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Flashcards in ASTHMA and COPD Deck (31)
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1

aetiology of airway obstruction in COPD

outside to inside
- alveolar walls
- smooth muscle
- mucosa
- lumen

2

what does atopic mean?

allergic

3

characteristics of athma

- airway hyper-responsiveness
- reversible airflow obstruction
- airway inflammation

4

evolution of asthma

- bronchoconstriction
- chronic airway inflammation
- airway remodelling - laying down collagen scar tissue

5

what happens to the basement membrane during remodelling?

it thickens

6

what happens to the submucosa during remodelling?

collagen deposition

7

what happens to the smooth muscle during remodelling?

hypertrophy

8

which interleukin allows TH2 cells to activate B cells?

IL-4

9

Which interleukin causes eosinophils to differentiate and activate?

IL-5

10

Which interleukins cause mast cells to express IgE receptors?

IL-4 and IL-13

11

what is the inflammatory cascade in asthma?

1. genetic predisposition
2. eosinophilic inflammation = anti inflammatory medication eg corticosteroids, cromones, theophylline
3. meditaors TH2 cytokines = antileukotrines or antihistamines eg anti-IgE, anti-interleukin-5
4. twitchy smooth muscle (hyperreactivity) = brochodilators eg B2 agonists, muscarinic antagonists

12

what drugs will melt away eosinophil inflammation and restore mucosal architecture?

steroid inhalers

13

clnical syndrome of asthma

- episodic symptoms and signs
- diurinal variability - nocturnal / early morning
- non-productive cough, wheeze
- triggers
- associated atopy - increased IgE (rhinitis, conjunctivitis, eczema)
- blood eosinophilia > 4%
- repsonsive to steroids or beta agonists
- family history
- wheezing due to turbulent airflow

14

diagnosis of asthma

- history and examination
- diurinal variation of peak flow rate
- reduced forced expiratory ration (FEV1/FVC < 75%)
- reversibility to inhaled salbutamol (>15%)
- bronchospasm on triggers

15

COPD disease process

inflammation + mucociliary dysfunction + tissue damage = development of obstruction and ongoing disease progression

16

characteristics of COPD

- exacerbations
- reduced lung function

17

symptoms of COPD

- progressive breathlessness
- worsening quality of life
- non-atopic
- daily productive cough
-

18

what happens when you smoke (COPD)?

1. cigarette smoke
2. activated alveolar macrophage release neutrophil chemotactic factor cytokines, mediators,
3. proteases are then released which break down connective tissue and stimulate mucus hyper secretion
4. progressive airflow limitation

these steps lead to emphysema (alveolar wall destruction) and chronic bronchitis (mucus hyper secretion)

19

chronic bronchitis

- chronic neutrophilic inflammation
- mucus hypersecretiun
- mucociliary dysfunction
- altered lung microbiome
- smooth muslce psam and hypertrophy
- partially reversible

20

emphysema

- alveolar destruction
- impaired gas exchange
- loss of bronchial support
- irrreversible

21

asthma COPD overlap syndrome

COPD with blood eosinophils > 4%
- responds better to ICS with regard to exacerbation reduction
- difficult to distinguish between smokers who have airway remodelling

22

FVC in asthma and COPd

COPD FVC = reduced
asthma FVC = normal

23

Asthma list

Non smokers
Allergic
Early or late onset
Intermittent symptoms
Non productive cough
Non progressive
Eosinophilic inflammation
Diurnal variability
Good corticosteroid response
Good bronchodilator response
Preserved FVC and TLCO
Normal gas exchange

24

COPD list

Smokers
Non allergic
Late onset
Chronic symptoms
Productive cough
Progressive decline
Neutrophilic inflammation*
No diurnal variability
Poor corticosteroid response*
Poor bronchodilator response
Reduced FVC and TLCO
Impaired gas exchange

25

what is the diagnosis of sever asthma?

- peak flow <50%
- tachycardia >110bpm
- >25 resp/min
- cant complete sentences

26

what is the diagnosis of moderate acute asthma?

- PEV>50-75%
- increasing symptoms

27

what is the diagnosis of acute severe asthma?

- PEF 33%-50%
- resp rate > 25
- heart rate > 110
- inability to complete sentences

28

what is the diagnosis of life-threatening asthma?

- PEF <44%
- O2 < 92%
- altered conscious level
- cyanosis
- exhaustion
- hypertension
- silent chest

29

what is panacinar emphysema?

alpha 1 antitrypsin
- resp bronchiole to alveoli enlarged

30

what is centriacinar emphysema?

- coal dust and tobacco
- enlargement of resp bronchiole