9: Pulmonary (Quiz W10) Flashcards
Obstructive Dz
Emphysema Chronic Bronchitis Asthma Bronchiectasis CF lung CA
Restrictive Dz
ARDS Chronic- interstitial fibrosis (eg sarcoidosis), pneumoconiosis, granulomatous Chest wall deformities Neuromuscular lung CA
Spirometry
in office lung eval
FVC- forced vital capacity; >80% normal
FEV1: forced expiratory volume in 1 second; >80% normal
FEV1:FVC <0.7
obstructive disease
*this will diagnose COPD
FEV1:FVC >0.7
restrictive disease
DLCO
Diffusing capacity of gas across the lungs
Methacholine challenge
evaluates bronchial hypereactivity (asthma)
if suspect asthma and spiro is normal, do this!
FEF25-75
Forced expiratory flow 25-75%. More sensitive than FEV1, determines early obstructive disease.
>60% normal small airway obstruction
40-60% Mild small airway obstruction
20-40% Moderate small airway obstruction
< 10% Severe small airway obstruction
Emphysema
enlargement of airspace distal to terminal bronchiole with destruction of alveolar walls
dyspnea, minimal cough, hyperinflated lung capacity, tachypnic
Ventilation > Perfusion = some areas are ventilated but not perfused thus dead space
Chronic bronchitis
cough, sputum production, likely RCHF/cor pulmonale, overweight, normal resp rate
Perfusion>Ventilation= partial oxygenation of mixed venous blood
COPD RFs
1 smoking
air pollution, second hand smoke, industrial pollutants
A1AT (if FHx, nonsmoker, onset 30-50 yrs)
COPD Pathophysiology
small airway dz
Airway inflammation, fibrosis, epithelial hyperplasia, luminal plugs, increased airway resistance, narrowing of the terminal airways
parenchymal destruction
COPD Pathophys
parenchymal destruction
Loss of alveolar attachments, decrease of elastic recoil
- -> irreversible enlargement of airspaces distal to the terminal bronchial
- -> FEV1 decline, air trapping, and hyperinflation
COPD Centrilobar
heavy smokers
central acini affected, severe in upper lobes
COPD Panacinar
acini uniformly enlarged, severe in lower lobes
A1AT deficiency
COPD PEs
pulse ox increased AP chest diameter tripod, accessory muscles Auscultation: decreased breath sounds, crackles at bases Hyperresonant Cyanosis, weight loss 6 minute walk test
COPD Xray
usu normal
may be hyperinflation, hyperlucency
COPD EKG changes
if RVH- tall P wafes, tall R waves in V1/V2
COPD Sequalae
VD, Osteoporosis, Respiratory infxn, anxiety, depression, cognitive deficits, diabetes, lung cancer, bronchiectasis
COPD Work up: Sx Questionnaire
COPD Assessment Test
Clinical COPD Questionnaire
mMRC Breathlessness Scale
COPD Work up: Spirometry
spiro AFTER SABA to remove bronchospasm component
COPD Work Up: Exacerbation risk
2+ exacerbations in last year or FEV1 <50% predicted?
Normal (GOLD scale)
FEV1 >85% predicted
Mild (GOLD 1)
FEV1 > 80% predicted
