22 Obstructive Pulmonary Disorders Flashcards
1
Q
Spirometry
A
pulmonary function testing [PFT]
2
Q
common ventilatory parameters
A
1 tidal vol
2 residual vol
3 vital capacity/forced capacity
4 functional residual capacity
3
Q
when chest vol INCREASES…
A
alveolar pressure decreases
air flows INTO respiratory synth
4
Q
when chest vol DECREASES
A
alveolar pressure increases
air flows out to atmosphere which has lower pressure
5
Q
tidal volume [Vt]
A
amt that moves during a single inspiration or expiration
6
Q
residual vol [RV]
A
vol of air still in lungs after MAX expiration
-keeps alveoli fr collapsing since no smooth muscles to contract
7
Q
forced vital capacity [FVC]
A
*total vol of air exhaled
*time required for air xchange is also measured
VT + IRV + ERV
8
Q
Inspiratory + expiratory reserve [IRV and ERV]
A
addition vol you inspire or expire maximally
9
Q
FEV1
A
forced expiratory volume in 1 second
*reliable + index of OBSTRUCTIVE AIRWAY DISEASE
10
Q
Arterial Blood Gas [ABG]
A
-assesses oxygenation + acid-base status
11
Q
air flows towards ____
A
low pressure or low resistance
12
Q
normal PaO2
A
80-100 mmHg
13
Q
normal PaCO2
A
45-35 mmHg
14
Q
normal HCO3-
A
22-26 mEq/L
15
Q
normal O2 Saturation
A
96-100%
16
Q
normal pH
A
7.35-7.45
17
Q
lethal pH range
A
below 6.9
above 7.6
18
Q
PaCO2: respiratory function
A
respiratory acidosis/alkalosis
-opposite change to CO2 to pH
19
Q
hco3: renal (metab) function
A
metab acidosis or alkalosis
-same changes of HCO3 as pH
20
Q
retaining CO2 leads to
A
acidosis
21
Q
Obstructive Pulmonary Disorder
A
-manifested by increased resistance to airfloww
22
Q
Obstructive Pulmonary Disorder
diagnosis
A
INCR: residual vol, functional residual capacity,
DECR: FEV1, FEV1/FVC ratio (less than 70%)
23
Q
Bronchodilator for Obstructive Pulmonary Disorder
A
- diagnosis test should be repeated in 15-20 mins
- improvement in FEV1 after use of bronchodilator helps diagnose Asthma
- no significant improvement = COPD
24
Q
Postive Bronchodilaroe Response
A
FEV1 improves >15%
-partially reversible bronchospasms of smooth muscles (asthma, asthmatic bronchitis)
25
Restrictive Pulmonary Disorders
manifested by decreased lung expansion
26
Restrictive Pulmonary Disorders
| diagnosis
DECR: VC, TLC, FRC, RV
-normal FEV1/FVC ratio since both of them are reduced
27
the greater the DECR in lung vol, the ____ the severity of the disease
GREATER
28
Restrictive Pulmonary Disorders
| ABG
1 DECR PaO2
2 NORM/DECR Pa CO2
3 INCR Ph (alkalosis)
29
functional residual capacity [FRC]
ERV + RV
30
why is restrictive pulmonary disorder more prone to alkalosis?
