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DPT 528 > Chronic Obstructive Pulmonary Diseases > Flashcards

Chronic Obstructive Pulmonary Diseases Flashcards

1
Q

does obstructive disease produce obstruction of expiratory or inspiratory flow?

A

expiratory

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2
Q

airflow obstruction can be related to:

A

retained secretions

inflammation of muscosal lining or airway walls

bronchiole constriction

weakening of support structures of airway walls

air sac destruction

air sac overstimulation w/destruction of surfactant

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3
Q

with obstructive disease, there is a decrease in the size of what structures?

A

bronchiole lumens

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4
Q

with obstructive disease, there is an increase in the size of what structures?

A

alveolar sacs

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5
Q

what conditions lead to decreased size of the bronchiole lumens and increased size of the alveolar sacs and resistance to expiratory flow?

A

COPD and obstructive diseases

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6
Q

what leads to hyperplasia of the mucus secreting cells, reactive airways, destruction of terminal bronchioles, and actual alveolar sacs destruction

A

obstructive disease

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7
Q

what disease is associated with enlarged submucosal glands?

A

chronic bronchitis

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8
Q

what disease is associated with smooth muscle constriction?

A

asthma

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9
Q

what disease is associated with destroyed alveolar walls and fused into one large sac?

A

emphysema

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10
Q

what is the most common cause of COPD?

A

smoking

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11
Q

can genetics cause COPD?

A

yes

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12
Q

what is one pack year?

A

smoking 20 cigarettes a day for a year

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13
Q

is how many cigarettes you smoke or how old you were when you started smoking more important?

A

how old you were when you started smoking

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14
Q

what is the cycle involved in COPD starting with inhalation exposure?

A

inhalation exposure –> inflammatory response–> increase in protease activity and decrease in anti protease activity–> breakdown of elastin and CT–> hyperplasia of mucus-secreting cells

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15
Q

what are the physical impairments of COPD?

A

inflammation, decreased elastic lung recoil, decreased O2 perfusion, rib cage takes on barrel shape, diaphragm flattens, pelvic floor dysfxn

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16
Q

why is there a decrease in O2 perfusion in COPD?

A

bc there is a lack of gas exchange from decrease elastic recoil

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17
Q

why is there pelvic floor dysfxn in COPD?

A

bc they have more forceful exhalations that increase abdominal pressure and puts pressure on the pelvic floor

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18
Q

what are the accessory muscles of inspiration?

A

SCM, scalenes, upper trap, and pec group

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19
Q

t/f: decreased strength of both skeletal and respiratory musculature are “independently associated w/poorer exercise capacity and lower extremity functioning across the spectrum”

A

true

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20
Q

what is usually the cause of an inability to exercise in COPD?

A

LE weakness

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21
Q

what factors affect aerobic metabolism and poor muscle endurance?

A

a shift from type 1 to type 2

reduction in mitochondrial density per fiber bundle

reduction in capillary density

high pro-inflammatory mediators

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22
Q

what are the psychological impairments of obstructive disease?

A

SOB causes anxiety and depression which leads to sickness and further weakness

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23
Q

what disease leads to lung hyperinflation?

A

obstructive disease

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24
Q

what are common physical signs of obstructive lung disease?

A

elevation of the shoulder girdle

horizontal ribs

barrel-shaped thorax

low, flattened diaphragm

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25
Q

would radiographic mechanical changes in structures of obstructive lung disease be found early on?

A

no, only in ppl with severe disease

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26
Q

are the results of radiographs or spirometry more important in early obstructive lung disease?

A

spirometry

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27
Q

what is the gold standard for dx of bronchiectasis? (KNOW THIS)

A

CT

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28
Q

what are the symptoms of obstructive lung disease?

A

dyspnea on exertion, esp during functional activities

may have increased anxiety levels

secretion production and cough

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29
Q

is COPD associated with larger or smaller lung volumes and capacities?

A

larger

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30
Q

is vital capacity normal or increased/decreased in obstructive disease ?

A

normal to decreased

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31
Q

are residual volume and functional residual capacity normal or increased/decreased in obstructive disease?

A

increased

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32
Q

is total lungs capacity normal or increased/decreased in obstructive disease?

A

normal to increased

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33
Q

is the RV/TLC ratio normal or increased/decreased in obstructive disease?

A

increased

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34
Q

does FEV1/FVC ratio increase or decrease with disease progression of COPD?

A

decreases

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35
Q

what is the FEV1/FVC ratio in obstructive disease?

