Obstructive Lung Disorders Flashcards by Heather White

Atelectasis will cause

a V/Q mismatch

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What is the presentation of atelectasis?

Typically asymptomatic, but may have SOB, cough, fever, or elevated WBC

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In obstructive lung disease the problem is with getting air

out of the lung

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What are the PFT findings in obstructive lung diseases?

Decreased FEV1 (< 0.8)
FEV1/FVC = lowered with obstructive patterns

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In restrictive lung disease the problem is with getting air

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Chronic obstructive pulmonary disease (COPD) includes

Emphysema and Chronic Bronchitis

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Will expiration be prolonged in obstructive lung disease?

Yes, very prolonged expiratory phase

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What causes the obstruction in chronic bronchitis?

Obstructive airflow secondary to thick mucus, not as structural of a process as emphysema

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What is the presentation of chronic bronchitis?

Dyspnea (worse with exertion)
Decreased FEV1/FVC
Flare will lead to decreased alveolar lumen

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What complications are associated with chronic bronchitis?

Pneumonia distal to obstruction
Hypoxemia
Hypercapnia
VQ mismatch

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What is bronchiectasis most commonly due to?

Cystic Fibrosis
Aspiration
Immunodeficiencies
Connective tissue disorder

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What is the common presentation of bronchiectasis?

Productive cough
Foul smelling sputum, purulent
Hemoptysis

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What are the components of the atopic triad?

Atopic Dermatitis (Eczema)
Allergic Rhinitis (hay fever)
Asthma

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During asthma exacerbation, the patient will have increased lung volumes leading to what complications?

Muscular fatigue
Respiratory failure
Pulses paradoxus from intrathoracic pressure

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What are the complications of asthma?

Repetitive cellular damage leading to fibrosis

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What gene is impacted in cystic fibrosis?

CFTR protein on chromosome 7

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CFTR is a chloride transportation protein of the exocrine glands so alteration in this protein will cause what effects?

Change in water concentration/movement
Thickening of the secretions (dehydration)

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What lung conditions do you likely hear crackles (rales) on exam?

Bronchiectasis
Bronchitis
Pneumonia
Fibrosis
CHF

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What lung conditions do you likely hear wheeze on exam?

Asthma
COPD
And other causes of airway obstruction

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When rhonchi are heard on exam what does that suggest?

Suggest secretions in the large airways

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What is the etiology behind extrinsic (allergic) asthma?

Allergic response to environmental or animal allergens

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What is the etiology behind intrinsic (non-allergic) asthma?

Occupational/pollution
Cold/humidity
Stress
Medications (ASA or NSAIDs)
Exercise

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Is it possible for a patient to have both extrinsic and intrinsic etiology of asthma?

Yes

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What are the risk factors associated with asthma?

Atopy
Environmental/occupational exposures
Childhood asthma or symptoms
Family history

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What are the signs of asthma?

Expiratory wheezes Diminished breath sounds Accessory muscle use Tripoding (severe exacerbation)

What is part of the work-up/diagnosis for asthma?

Clinical findings and HISTORY PFT's Bronchoprovocation testing (methacholine, mannitol, exercise or dry air)

What medication class do all asthma patients receive?

SABA as needed (albuterol)

What is the management for step 1 asthma?

All ages: SABA as needed < 4 years old: sick plan with few days of ICS due to association with URI's

What is the management for step 2, mild persistent asthma?

All ages: Continue SABA as needed Children (up to 11): daily low dose ICS or Montelukast > 12 years: Daily low dose ICS, or daily combination inhaler (can also alternatively use Montelukast)

What is the management for step 3, moderate persistent asthma?

All ages: continue SABA as needed < 4: Daily combo inhaler (low dose ICS with LABA), daily montelukast, or medium dose ICS >4: Daily combination inhaler PLUS as needed Symbicort, or daily medium dose ICS, or low dose ICS plus Montelukast

What is the management for step 4, severe asthma?

Daily combination inhaler (medium dose ICS with LABA) or daily medium dose ICS with Montelukast

What is the management for step 5, severe persistent asthma?

