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Phase 2 Kirsty McLauchlan and Vicky Cox

Respiratory. Phase 2 Kirsty McLauchlan and Vicky Cox. The Peer Teaching Society is not liable for false or misleading information…. Aims. Asthma COPD Pulmonary Fibrosis. The Peer Teaching Society is not liable for false or misleading information…. Introduction.

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Phase 2 Kirsty McLauchlan and Vicky Cox

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  1. Respiratory Phase 2 Kirsty McLauchlan and Vicky Cox The Peer Teaching Society is not liable for false or misleading information…

  2. Aims • Asthma • COPD • Pulmonary Fibrosis The Peer Teaching Society is not liable for false or misleading information…

  3. Introduction The Peer Teaching Society is not liable for false or misleading information…

  4. Asthma • A chronicrelapsing/episodicinflammatory condition of the airways • Characterised by • Airflow limitation • Airway hyper-responsiveness • Bronchial inflammation The Peer Teaching Society is not liable for false or misleading information…

  5. Asthma - Epidemiology • 15 % of population • 5.2 million people in UK – 1.1million children • Prevalence is increasing • More in developed counties eg. UK, NZ, Australia The Peer Teaching Society is not liable for false or misleading information…

  6. Asthma – Aetiology (cause) Asthma Extrinsic Intrinsic Childhood – atopic Middle-aged Late onset – occupational - NSAID-intolerance - β-adrenoreceptor blocking agents Not immunologically mediated Type I hypersensitivity reactions The Peer Teaching Society is not liable for false or misleading information…

  7. Asthma - triggers ALLERGENS (atopy) Occupational sensitizers Viral infection Cold air Atmospheric pollution Exercise Emotion Drugs – NSAIDs, β-adrenoreceptor blocking agents Irritant dusts, vapor, fumes (cigarette smoke) The Peer Teaching Society is not liable for false or misleading information…

  8. Asthma – what is Atopy? • Type of hypersensitivity – (Type 1) • Runs in families • Have increased IgE antibodies – allergen specific • Can be caused by environmental factors • Early exposure to allergens • Maternal smoking • Hygiene hypothesis The Peer Teaching Society is not liable for false or misleading information…

  9. Occupational Asthma latex dyes animals paints Flour Wood dust bleach Antibiotics The Peer Teaching Society is not liable for false or misleading information…

  10. Asthma - Pathogenesis AIRWAY OBSTRUCTION REMODELING Inflammation Mucus and oedema Bronchoconstriction Epithelium Smooth muscle Basement membrane The Peer Teaching Society is not liable for false or misleading information…

  11. Asthma 1. INFLAMMATION The Peer Teaching Society is not liable for false or misleading information…

  12. Asthma – 2. Bronchoconstriction • IgE = bronchoconstriction • By blocking β-adrenoreceptor in smooth muscle surrounding airways This is why β-adrenoreceptor blockers (e.g propranolol) can trigger asthmatic response! The Peer Teaching Society is not liable for false or misleading information…

  13. Asthma 3. oedema + mucus The Peer Teaching Society is not liable for false or misleading information…

  14. Asthma - remodeling • Hypertrophy • Contractility • Loss of cilia • Goblet cells • = more infection • + more mucus Deposition of collagen = thickened basement membrane The Peer Teaching Society is not liable for false or misleading information…

  15. Asthma – Clinical Features • Episodes/attack of shortness of breath and wheezing • Bilateral, polyphonic, expiratory, widespread • Worse at night • Cough The Peer Teaching Society is not liable for false or misleading information…

  16. Asthma – investigations • Spirometry – reduced FEV1 • PEF – reduced • 15% improvement in either after a bronchodilator indicates asthma • Exercise tests • Blood count – eosinophils • Exhaled nitric oxide - eosinophils The Peer Teaching Society is not liable for false or misleading information…

  17. Asthma - Treatment • Controlling extrinsic factors • Long term treatment • Treatment of acute attack The Peer Teaching Society is not liable for false or misleading information…

  18. Asthma - Pathogenesis AIRWAY OBSTRUCTION REMODELING corticosteroid Inflammation Mucus and oedema Bronchoconstriction Epithelium Smooth muscle Basement membrane B2-agonist The Peer Teaching Society is not liable for false or misleading information…

  19. Step-wise management salbutamol budesonide salmeterol monteleukast prednisolone The Peer Teaching Society is not liable for false or misleading information…

  20. Management of Acute Attack IV aminophylline The Peer Teaching Society is not liable for false or misleading information…

  21. Practice Questions

  22. Chronic Obstructive Pulmonary Disease • ‘A common progressive disorder characterized by airway obstruction with little or no reversibility’ • Chronic bronchitis • Empyhsema The Peer Teaching Society is not liable for false or misleading information…

  23. COPD Obstructive: - FEV1 (<80% predicted) -FEV1/FVC(<0.7 predicted) The Peer Teaching Society is not liable for false or misleading information…

  24. COPD - epidemiology • Prevalence: 10-20% of over-40s • 2.5 x 106 deaths worldwide The Peer Teaching Society is not liable for false or misleading information…

