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Respiratory Disease - Coggle Diagram

- - - - Can be treated with glucoroticoids
      - Eosinophil count of >2%
      - Most common form of asthma
    - - Paucigranulocytic asthma
        
        Normal eosiniphil count (<1.9%)
        
        Normal neutrophil count
      - Neutrophilic asthma
        
        Normal eosinophil count (<1.9%)
        
        Raised neutrophil count
    - - A type of eosinophilic asthma
      - Has raised neutrophil count
  - - - IgE primes mast cells
      - Mast cells degranulate when they encounter the allergen again
      - Mast cells release histamine and propagandins which lead to smooth-muscle cell constriction in the bronchi
    - - Primarily neutrophil response
      - Potentially obesity-associated asthma
      - Smooth-muscle mediated paucigranulocytic asthma
  - - - Difficult
      - Also not all asthma comes from allergenic origin
    - - Airway smooth muscle contraction
        
        Short-acting beta2-adrenoceptor agonists (SABAs) causes rapid relief
        
        Inhaled SABA is first line treatment
        
        Frequent or regular use of SABA is associated with adverse effects
        
        Higher use of SABA is associated with adverse clinical outcomes
        
        Long-acting beta2-adrenoceptor agonists (LABAs) reduces number of exacerbations and best used in combination with glucocorticoids
      - Prevent or reverse airway inflammation
        
        Anti-inflammatory cortiocosteroids which binds hormone receptor GR and suppresses the immune response
        
        Inhaled corticosteroids decreases inflammatory cell numbers and activation as well as reducing asthma symptoms
        
        Oral cortiocosteroids is used for the most severe asthma
    - - Cytokines targeting monoantibodies
      - CXCR2 inhibitors
- - - - According to acuity of presentation
    - - Exposures
        
        Occupational
    - - History
        
        Family History
        
        Medications
        
        Exposures
        
        Environmental
        
        Occupational
  - - - FEV1
      - FVC
      - FER (FEV1/FVC)
    - - Chest X-ray
      - High resolution CT scans
  - - - Progression
- - - - Aches and pains, sore throat etc.
    - - Tiredness
      - Fever
      - Dry cough
  - - - ACE2
      - NRP1
      - TMPRSS2
      - RBD region
      - ACE2 and TMPRSS2 expression
        
        Gut
        
        Lung
        
        Human nasal epithelium
      - Genome
    - - Viral pneumonitis present in >90% of symptomatic cease 3-5 days after infection
        
        ~80% recover without specific treatment
      - Risk factors
        
        Age
        
        COPD
        
        NCDs e.g. HT, diabetes, obesity
        
        Immunodeficiency
        
        Poverty
        
        Low Vitamin D
      - Phases
        
        Early symptomatic
        
        Symptomatic
        
        Pre-symptomatic
      - ∼20% of patients deteriorate, often rapidly, ∼7 to 10 days after symptom onset
        
        25% of these patients will require mechanical ventilation
      - Outcomes
        
        Less severe
        
        Severe
        
        Differences due to:
        
        Auto-Abs against the different type I IFN subtypes
        
        Post-COVID-19 lung fibrosis
        
        Brain
        
        CNS infection
  - - - Heparan sulfate
        
        Structure
        
        ACE receptor
        
        S protein spike unit
        
        RBD
      - Domain antibodies
      - Queensland S protein vaccine
- - - - Bupropion (combination with NRT):
        Mechanism
        Reduce urge to smoke & symptoms of nicotine withdrawal
    - - Cytisine: Partial agonist but cheap
      - E-cigarettes: Potential for harm
      - Nortrytiline: Tricyclic antidepressant (pay attention to side effects)
      - Opioid receptor antagonists: Limited success & do not use now
      - Vaccinations: Need to see doctors regularly, not all people will take this
        Mechanism: Bind to the antidoies → Nicotine get to the blood stream will be blocked→ Nicotine does not get to the brain
    - - Varenicline (combination with NRT) (Champix)
        α4β2 Nicotinic Ach receptor
        Adverse effects - Nausea &GI side effects, headache, insomnia
      - Nicotine Replacement Therapy (NRT) :
        e.g. Spray, gum/inhaler/lozenge, patches,
        Maintain plasma levels of nicotine - slow remission
        Best use before stopping smoking
    - - Pharmacokinetic
      - Pharmacodynamic