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20 Cards in this Set
- Front
- Back
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Asthma (definition)
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- Eosinophilia airway inflammation
- paroxysmal - symptoms come and go - bronchoconstriction - hyper-responsiveness to certain triggers |
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Pathology of asthma
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- eosinophilic damage = increased mucous production and SM proliferation
- chronic inflammation leads to increased mucous production and smooth muscle proliferation - fibroblastic remodelling |
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Phys Exam findings of asthma
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- diffuse, bilateral polyphonic wheeze
- +/- atopy |
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FEV1/FVC
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- determines whether obstructive process
- normal >80% - <70% (0.7) = OBSTRUCTIVE |
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FEV1
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- decreases 15-30 ml/yr after 30 (2x^ in smokers)
- determines severity of obstruction - 70-79% = mild - 60-69% = moderate - 50-59% = mod/sev - 35-49% = severe - <35% = VERY severe |
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Asthma Control Parameters
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- <4d/wk daytime symptoms
- <1n/wk nighttime symptoms - normal physical activity - mild and infrequent exacerbations - no absences from work or school - <4 doses of SABA /wk - FEV1 or pEF >90% pb - 10-15% PEF diurnal variation - sputum eosinophils = <2-3% |
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Treatment of asthma
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Ist line:
- SABA |
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COPD pathology
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- neutrophilic inflammation; CD8+ Tcell response
- recruitment into airways of neutrophils and cytokines = enzymatic damage from particulate - mucous hypersecretion - remodelling - loss of alveolor support structures/elastic recoil - gas trapping - hyperinflation |
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PFT changes associated with COPD
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- FEV1 <80%
- FEV1/FVC ratio <70% (obstructive) - ^ FRC (loss of elastic recoil) - ^ RV (gas trapping) |
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COPD stages by symptoms
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Mild - SOB hurrying or up slight hill
Moderate - SOB needing to stop at 100m Severe - SOB on ADLs |
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Only therapies in COPD to decrease mortality
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- smoking cessation
- oxygen therapy |
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Comprehensive Mgmt for COPD
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- education
- smoking cessation - exercise - LAAC - LABA - SAAC for AE |
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What is the benefit of the air chamber on a puffer?
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- deliver meds to lungs by an additional 21%
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SABA (eg Salbutamol)
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- reliever and prevention for exercise
- MOA - ^ cAMP = relaxation of SM |
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ICS
Eg. Fluticasone |
Inhaled Corticosteroids
- controller - must be taken every day - limit and prevent further inflammation - decrease hyper-responsiveness - ONLY ASTHMA MED PROVEN TO DECREASE MORTALITY |
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Signs and Symptoms of ILD
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- dyspnea
- non-productive cough - crackles - oxygen desaturation |
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PFT changes for ILD
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- restrictive pattern
- low lung volumes - low DLCO |
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IPF
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- MOST COMMON form of IPF
- interstitial pneumonia pattern on CXR -worse at bases - fibrosis with very little inflammation - >50 yo, M - velcro crackles - CLUBBING |
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Sarcoidosis
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- multisystemic dz w thoracic involvement
- EP symptoms - Lofgren's syndrome: LA; erythema nodosum; polyarthritis - non-caseating granulomas - tx with corticosteroids |
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Chronic Bronchitis
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- productive cough on most days for at least 3 consecutive months in successive years
- obstruction d/t narrowing of the airway lumen by mucosal thickening |
