPD to reduce sputum viscosity.

19

What is the treatment for acute COPD?

Nebulised salbutamol + Ipratropium
Oral prednisolone
24 - 28 % Oxygen (titrated with SATs)
Antibiotics (amoxicillin/doxycyline)
IV theophyllines if there is a poor response to neubulised bronchodilators

20

What investigations are required if you have an infective axacerbation of COPD?

- ABG
- CXR
- ECG
- Theophylline level if on theophylline
- Sputum culture
- Blood cultures

21

What patients with COPD should be assessed for long term oxygen therapy? What does the assessment comprise?

FEV1 less than 30% predicted
Cyanosis
Polycythaemia
Peripheral oedema
Raised JVP
Oxygen sats less than 92%

Assessment is measurement of ABG on 2 ocassions at least 3 weeks apart. Offer oxugen therapy to those with a p02 of less than 7.3 or less than 8 with
1. Polycythemia
2. Nocturnal hypoxia
3. Peripheral oedema
4. Pulmonary hypertension

22

What is the most common causitive organism for an infective exacarbation of COPD?

Haemophilus influenzae
Strep pneumonia
Moraxells catarrhalis

23

Where is the gene for alpha 1 anti trypsin found?

Chromosome 14

24

How is alpha 1 anti trypsin inherited?

Autosomal recessive/Co domiannt

25

What is the management for alpha 1 anti trypsin deficiency?

Supportive - bronchodilators
IV alpha 1 anti trypsin deficiency
Surgery - volume reduction or lung transplant