A

<70%

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36
Q

what is normal FEV1/FVC ratio?

A

75%

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37
Q

with obstructive disease, is there a difference with in PFTs pre and post bronchodilators?

A

there can be

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38
Q

what % of change in PTFs pre and post bronchodilators would indicate a meaningful change?

A

12%

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39
Q

t/f: the use of bronchodilators prior to exercise w/PT may improve pt’s exercise tolerance

A

true

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40
Q

COPD is the __ leading cause of death

A

4th

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41
Q

t/f: COPD is preventable and treatable

A

true

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42
Q

what is COPD?

A

chronic airflow limitation caused by mix of parenchymal alveolar disease (emphysema) and small airway disease (obstructive bronchiolitis)

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43
Q

COPD is a combo of what 2 obstructive diseases?

A

emphysema and obstructive bronchiolitis

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44
Q

what are the risk factors for COPD?

A

cigarette smoking, air pollution, inhalation of smoke or noxious particles

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45
Q

what is the most common risk factors for COPD?

A

cigarette smoking

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46
Q

what is emphysema?

A

condition of the lungs characterized by destruction of alveolar walls and enlargement of air spaces distal to the terminal bronchioles

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47
Q

what are the subtypes of emphysema?

A

centrilobular (centriacinar)

panlobular (panacinar)

distal acinar (paraseptal)

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48
Q

what is the most common cause of emphysema?

A

heavy smoking

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49
Q

what is the most common subtype of emphysema?

A

centrilobular

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50
Q

t/f: the lungs can repair itself with emphysema

A

true

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51
Q

what is effected by centrilobular emphysema?

A

the central part of the respiratory unit

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52
Q

what is effected by panlobular emphysema?

A

the distal component of the respiratory unit

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53
Q

what is affected by distal acinar emphysema?

A

closer to the septum

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54
Q

how does a patient with emphysema present?

A

older

thin

severe dyspnea

quiet chest

hyperinflation

flat diaphragm

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55
Q

how does a patient with chronic bronchitis present?

A

overweight

cyanotic

elevated hemoglobin

peripheral edema

rhonchi and wheezing

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56
Q

what is chronic bronchitis?

A

presence of a productive cough for 3 months in each of 2 successive years provided that the other causes of mucus production have been ruled out

hypertrophy of submucosal glands

hypersecretion of mucus

57
Q

does the hypersecretion of mucus in chronic bronchitis begin in large or small airways?

A

large airways first, then small airways

58
Q

what is the Reid index?

A

the ratio of gland to bronchial wall thickness?

normally 3:1

59
Q

what is a normal Reid index?

A

3:1

60
Q

how high can a Reid index be in chronic bronchitis?

A

8:10

61
Q

what is the pathophysiology of COPD?

A

decreased elastic recoil

trapped mucus

air can’t get out

62
Q

what are the symptoms of COPD?

A

productive cough

dyspnea

63
Q

describe the cough associated with COPD?

A

productive

starts intermittently and progresses to daily

sputum initially thin and watery and becomes more purulent

purulent during period of infection

64
Q

describe the dyspnea associated with COPD?

A

increased effort to breath, heaviness, air hunger, and gasping

persistent and progressive

1st noted with strenuous exercise and progresses to w/walking and functional activities

65
Q

expiration of greater than ___ seconds is abnormal

A

4

66
Q

what are the signs for COPD?

A

barrel chest

flattened hemidiaphragms

tripoding

pursed lip breathing

central cyanosis

jugular vein distention

ankle swelling

67
Q

what are the diagnostic tests for COPD?

A

auscultation

breath sounds

CT scan for early detection

68
Q

in COPD, what would you hear upon auscultation?

A

prolonged expiratory phase

possible wheezing on expiration

69
Q

what breath sounds are associated with COPD?

A

diminished breath sounds in all lung fields

rhonchi and localized wheezing with secretions

70
Q

what is tripoding?

A

leaning over to try to catch your breath, commonly seen in COPD

71
Q

in the advanced stages of COPD, what additional signs would be present?

A

central cyanosis

jugular vein distention

ankle swelling

72
Q

what would you see on a CT of COPD?