  25. COPD - aetiology • caused by long-term exposure to toxic particles • (cigarette smoking >90% of cases) The Peer Teaching Society is not liable for false or misleading information…

  26. COPD - pathophysiology Inactivation of α1-antitrypsin by cigarette smoke Widespread narrowing of small ariways Columnar cells are replaced by squamous cells Neutrophils & CD8 lymphocytes The Peer Teaching Society is not liable for false or misleading information…

  27. COPD - pathophysiology Early disease, predominantly in the small airways, is reversible. The Peer Teaching Society is not liable for false or misleading information…

  28. COPD - pathophysiology With mucous gland hypertrophy The Peer Teaching Society is not liable for false or misleading information…

  29. Chronic Bronchitis - pathophysiology • Lumen occlusion by mucus plugging • Goblet cell metaplasia • Smooth muscle hyperplasia • Distortion due to fibrosis . Airway narrowing The Peer Teaching Society is not liable for false or misleading information…

  30. Emphysema - pathophysiology • permanent enlargement of airspaces • loss of alveolar walls  reduced elastic recoil • loss of alveolar supporting structure Reduced surface for gas exchange . Airflow limitation The Peer Teaching Society is not liable for false or misleading information…

  31. Chronic Bronchitis • “cough and sputum production on most days for 3 months of 2 successive years” The Peer Teaching Society is not liable for false or misleading information…

  32. Emphysema • “ enlarged air spaces distal to terminal bronchioles, with destruction of alveolar walls” The Peer Teaching Society is not liable for false or misleading information…

  33. Symptoms of COPD • Productive cough • White or clear sputum • Wheeze • Dyspnoea The Peer Teaching Society is not liable for false or misleading information…

  34. COPD vs. Asthma COPD: - age of onset > 35 years - smoking (active or passive) - chronic dyspnoea - sputum production - minimal diurnal or day-to-day FEV1 variation The Peer Teaching Society is not liable for false or misleading information…

  35. Signs of COPD Mild disease: no signs or quiet wheeze Severe disease: - tachypnoea - prolonged expiration - use of accessory muscles - intercostalindrawing - lip-pursed expiration - poor chest expansion - hyperinflated lungs The Peer Teaching Society is not liable for false or misleading information…

  36. Signs of COPD Mild disease: no signs or quiet wheeze Severe disease: - tachypnoea - prolonged expiration - use of accessory muscles - intercostalindrawing - lip-pursed expiration - poor chest expansion - hyperinflated lungs The Peer Teaching Society is not liable for false or misleading information…

  37. Pink Puffers/Blue Bloaters Normally respiratory drive is largely initiated by PaCO2. The Peer Teaching Society is not liable for false or misleading information…

  38. Respiratory Failure • PaO2 < 8kPa • PaCO2 > 7kPa The Peer Teaching Society is not liable for false or misleading information…

  39. CorPulmonale “heart disease secondary to respiratory disease” • Pulmonary hypertension • Right ventricular hypertrophy • Right heart failure The Peer Teaching Society is not liable for false or misleading information…

  40. CorPulmonale – clinical features • Dyspnoea • Fatigue • Syncope • Cyanosis • Tachycardia • Raised JVP • RV Heave • Loud P2 • Pansystolic Murmur • tricuspic regurgitation The Peer Teaching Society is not liable for false or misleading information…

  41. COPD - Investigations • Lung Function tests (↓FEV1:FVC, ↓ PEFR) • Chest X-ray (often normal) • High-resolution CT (to show bullae in empyhsema) • Blood gases (often normal) The Peer Teaching Society is not liable for false or misleading information…

  42. COPD – Assessing Severity • British Thoracic Society/NICE COPD guidelines • Mild: FEV1 50-80% of predicted • Moderate: FEV1 30-49% of predicted • Severe: FEV1 <30% of predicted The Peer Teaching Society is not liable for false or misleading information…

  43. COPD – Treatment • General Treatments • stop smoking • encourage exercise • treat poor nutrition or obesity • influenza and pneumococcal vaccinations The Peer Teaching Society is not liable for false or misleading information…

  44. COPD - Treatment Initial Treatment Antimuscarinic (e.g. Ipratropium) or β2 agonist (e.g. Salbutamol) inhaled PRN The Peer Teaching Society is not liable for false or misleading information…

  45. COPD - Treatment The Peer Teaching Society is not liable for false or misleading information…

  46. COPD - Treatment Severe Disease LABA + Inhaled Steroid + Anticholinergic + Refer to specialist + Consider steroid trial The Peer Teaching Society is not liable for false or misleading information…

  47. COPD - Treatment Long Term Oxygen Therapy Consider LTOT if PaO2 <7.3kPa The Peer Teaching Society is not liable for false or misleading information…

  48. COPD – Acute Management The Peer Teaching Society is not liable for false or misleading information…

  49. COPD – Acute Management The Peer Teaching Society is not liable for false or misleading information…

  50. Pulmonary Fibrosis – (interstitial lung disease) • Also known as diffuse parenchymal lung disorders • Collection of disorders affecting • Alveoli • Alveolar epithelium • Capillary endothelium • And the spaces in-between The Peer Teaching Society is not liable for false or misleading information…

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