Define bronchitis
Inflammation of large airways
What is the difference between asthma and bronchitis?
Asthma affects the small airways while bronchitis inflames the large airways
What are some causes of bronchitis?
Air pollution, Allergies, Occupational hazards
What are some symptoms of bronchitis?
Cough Mucus production Shortness of breath Wheezing Cyanosis in severe cases
What are some treatment options for bronchitis?
Short-term steroid therapy
Bronchodilators
Hydration
Antibiotics
Emphysema is associated with inhalation or exhalation?
Emphysema is the impaired ability to exhale
What is the most common cause of emphysema?
Smoking
Emphysema effects what part of the airways?
Terminal
What are some of the treatment options for emphysema?
Short-acting bronchodilators Long-acting anti-cholinergic bronchodilators Inhaled corticosteroids Oral steroids Antibiotics Oxygen in endstage
What type of lung infection is associated with swelling and mucus buildup in the bronchioles due to a viral infection and is commonly seen in children under two years of age?
Bronchiolitis
What are some of the symptoms of bronchiolitis?
Shortness of breath
Cough
Wheezing
What are some treatment options for bronchiolitis?
Antibiotics Hydration Chest physical therapy Steroid therapy Bronchodilators
Bronchiolitis infects primarily the larger or smaller airways?
Larger
What is bronchiectasis?
Loss of airway wall integrity
–Destruction and widening of large airways
What is a common cause of bronchiectasis
Cystic fibrosis causes about half of the cases
What are some symptoms of bronchiectasis?
Shortness of breath Cyanosis Halitosis (bad breath) Chronic cough with sputum Finger clubbing
What are some of the treatment options for bronchiectasis?
Hydration
Antibiotics
Antiviral drugs
Humidified oxygen and IV fluids
Which disease has the nickname “pink puffer?”
Pulmonary emphysema
Think about taking a puff from a cigarette
Which pulmonary disease has the nickname “blue bloater?”
Chronic bronchitis
Which divisions of the airway are conducting and which are responsible for gas exchange?
1-16: conducting
17-23: gas exchange
What type of cell produces surfactant?
Type II alveolar cell
What are the six risk factors that predispose patients to post operative pulmonary dysfunction?
- Pre-existing pulmonary disease***
- Thoracic or upper abdominal surgery
- Smoking (major factor for developing COPD)
- Obesity
- Age > 60
- Prolonged general anesthesia
How will a pulmonary function test differ in a normal patient versus one with chronic constructive pulmonary disease?
COPD patient will have:
decreased ERV
Increased FRC and RV
Increased TLC
Bronchospasm effects inspiration or expiration?
Inspiration
Remember the “shark fin” capnogram
FEV/FVC <____% = COPD
70
When there is an increased difficulty on expiration because of the airflow resistance what happens in COPD patients?
Increased air trapping
–RV and TLC increase
How long before surgery should the patient discontinue smoking?
They shouldn’t have started
But since they did 6-8 weeks
What effect does cigarette smoking have on mucus production and clearance?
Increases mucus production and decreases clearance
What are some important factors to assess preoperatively?
SpO2 on room air
Listen to breath sounds
History
Medications
What is an important factor to be mindful of before extubating a patient with COPD?
Full reversal from NMBs
What type of ventilation will optimize lung function in COPD patients?
Controlled mechanical ventilation
-May not tolerate spontaneous ventilation without assistance
What type of respiratory rate is most efficient for COPD patients?
Slow respiratory rate provide sufficient time for complete exhalation
Make sure you look at pictures of the flow volume loops
Obstructive lung diseases will be more to the left and restrictive’s will be to the right
What type of extubation may be beneficial for a patient with a reactive airway?
Deep
Patients with emphysema would best tolerate what type of extubation?
Awake
Why is it important to keep COPD patients close to their normal limits with ventilation?
Parameters outside their norm may decrease ventilatory drive