A

focal emphysema and air trapping

73
Q

describe stage 1 (mild) COPD

A

FEV1: >80

FEV1/FVC: <0.7

chronic cough, sputum

74
Q

describe stage 2 (moderate) COPD

A

FEV1: 50-80

FEV1/FVC: <0.7

chronic cough, sputum, dyspnea

75
Q

describe stage 3 (severe) COPD

A

FEV1: 30-50

FEV1/FVC: <0.7

chronic cough, sputum, dyspnea

76
Q

describe stage 4 (very severe) COPD

A

FEV1: <30

FEV1/FVC: <0.7

chronic cough, sputum, dyspnea

77
Q

a decrease in what levels would characterize disease progression in COPD?

A

O2

78
Q

with emphysema, will PaCo2 initially be high, low, or normal?

A

normal

79
Q

with chronic bronchitis, will PaCo2 increase or decrease with progression?

A

increase

80
Q

when do blood gas abnormalities usually worsen?

A

during exercise, sleep, and acute exacerbations

81
Q

PaO2 of <60 with or w/o PaCo2 of >50 is indicative of what?

A

respiratory failure

82
Q

what is the main goal in medical treatment of COPD?

A

relief of symptoms

83
Q

what are the goals of medical treatment for COPD?

A

relief of symptoms

disease progression prevention

improve exercise tolerance

enhance health status

prevent and treat complications

reduce mortality

84
Q

what is hematocrit of >55% indicative of?

A

polycythemia

85
Q

what is the medical treatment for COPD?

A

smoking cessation

pharmacotherapy

flu vaccine

treatment for sleep disorders

supplemental o2 in later stages

pulmonary rehab and exercise training

surgical excision of bullae or lung volume reduction surgery (LVRS)

bronchodilators, antiinflammatories, combo, or antibiotics

86
Q

what is the prognosis for COPD?

A

progressive disease with expected worsening over time

87
Q

what is the BODE index?

A

body mass

obstruction

dyspnea

exercise

score of 7-10 has high mortality rate

88
Q

what are implications for PT treatment with a pt with COPD?

A

secretion clearance

controlled breathing at rest and with activity

ambulation w/rolling walker

education on use of recovery from SOB positions

endurance training

strength training

89
Q

if we have a pt with COPD, when would we not want to do secretion clearance?

A

when they have hemoptysis (bloody cough)

90
Q

what is bronchiectasis?

A

irreversible dilation of the bronchia w/ chronic inflammation and infection

often idiopathic or associated with prior lung infection/injury

distortion of conducting airways, thickening, herniation, or dilation

91
Q

what is localized bronchiectasis?

A

due to intraluminal obstructive process

inhaled foreign body

tumor

92
Q

what is diffuse bronchiectasis?

A

underlying systemic cause

93
Q

what are the 3 mechanisms of bronchiectasis?

A

1) bronchial wall injury/structural weakness

2) traction from adjacent lung fibrosis

3) bronchial lumen obstruction

94
Q

what mechanism of bronchiectasis results following an infection or inhalation accident or genetic condition?

A

bronchial wall injury/structural weakness of bronchial walls

95
Q

what mechanism of bronchiectasis results following fibrotic changes from restrictive lung disease?

A

traction from lung fibrosis

96
Q

what mechanism of bronchiectasis results following a slow growing tumor in the airway and fibrotic changes?

A

bronchial lumen obstruction

97
Q

what conditions are associated with bronchiectasis due to traction?

A

restrictive pulmonary diseases, sarcoidosis, usual interstitial pneumonitis (idiopathic pulmonary fibrosis), infections, tuberculosis, and radiation fibrosis

98
Q

what are the triad of symptoms associated with bronchiectasis?

A

1) cough
2) sputum production
3) hemoptysis

99
Q

when is sputum greatest in bronchiectasis?

A

in the morning

100
Q

what are the diagnostic tests for bronchiectasis?

A

HRCT (GOLD STANDARD)

PFTs

blood work

sputum testing

gastroesophageal evaluation

101
Q

what is the gold standard for diagnosing bronchiectasis? (KNOW THIS)

A

HRCT

102
Q

what is the criterion for dx of bronchietasis on HRCT?

A

internal luminal diameter of one or more bronchi exceeds that of adjacent pulmonary artery

103
Q

what is the signet ring sign? (KNOW THIS)

A

cylindrical, varicose, and saccular

dilated bronchus and adjacent arteriole seen on CT

104
Q

what is the most severe form of bronchiectasis?

A

saccular

105
Q

what type of bronchiectasis may form a honeycomb pattern?

A

saccular and cystic

106
Q

what is being looked for in a sputum test for bronchiectasis?