- decreased PaO2 means HYPOXEMIA
- low O2 in tissue
- baroreceptors are triggered by low O2
- baroreceptors tells lungs to hyperventilate
- hyperventilation decreases CO2
- decrease in CO2 leads to alkalosis
31
Normal Range for FEV1/FVC
FEV1/FVC: 75%
FEV1: 3.0L
FVC: 4.0L
32
Restrictive Range for FEV1/FVC
FEV1/FVC: 83%
FEV1: 2.5L
FVC: 3.0L
33
Obstructive Range for FEV1/FVC
FEV1/FVC: 25%
FEV1: 1.0L
FVC: 4.0L
34
Obstructive Pulmonary Disorder
| Classifications
1 obstruction in wall of lumen (asthma/bronchitis)
2 obstruction fr incr pressure around outside of airway lumen
3 obstruction of airway of lumen
35
Asthma
airway obstruction in the wall of lumen
- reversible
- airway inflammation
- incr airway responsiveness to a variety of stimuli
36
Asthma
| etiology
- occurs in 5-12% of US pop
| - most common chronic disease of children
37
2 types of Asthma
1 Intrinsic
| 2 Extrinsic
38
Intrinsic Asthma
- non-allergic, adult onset
- dvlps in midl age w less favorable prognosis
- no hx of allergies
- resp infections or psych factors appear to be contributory
- allergen-specific immunotherapy + environmental control NOT helpful
39
Extrinsic Asthma
- allergic, pediatric onset
- .3-.5 of asthma cases
- IgE response - mast cells activation (histamine)
- inflammatory cell infiltration (neutro, eosino, + lymphocytes)
40
histamine
vasodilator
41
leukotriene
bronchoconstrictor
42
Asthma
| clinical manifestations
```
1 wheezing (expiratory)
2 tightness of chest
3 dyspnea
4 dry cough
5 productive cough (incr sputum)
6 hyperinflated chest (barrel chest, xray)
7 decr breath sounds (phys exam)
```
43
Severe Attck of Asthma
| clinical manifestations
```
1 orthopnea
2 agitation
3 tachypnea: >30 breaths/min
4 tachycardia: >120 bts/min
5 pulsus paradoxus
6 PEFR: <80L/min
7 intercostal retractions
8 distant breathes w inspiratory wheezing
9 use of accessory muscles (chest + neck)
```
44
pulsus paradoxus
- normally, when inhaling, BP falls, but not by much
| - in pulsus paradoxus, BP falls by >10mmHg
45
Asthma
| diagnosis
```
1 radiographic finding
2 physical finding
3 sputum examination
4 PFT
5 skin testing
6 ABG
7 CBC
```
46
radiographic finding as a diagnosis for Asthma
hyperinflation w flattening of diaphragm
47
sputum examination as a diagnosis for Asthma
- Charcot-Leyden Crystals
- eosinophils
- Cruschmann Spirals
48
Charcot-Leyden Crystals
formed fr crystallized enzymes fr eosinophilic membranes
| -a form of sputum exam for asthma
49
Cruschmann Spirals
mucous casts of bronchioles
| -form of sputum exam for asthma
50
Asthma
| PFT
- DECR in forced expiratory vol
| - PEFR
51
PEFR
peak expiratory volumes decrease
- ratio of FEV1/FVC before + after administration of short-acting bronchodilator
- ---- >15% change
52
skin testing as a diagnosis for Asthma
for young patients w extrinsic asthma
53
Asthma
| ABG
MILD ATK: normal
BRONCHOSPASM INTENSIFIES: RESP. ALKA + hypoxemia
LATE STG: PaCO2 elevation, sign that patient is getting worse
54
Asthma
| CBC
elevated WBC + eosinophil
55
Asthma
| Treatments
1 avoid triggers
2 environ control (dust, allergens, air purifiers)
3 preventative therapy (stop smoking, aerosols, odors)
4 desensitization
5 anti type I hypersensitivity
56
desentization
allergen specific immunotherapy
57
anti type I hypersensitivity medications
```
1 O2 therapy
2 small-vol nebulizers
3 B2 agonist
4 corticosteroids
5 leukotriene modifiers
6 mast cell inhibitors
```
58
nebulizers
machine to help inhale med
59
B2 agonist
beta 2 agonist like ibutrol
| -dilate bronchi
60
corticosteroids
