Cardio, COPD & Asthma PDF

Lec 4: Airway obstructive diseases Asthma: small airway obstructive disease Allergy: inappropriate immune reaction against harmless substances Induce high level of specific IgE → inflammatory cells Characteristics: Rhinitis (related to nose): sneezing, rhinorrhea, nasal obstructi...

Lec 4: Airway obstructive diseases Asthma: small airway obstructive disease Allergy: inappropriate immune reaction against harmless substances Induce high level of specific IgE → inflammatory cells Characteristics: Rhinitis (related to nose): sneezing, rhinorrhea, nasal obstruction and pruritus Conjunctivitis Utrticaria (hives) with marked itchiness Eczema (skin) Food allergy (intestine) Bronchoconstriction: asthma ➔ Asthma is a type of allergic reaction. Characteristics: Chronic airway inflammation Variable and reversible airflow obstruction Increased airway hyperresponsiveness to a variety of stimuli Respiratory symptoms: Wheeze SOB Cough and chest tightness –vary over time and in intensity Variable expiratory flow limitation Pathophysiology: Pathogenesis of limited airflow: Increased inflammatory response → excessive mucus Smooth muscle contraction Hypertrophy of bronchial muscles → airway swell  Smooth muscles is affected by: Bronchodilation Bronchoconstriction Adrenergic control: stimulate β Cholinergic control: vagal adrenergic receptors stimulation Cyclic AMP: stimulate β Release of mediators: smooth adrenoreceptors muscle inflammatory responses Medication for airflow obstruction Bronchodilators SABA Salbutamol (ventolin) Terbutaline (bricanyl) LABA Salmeterol (Serevent) Formoterol Anticholinergic brochodilators Ipratropium (atrovent) Oxitropium Xanthines (caffeine & Theophylline (oral) theophylline) Aminophylline (IV) Magnesium sulphate (IV) → / inhibit smooth muscle contraction Anti-inflammatory Inhaled corticosteroids Beclometasone (becotide) drugs Budesonide (pulmicort) Fluticasone Oral steroid (systemic) Prednisolone Mast cell stabilisers Na cromoglycate (intal) -puffer Leukotriene receptor Montelukast (singulair) anatgonists Zafirlukast (Accolate) Combination Steriods + LABA Fluticasone + salmeterol (seretide) Budesonide + formoterol  (symbicort) Suggested controller: combination with different dosage Reliever: SABA Adult/ adolescents Children 6-11 yo Trigger factors: Intrinsic factor No specific one Host factor Genetic Obesity Sex Environment factor Allergens/ external stimuli (pollen, cold air and dust mite) Infections Tobacco smoke outdoor/ indoor air pollution Diet Diagnosis: Symptoms --> history/ examination --> spirometry with reversibility test --> treat Symptoms: Increase probability (4) Decrease probability (5) More than 1 type of symptoms Isolated cough with no other (wheeze, SOB, cough and chest symptoms tightness) Chest pain Symptoms often worse at night Chronic production of sputum Symptoms vary over time and in SOB associated with dizziness, intensity light-headedness of peripheral Symptoms triggered by tingling environmental factor/ exercises Exercise-induced dyspnoea with noisy inspiration Variable airflow limitation A. Confirm presence of airflow limitation FEV1/ FVC is reduced– 200mL ○ Children: increase > 12% predicted Excessive diurnal variability from 1-2 weeks twice-daily PEF monitoring ○ Daily amplitude*100/ daily mean, averaged  Significant increase in PEV1/ PEF after 4 weeks of controller treatment Negative testing repeat when patient is symptomatic/ without bronchodilator// refer for additional tests ( 75% predicted// after using bronchodilator  Procedure: Exercise for 6-8 min at 70-80% maximal work load → measure peck flow OR FEV1 before, at 2 mins of ex., immediately after, and 5 min. intervals thereafter Now: mixed gases provided by a machine Positive result: ○ the lowest value obtained is a >15% decrease in PF or FEV1 ○ the fall occurs at 5 to 10 mins after exercise ○ lung function returns to normal after 30 to 60 mins ➔ Oxygen therapy ➔ Salbutamol and terbutaline (SABA) are allowed for Olympic competition only if athletes passed the ‘provocation test’ ( of > 10% FEV1 after exercise) ○ Proper use of medication ○ Self-monitoring of disease Peak flow rate → variability and best lung function Symptoms and response to medication  *Admission signs for children: Inability to complete a sentence PEFR < 40% of best function Increasing exhaustion and a poor response to treatment ○ reinforcement of action plan ○ regular follow up Role of PT: assessment & treatment; motivator; counselor; monitor; organizer; educator COPD Chronic obstructive lung disease / Chronic Obstructive Pulmonary Disease COPD/ Chronic Airflow Limitation CAL Definition: Diffuse airway narrowing → increased resistance to airflow Types: Emphysema 肺氣腫 Chronic bronchitis Mixture of both Obstruction of airways Pathology: Enlargement of air spaces distal to the terminal bronchiole (terminal bronchioles, respiratory bronchioles and aveoli) --> destruction of their walls --> ↓ surface area for gas exchange Emphysema & chronic bronchitis Emphysema Chronic bronchitis Eitology/ pathology Cigarette smoke Etiology: --> stimulate macrophages Cigarette smoking --> neutrophil release Air pollution --> lysosomal elastase --> destroy lung disease Pathology: Large bronchi: *α1- antitrypsin deficiency hypertrophy of --> decrease antiprotease mucous glands (elastase inhibitor) Small airways: chronic inflammatory changes From small airways --> large bronchi Expectoration of sputum on most days for at least 3 months in the year for 2 successive years Presentation Pink puffer Blue bloaters S/S thin (use a lot of high incidence of energy to breathe) heart failure intense dyspnoea Chronic cough with small sputum volume expectoration for rarely develop years peripheral oedema purulent sputum (heart failure) peripheral oedema near normal blood a pattern of gases breathing that sets Spirometry up a back pressure ○ ↑ TLC in lung ○ Severe poor blood gases airway with low PO2 and obstruction high PCO2 Severe ariway obstruction CXR Long thin Congested lung mediastinum fields (more lung Flattened diaphragm markings) hyperinflated chest Sign of heart failure and inflammation Common symptoms of COPD increasing shortness of breath over several years chronic cough poor exercise tolerance airway obstruction over-inflated lungs impaired gas exchange Blood gases: Emphysema Chronic bronchitis Near normal Low PaO2 (blue/ cynosis) Faster respiratory rate due (In pp) High PaCO2 → CO2 to reset of respiratory centre retention → Respiratory center is → increased ventilation conditioned to the high CO2 level →  CO2 X provide the normal ventilatory drive → ventilation is stimulated by low blood oxygen level → hypoxic drive → increased O2 will resulted in reduced ventilation rate Barrel chest A sign of hyperinflation and air-trapping: not cyanotic Horizontal ribs prominent sternal -angle Increased AP diameter of the chest E.g. In patients with cystic fibrosis Diagnosis: 1. Spirometry: FEV1/ FVC