A

Haemophilus influenzae and Peudomonas aeruginosa

107
Q

what will blood work show in bronchiectasis?

A

ventilation-perfusion mismatch

108
Q

what would be heard in a pt with bronchiectasis upon auscultation?

A

crackles over the involved lobes

rhonchi during periods of mucus retention

shallow breathing to avoid coughing

109
Q

what is the goal of medical management of bronchiectasis?

A

decrease the # of exacerbations and improve QOL

110
Q

how are acute exacerbations of bronchiectasis treated?

A

with antibiotics if needed

111
Q

what is the long term management for bronchiectasis?

A

nebulizer meds

bronchodilators as needed

pulmonary hygiene

112
Q

what does the prognosis for bronchiectasis depend on?

A

the underlying disease/condition

113
Q

what two obstructive diseases have the poorest prognosis?

A

CF and bronchiectasis

114
Q

what are the prevention measures for bronchiectasis?

A

genetic screening

115
Q

what are the implications for PT treatment of bronchiectasis?

A

secretion clearance

controlled breathing

strength and endurance training

116
Q

what is CF (cystic fibrosis)?

A

a multisysmteic disease affecting organs that have epithelial surfaces

mucus stasis in conducting airways of lungs, nasal sinuses, sweat glands, small intestine, pancreas, and biliary system

failure of the airways to clear mucus

117
Q

what systems are most affected by CF?

A

pancreatic and pulmonary

118
Q

CF is characterized by the abnormal transport of ___ and ___

A

salt, water

119
Q

what are the symptoms of CF?

A

failure of the airways to clear mucus normally

persistent cough that becomes productive with tenacious, purulent, green sputum

recurrent lung infiltrates

meconium ileus at birth

malabsorption of nutrients

maldigestion and fecal impaction in terminal ileum

failure to thrive with steatorrhea (fatty stool)

pancreatic insufficiency

120
Q

what are the diagnostic tests for CF?

A

sweat test (looks for elevated chloride)

newborn screen

radiographic tests (obstructive and restrictive signs)

ABGs (decreased gas exchange)

121
Q

is CF obstructive or restrictive?

A

both

122
Q

what are the goals of medical management of CF?

A

controlling lung infection, promoting mucus clearance, improving nutritional status, pancreatic status, and nutritional supplementation

123
Q

what is the prognosis for CF?

A

dramatic increase in median age of survival

124
Q

how is CF prevented?

A

genetic screening

screening of CF carrier status

125
Q

what are the implications for PT with CF?

A

secretion clearance techniques

controlled breathing techniques

exercise and strength training

inspiratory muscles training

thoracic stretching exercises

postural reeducation

126
Q

what is asthma?

A

chronic inflammatory disorder of airways

“episodic” obstructive lung condition

127
Q

what causes asthma attacks?

A

viral/allergen exposure, exercise, inhalation of cold air

128
Q

what are the symptoms of asthma?

A

wheezing, chest tightness, SOB

129
Q

what are the diagnostic tests for asthma?

A

PFTs to evaluate the current fxn and reversibility of the obstruction after bronchodilators administration

130
Q

what are the special types of asthma?

A

seasonal, exercise-induced, asthmatic bronchitis

131
Q

the following lung fxn is indicative of what step of asthma? :

FEV1 or PEF ≤60% predicted

PEF variability >30%

A

step 4 (severe persistent)

132
Q

the following lung fxn is indicative of what step of asthma? :

FEV1 or PEF >60% to <80% predicted

PEF variability >30%

A

step 3 (moderate persistent)

133
Q

the following lung fxn is indicative of what step of asthma? :

FEV1 or PEF ≥80% predicted

PEF variability 20% to 30%

A

step 2 (mild persistent)

134
Q

the following lung fxn is indicative of what step of asthma? :

FEV1 or PEF ≥80% predicted

PEF vari

A

step 1 (mild intermittent)

135
Q

what is the medical management for asthma?

A

emphasis on long term management

objective measures of fxn and monitoring

ID and elimination of causes

comprehensive pharmacological therapy

therapeutic partnership

136
Q

what % of children with asthma will continue to have symptoms into adulthood?

A

50%

137
Q

how is asthma prevented?

A

adhering to medical and pharmacological recommendations

avoidance of personal asthma-triggering substances

138
Q

what are the implications for PT with asthma?

A

intervention shouldn’t begin until medical regimin has been established

secretion clearance

controlled breathing

exercise and strength

thoracic stretching

postural reeducation

DPT 528 (9 decks)

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