counters histamine/inflammatory rxn
61
leukotrine modifier
med to counter bronchoconstriction
62
Chronic Bronchitis
aka type B COPD, "blue bloater"
- obstruction in the wall of lumen
- chronic recurrent productive cough that lasts more than 3 months for 2 cosuccessive years
- hypersecretion of bronchial mucus
63
Chronic Bronchitis
| etiology
- persistent, IRREVERSIBLE, when paired w emphysema
- 1:2 male to female ratio
- >30-40 rys
64
Chronic Bronchitis
| pathogenesis
1 Chronic Inflammation + swelling of bronchial mucosa results w Scarring
2 Hyperplasia of bronchial mucous gland/goblet cells
3 Incr bronchial wall thickness
4 Pulmonary Hypertension [cor pulmonle]
65
inflammation + swelling in chronic bronchitis
- results w scarring
- --INCR IL8 (recruit neutrophil actvtn), CD8 T-lymph
- --extends to surrounding alveoli prevents proper oxygentn + potentiates airway obstrctn
66
hyperplasia of bronchial mucous in chronic bronchitis
--incr mucus prodctn w formtn of mucus plugs
67
incr brochial wall thickness in chronic bronchitis
- resistance increases work for breathing + o2 demands
| - ventilation-perfusion mismatch w hypoxemia + hypercarbia; incr pulmonary artery resistance
68
pulmonary hypertension in chronic bronchitis
- inflammation in bronchial walls w vasoconstriction of pulmonary vessels + arteries
- SNS activation
- autoregulatn
- RSHF may occur w/t high pulmonary resistance
69
last stage of chronic bronchitis pathogenesis
destruction of bronchial walls - dead space/emphysema
- -results in dilation of airway sacs:bronchiectasis
- dilated sacs contain pools of infected secretion that DO NOT clear themselves
- ---can cause further infection that can spread to adjacent lung fields by the lymphatics or venous drainage to other areas of the body (commonly the brain)
70
chronic bronchitis
| clinical manifestations
1 typically patient is overweight
2 commonly assoc w Emphysema (late stage)
3 SOB on expiration
4 excessive sputum
5 chronic cough
6 evidence of excess body fluids (edema, hypervolemia)
7 cyanosis (late sign)
71
why are chronic bronchitis patients generally overweight?
EDEMA
72
Chronic Bronchitis
| diagnosis
```
1 Chest XRay
2 PFT
3 ABG
4 ECG
5 Secondary polycythemia****
```
73
chest xray for chronic bronchitis
looks for signs of pulmonary hypertension or cor pulmonale
1 incr bronchial vascular markings
2 enlarged horizontal cardiac silhouette
3 congested lung fields
4 evidence of previous pulmonary infection
74
Chronic Bronchitis
| PFT
1 normal TLC
2 INCR RV
3 DECR FEV1
4 DECR FEV1/FVC
75
chronic bronchitis
| ABG
INCR PaCO2
| DECR PO2
76
chronic bronchitis
| ECG
- atrial arrythmias
| - evidence of right ventricular hypertrophy (cor pulmonale)
77
secondary polycythemia
incr in RBC
| -due to LOW O2 (nocturnal hypoxemia)
78
chronic bronchitis
| mgmt
a form of treatment for chronic bronchitis
- smoking cessation
- bronchodilator therapy
- reduction to exposure of irritants
other:
- adequate rest
- proper hydration
- physical conditioning (treadmill/walk/bike)
- influenza + pneumococcal vaccines
79
chronic bronchitis
| treatments
1 mgmt
2 low dose O2 therapy
3 medication
80
chronic bronchitis
| medication
1 inhaled short-acting B2 agonist
2 inhaled anticholinergic bronchodilators
3 cough suppressants
4 antimicrobial agents (bacterial infections)
5 inhaled/oral corticosteroids
6 theophylline products
81
low-dose o2 for chronic bronchitis
normally, low O2 sends a signal to baroreceptors to prevent CO2 fr accumulating
high dose will prevent that pathway and will try to increase CO2 retention.
