Obstructive Lung Disease

Question 1

In obstructive disorder what is the FEV1, FVC and FEV1/FVC radio?

Answer 1

FEV1 - Reduced
FVC - usually reduced but to a lesser extent.
Ratio - Reduced (<0.7)

Question 2

In restrictive disorder what is the FEV1, FCV and FEV1/FCV radio?

Answer 2

FEV1 - Reduced,
FVC - Reduced
The ratio is normal (>0.7)

Question 3

Define:

• FEV
• FEV1
• FVC

Answer 3

• FEV = Forced expiratory volume.
• FEV1 = Amount of air forced out per second.
• FVC = Forced vital capacity

Question 4

What is the FEV1/ FVC ratio a measure of and what is normal?

Answer 4

It is a measure of airflow obstruction, above 0.7 is normal

Question 5

When does hypoxia tend to occur?

Answer 5

When the V/Q ratio is mismatched.

Question 6

What are some common obstructive lung diseases?

Answer 6

• Asthma
• COPD
• Bronchiectasis
• Cystic Fibrosis

Question 7

Describe the difference between asthma and COPD?

Answer 7

Asthma - Non-smoking related, history of atopy, tends to present in younger patients, intermittent, non-progressive, eosinophil infiltration.

COPD - Smokers, non-allergic, occurs in over 50s, chronic, progressive decline and neutrophils

Question 8

What is asthma?

Answer 8

Clinical diagnosis which should be considered when a patient presents with one of the following symptoms:
- Wheeze, breathlessness, chest tightness and cough. Especially if diurnal variation and symptoms of atopy

Question 9

Describe the pathophysiology of asthma?

Answer 9

• Airway narrowing/obstruction.
• Airway hyper-responsiveness.
• Airway inflammation

Question 10

What are important mediators in asthma?

Answer 10

Leukotrienes, interleukins and tissue damaging eosinophil proteins. T-lymphocytes in allergic asthma

Question 11

What are some genetic predisposition and triggers for asthma?

Answer 11

• Viral,
• Allergens, eg, animal dander, dust mites, pollen and fungi.
• Food/nutrition,
• Chemicals (smoke)
• Exercise

Question 12

What are some of the non-pharmacological treatments for asthma?

Answer 12

• Achieve and maintain a normal BMI if overweight.
• Breathing exercise programmes.
• Stop smoking (patient and/or household members)

Question 13

What is the pharmacological treatment for asthma?

Answer 13

Beta(2) agonists and steroids

Question 14

Describe the clinical features of life-threatening asthma

Answer 14

Altered consciousness, exhaustion, arrhythmias, hypertension and cyanosis. SpO2 < 92%

Question 15

What are the clinical features of near fatal asthma?

Answer 15

Raised PCO2, and/or requires ventilation

Question 16

Describe the immediate management of acute severe asthma

Answer 16

Immediate treatment;

• Oxygen (maintain sats @ 94-98%),
• SABA (salbutamol or terbutaline) via nebuliser.
• IV steroid (hydrocortisone).
• Add or take away antibiotics or muscarinic antagonists

Question 17

What treatment is given to patients with severe acute asthma that has not responded to immediate treatment?

Answer 17

IV magnesium sulphate (bronchodilator and anti-inflammatory)

Switch from nebulised to IV salbutamol or IV methylxanthine. Continue to monitor blood gases and patient exhaustion.

Question 18

What is COPD characterised by?

Answer 18

Persistant airflow limitation that is usually progressive and associated with an enhanced inflammatory response in the airways/lungs to gases.

Question 19

What are some of the main causes of COPD?

Answer 19

• Tobacco smoking,
• Individual susceptibility,
• In/outdoor pollution from biomass fuels,
• Genetic abnormalities (alpha antitrypsin deficiency),
• Abnormal lung function,
• Age and sex (females at greater risk)

Question 20

Describe the effects of cannabis with lung disease

Answer 20

• It has a different pattern of inhalation meaning people breath in deeper which can mean smokers getting COPD at a younger age. Joints can also be contaminated with aspergillosis.

Question 21

Describe features of alpha 1 antitrypsin deficiency?

Answer 21

• Increases the risk of lung and liver disease.

- It is an enzyme that is produced in the liver which counteracts proteinases

Question 22

Describe how smoking results in emphysema

Answer 22

It causes a decrease in alpha1 antitrypsin activity and causes the attraction of inflammatory cells (causing release of elastase which inhibits the action of alpha antitrypsin resulting in a deficiency) both resulting in a destruction of elastic fibres in the lung and emphysema.

Question 23

What is the pathophysiology of COPD?

Answer 23

• Inflammation and fibrosis of the bronchial wall.
• Hypertrophy of submucosal glands and hypersecretion of mucous.
• Loss of elastic parenchymal lung fibres.

Question 24

When should you consider diagnosing someone with COPD?

Answer 24

Breathlessness, chronic cough/sputum production and exposure to risk factors.

Question 25

Describe the clinical presentation of COPD

Answer 25

- Gradual onset, - Around 50/60s, - Chronic cough, - Sputum production which is typically worse in the morning. - Increasing SOB, - Diminishing exercise tolerance, - History of exposure to risk factors

Question 26

Describe the clinical presentation of a 'pink puffer'

Answer 26

- Increased SOB but little cough, - Pursed lips, - Barrel chest due to air trapping, - Use of accesory muscles, - Decreased breath sounds

Question 27

Describe clinical symptoms of a 'blue bloater'

Answer 27

- Blue = cyanosed, - Bloater - signs of right heart failure, - Expectorant cough, - Crackles and wheese

Question 28

What are some systemic symptoms of COPD?

Answer 28

- Weight loss, - Skeletal muscle dysfunction, - CVS disease, - Depression - Osteoporosis

Question 29

What are the 5 fundamentals of COPD?

Answer 29

1. Support to stop smoking, 2. Pneumococcal and flu vaccination. 3. Pulmonary rehab. 4. Codevelop a personalised self management plan, 5. Optimise co-morbidities

Question 30

What is Domiciliary oxygen therapy?

Answer 30

Non-invasive positive pressure ventilation which is given to patients with a P02 <7.3-8 kPa. They must have stopped smoking.

Question 31

What are the different types of restrictive lung disease?

Answer 31

1. Idiopathic pulmonary fibrosis, 2. Hypersensitivity pneumonitis, 3. Sarcoidosis, 4. Connective tissue disease related lung disease

Question 32

What will you find on clinical examination

Answer 32

PC - Dysponea, dry cough and malaise. Exam - Bilateral fine crackles.

Question 33

What are some of the features of restrictive lung disease?

Answer 33

Decreased FVC and FEV1 however the V/Q ratio is maintained. Care is often palliative