Daily high dose ICS with LABA OR Daily high dose ICS with Montelukast Consider Omalizumab (Xolair)

What are mechanisms of prevention in asthma?

Avoid triggers Allergens (allergy medications, immunotherapy, air filters, or washing face/hands) Medication Management Asthma Action Plan

What are signs of bronchioctasis?

Crackles Wheezing Digital clubbing

What are symptoms of bronchiocstasis?

Chronic Cough - Productive - Malodorous thick, mucopurulent mucus - Hemoptysis Fatigue SOB Fever/chills Pleuritic Chest Pain

What is a symptom that is a common "buzz word" on exam questions associated with bronchiectasis?

Persistent or recurrent cough with mucopurulent sputum

What should be included in the work-up of bronchiectasis?

Labs - CBC, Immunoglobulins, Sweat Chloride, Sputum smear, Alpha-1 tripsin, Rh factor CXR CT (gold standard) PFTs (for prognostics) Bronchoscopy

What is the treatment for bronchiectasis?

Treat and control underlying disease/infection Bronchodilators (Duonebs or SBA and combo's) Chest physiotherapy (Chest PT) Surgery (sever cases)

What antibiotic should be used for psuedomonas coverage in bronchiectasis?

Fluoroquinolone: Levofloxacin (oral) Pipercillin/Tazobactam (Zoyn) (IV)

What are some oral antibiotics that can be used to treat bronchiectasis?

Fluoroquinolones Amoxacillin or Augmentin Macrolides

What is the most common cause of acute bronchiolitis in pediatric patients?

RSV

What are the types of bronchiolitis?

Acute (most common) Bronchiolitis Obliterans Proliferative Follicular Bronchiolitis

What are the symptoms of bronchiolitis?

Upper respiratory symptoms Fever Wheezing Tachypnea Shallow respirations Poor appetite

What should be included in the work-up of bronchiolitis?

Clinical context and medical history CXR Viral panel PFT's Biopsy (not for acute)

When is endotracheal intubation indicated in severe bronchiolitis?

Only in respiratory failure

What is the treatment for mild-moderate bronchiolitis?

Supportive therapy and parent eduction

What is the treatment for severe bronchiolitis?

Admission with supportive care Respiratory support (nasal suctioning and LFNC) Bronchodilator +/- Glucocorticoids CPAP for risk of respiratory failure Intubation for respiratory failure

Is COPD more common in women or men?

Women, there are also more death in women

What patients are most likely to be diagnosed with COPD?

Current or former smokers History of asthma

What are the risk factors associated with COPD?

Smoking! Air pollutants Genetic factors Respiratory infections Atopy and Asthma

What is atopy?

Genetic predisposition to develop atopic triad or atopic triad symptoms (rhinitis, eczema, asthma)

What are the signs/symptoms of COPD?

Cough Persistent, progressive dyspnea CO2 retention Weight loss (emphysema) Tachycardia Hypertension Wheeze/crackles Prolonged expiratory phase Barrel chest

What CXR findings can be associated with COPD?

Hyperinflated lungs Flat diaphragm

What is the treatment for Group A COPD?

SABA or LABA

What is the treatment for Group B COPD?

LABA Consider SABA and LABA

What is the treatment for Group C COPD?

Add LAMA

What is the treatment for Group D COPD?

Most started on LAMA Combination LAMA/LABA LABA/ICS

What organs are impacted in COPD due to containing mucus membranes?

Lungs Pancreas Liver Intestines Reproductive tract

What are the respiratory signs/symptoms of CF?

Persistent, productive cough Wheeze Dyspnea Hemoptysis Apical crackles Bronchiectasis Barrel chest Respiratory distress/failure Digital clubbing

What is the screening test for CF?

Newborn screen

What is the gold standard test for CF?

Sweat chloride test

What is the most definitive test in diagnosing CF?

Genetic testing (numerous different mutations)

What is an indicative chloride concentration on sweat testing for diagnosing CF?

>/= 60 mmol/L

What is the diet recommendation for a patient on Trikafta?

Require a diet high in fats to maximize absorption