10. Small Group Smoker w SOB

Question 1

when determining if something is obstructive or restrictive, what to look at first?

Answer 1

FEV1/FVC ratio.

if obstructive, then FEV1 to see how significant the obstruction is

Question 2

in obstructive disease, hyperresonance and diminished breath sounds argue for CB, emphysema, or asthma?

Answer 2

emphysema

Question 3

could emphysema, CB, and asthma all produce an obstructive pattern with incr RV?

Answer 3

yes

Question 4

in obstructive disease, airflow obstruction and diminished diffusion capacity argue for CB, emphysema, or asthma?

Answer 4

emphysema

Question 5

with emphysema, why might you palpate a liver edge? why would the diaphragm be flat?

Answer 5

due to the incr weight of the lungs (which have lost elastic recoil) on the abdominal contents.

Question 6

in emphysema, will you see VQ mismatch?

Answer 6

no, because both the alveoli and capillaries are destroyed at the same time.

Question 7

hyperinflation: why does it occur? benefits/problems?

Answer 7

adaptive because with a flow limitation (ie obstructive pattern) the only way to incr flow rate is to breathe at a higher lung volume. problem is that the resp system becomes less compliant as lung vol increases, and strength/mech advantage of inspiratory muscles are lost.

Question 8

what can account for dyspnea at a relatively low level of hypoxia?

Answer 8

if you are breathing at a high lung volume constantly, the incr work of the resp muscles sends a signal that you are dyspneic.

Question 9

why would patients with COPD breathe with pursed-lips?

Answer 9

because the added pressure on the airway helps reduce dynamic compression - keeps airways open longer

Question 10

should emphysema respond to bronchodilator therapy?

Answer 10

not really - problem is with alveoli, which bronchodilators don’t affect.

Question 11

what are treatment options with emphysema?

Answer 11

not many options: bronchodilators rarely help (though they help with asthma, and somewhat with chronic bronchitis). lung reduction surgery to keep the hyperinflation problems down might help

Question 12

why can you see a patient with COPD, with very minimal blood gas abnormalities?

Answer 12

this situation tends to occur more in emphysema than CB. there are actually very few low V/Q (shunt) areas so oxygenation tends to be preserved.

Question 13

in emphysema, how are the areas of high V/Q (ie dead space) compensated for?

Answer 13

by increasing ventilatory rate