low dose wont interfere w the pathway
82
2 types of COPD
chronic obstructive pulmonary diseases
Type A: Emphysema aka pink puffer
Type B: Chronic Bronchitis aka blue bloater
83
Emphysema
aka Type a COPD aka pink puffer (not cyanotic, puffy bc hyperventilation)
- obstruction related to loss of lung parenchyma
- destructive changes of alveolar walls w/o fibrosis
- abnormal enlargement of distal air sacs
- IRREVERSIBLE damage
- assoc w Chronic Bronchitis
84
the bigger the alveoli, the ___
the less recoil force/tension we have
-thats why abnormal enlargement is bad
85
Emphysema
| causes
- smoking >70 packs/year
- air pollution
- certain occupations (mining, welding, asbestos)
- a1-antitrypsin deficiency (could be genetic or acquired due to inflammation)
86
smoking causes alveolar damage
- inflammation leads to release of proteolytic enzymes
| - inactivates a1-antitrypsin
87
a1-antitrypsin
protects surfactant which protects lung parenchyma
88
lung parenchyma
substance of the lung outside of the circulatory system that is involved with gas exchange and includes the pulmonary alveoli
89
neutrophils + macrophage cause alveolar damage
by release of proteolytic enzymes
90
loss of elastic tissue in lung
results in loss of radial traction (normally holds airway open)
91
Emphysema pathogenesis
1 loss of elastic tissue in lungs
2 air becomes trapped in distal alveoli
3 loss of alveolar wall + air trapping leads to Bullae formation
4 reduction in pulmonary capillary bed
92
Bullae
large thin walled cysts in the lung
93
reduction in pulmonary capillary bed
exchange of O2 + CO2 bw alveolar + capillary blood impaired
94
Emphysema
| clinical manifestations
```
1 progressive, exertional dyspnea
2 THIN
3 barrel chest
4 use of accesory muscles
5 pursed-lip breathing
6 cough (minimal or absent)
7 digital clubbing
```
95
Thin emphysema
R/t incr respiratory effect, incr caloric expenditure, decr ability to consume adequate calories
96
barrel chest emphysema
incr total lung vol to compensate the lost lung capacity due to dead space
97
Emphysema
| Diagnosis
```
1 PFT
2 chest xray
3 ECG
4 ABG
5 patient Hx
6 physical findings
```
98
Emphysema
| PFT
INCR: RV, TLCl, functional residual capacity,
DECR: FEV1, FVC
99
Emphysema
| chest x ray
- hyperventilation
- low, flat diaphragm
- presence of blebs or bullae
- narrow mediastinum
- normal or small vertical heart
- barrel chest
100
Emphysema
| ABG
- mild DECR in PaO2
| - normal PaCO2 (elevated in late stages)
101
Emphysema
| phys findings
thin, wasted individual hunched forward
- using accessory muscles
* *decr breath sounds, lack of crackles + rhonchi
* *decr heart sounds
- prolonged expiration
- hyperresonance
- decr diaphragmatic excursion
- chronic morning cough
102
Emphysema
| treatment
similar to chronic bronchitis
1 o2 therapy
2 smoking cessation
3 medication
103
Emphysema
| medication
similar to chronic bronchitis
```
1 inhaled short acting B2 agonist
2 inhaled anticholinergic bronchodilators
3 inhaled/oral corticosteroids
4 theophylline products
5 cough suppressants
6 antimicrobial agents
```
104
air gets trapped in distal alveoli
emphysema
105
pursed lips
emphysema
106
presence of bullae
emphysema
107
abnormal enlargement of distal sac
emphysema
108
obstruction due to loss of lung parenchyma
emphysema
109
_____ may result with pulmonary hypertension in chronic bronchitis
RSHF
110
cor pulmonale is more associated with
chronic bronchitis
111
secondary polycythemia is a diagnosis for
chronic bronchitis
112
theophylline is to treat
emphysema + chronic bronchitis
113
antimicrobial is to treat
emphysema + chronic bronchitis
114
leukotriene modifiers is to treat
asthma
-leukotriene is a bronchoconstrictor
115
sputum testing is for
diagnosis of asthma
116
loss of elastic tissue is a characteristic of
emphysema
117
which OLD starts with resp alkalosis and then leads to acidosis?
Asthma
