Obstructive lung diseases Flashcards
(16 cards)
What are the 4 obstructive respiratory conditions?
Emphysema, Chronic Bronchitis, Asthma, Bronchiectasis
What are the causes of obstructive disease?
Smoking, pollution, genetics, infection, ageing,and allergies
What are the two diseases that make up COPD?
Emphysema and Chronic Bronchitis
How is Chronic Bronchitis defined?
Productive cough on most days for 3 months of the year for 2 consecutive years (other conditions ruled out)
What are features of chronic bronchitis?
Hypertrophy and hyperplasia of mucous glands and goblet cells (increased mucus)
Decreased cilia (secretion retention)
Chronic inflammatory changes in bronchial walls
Decreased gas exchange
Causes of chronic bronchitis?
Smoking, pollution
Chronic Bronchitis clinical presentation?
- Inspection = “Blue Bloater” (OBESE AND CYANOTIC) + MUCUS colour can WHITE, YELLOW OR GREEN
- Palpation = increased tactile fremitus in secretion retention areas + decreased tactile fremitus in air trapping areas
- Percussion = hyper resonance in air trapping area + dull over secretion areas
- Auscultation = decreased breath sounds + INSPIRATORY WET CRACKLES+ possible wheezing
- ABGs = increased CO2, decreased O2
- Chest XR = CARDIO MEGALY, white haziness
Emphysema definition?
Enlargement of the airway distal to terminal bronchioles, accompanied by destruction of their walls
Types of Emphysema?
- Centrilobar (more common) = rare among non-smokers, M>F, commonly found in patients with chronic bronchitis, affects the respiratory bronchioles
- PANLOBAR (less common) = affects terminal and respiratory bronchioles, due to ALPHA-ANTITRYPSIN (inhibits elastase, which breaks down elastin) deficiency (nothing stopping elastase from breaking down elastin)
Emphysema clinical presentation
- Inspection = “PINK PUFFER” (thin and wasted), BARREL CHEST, pursed lip breathing, increased accessory muscle use (30% diaphragm/70% accessory muscle) , 1:3 IE ratio
- Palpation = decreased tactile fremitus, decreased chest wall expansion
- Percussion = hyper resonant
- Auscultation = decreased breath sounds, may have dry crackles
- ABGs = decreased O2 (moderate), increased CO2
- Chest XR = increased black area (hyperinflated and decreased lung tissue), flattened diaphragm, flattened ribs
Asthma definition?
Chronic inflammatory condition of the airways characterised by hyper-responsiveness of the airways (trachea and bronchi) to various stimuli which results in narrowing of airways
Asthma pathophysiology?
Smooth muscle of airway is more sensitive and reactive, leads to BRONCHOSPASM, bronchial wall edema and inflammation
Narrowing of the airway increases airway resistance (both in and out)
What types of triggers are there for an asthma attack?
Idiopathic (exercise, drugs, inhaled irritants) Extrinsic (dust, animals, food)
What is the clinical presentation for asthma?
- Inspection = report of CHEST TIGHTNESS and DYSPNEA, PFT pre and post BRONCHODILATOR shows significant IMPROVEMENTS, increased accessory muscle use
- Palpation = decreased tactile fremitus, decreased chest wall excursion
- Percussion = hyper resonant
- Auscultation = WHEEZING, decreased breath sounds, possible crackles
- ABGs = increase CO2, decrease O2, decreased pH resp acidosis
What is the clinical presentation of Bronchiectasis?
- Inspection = thin and fatigued, clubbing (hypoxemia), HUGE AMOUNTS OF MUCUS, SEVERE COUGH
- Palpation = DECREASED chest wall EXCURSION, tactile fremitus (depends on specific lung changes)
- Percussion = depends on specific lung changes present
- Auscultation = decreased breath sounds, WHEEZING
- Chest XR = flattened diaphragm, dark lung fields in areas of trapping
Bronchiectasis the key features?
- Dilated bronchi and bronchioles from post-infection, congenital disorders, obstruction or connective tissue disease
- Secretion retention
