Obstructive Pulmonary Disease

Question 1

polycythemia

Answer 1

increase in the number of red blood cells

Question 2

COPD

Answer 2

• chronic obstructive pulmonary disease
• obstruct airflow, not a specific diagnosis
• emphysema, chronic obstructive bronchitis, chronic asthma

Question 3

risk factors of COPD

Answer 3

• exposure to air pollution
• secondhand smoke
• dust/chemicals
• heredity
• hx of childhood respiratory infections and socioeconomic status

Question 4

signs of COPD

Answer 4

dyspnea
sputum production
chronic cough
reduced function

Question 5

spirometry

Answer 5

• lung volumes
• basic and frequent performed test of pulmonary function
• diagnostic & prognostic

Question 6

when is COPD diagnosed

Answer 6

when the FEV1/FVC ratio is <0.70 after a bronchodilator has been given

Question 7

emphysema

Answer 7

• pathologic accumulation of air in the lungs
• disease of exhalation
• air trapping in the lungs
• forced expiration causes smaller airways to collapse during expiration

Question 8

what does emphysema cause

Answer 8

increase in residual volume, total lung capacity and a decrease in the FVC1/FVC ratio

Question 9

alpha-1 antityrpsin

Answer 9

• enzyme found in the blood
• protects lungs from inflammatory damage
• protects the body from a powerful enzyme called neutrophil elastase
• coats cells and provides protection against neutrophil elastase

Question 10

what does a deficiency of alpha 1-antitrypsin lead to

Answer 10

• chronic, uninhibited tissue breakdown

- lungs become not as elastic

Question 11

how does smoking affect the A-1AT

Answer 11

• changes it so that it can NOT bind to elastase allowing elastase to go crazy

Question 12

cigarette smoke creates a chronic inflammatory state which then leads to what..

Answer 12

elevated neutrophil count –> elevated elastase release = tissue damage

Question 13

A-1AT deficiency and cigarette smoking

Answer 13

• destruction of individual alveoli
• development of super alveoli
• destruction of connective tissue supports for the very smallest airways allowing them to collapse during expiration

Question 14

clinical manifestation of emphysema

Answer 14

• SOB
• apprehensive
• anxious
• addicted to O2
• thin, cachectic
• deformed chest with prolonged expiration
• absent or non-productive cough
• pulse Ox could be normal
• cardiac problems
• mild COPD –> mild hypoxemia
• deconditioning

Question 15

prognosis of emphysema

Answer 15

poor

Question 16

PT implications for emphysema

Answer 16

• reduce airway edema
• eliminate bronchial secretions
• increase exercise tolerance
• prevent/treat respiratory infxn
• avoid irritants
• relieve anxiety
• pulse Ox
• monitor HR and BP
• hypoxic drive

Question 17

what is hypoxic drive

Answer 17

• people who retain CO2 (emphysema pt)
• using oxygen to drive respiration instead of CO2
• people with emphysema rely more on blood O2 to drive respiration, if blood concentrations of O2 go up, chemoreceptors start to think they don’t have to breath as much, which then leads to slowed breathing

Question 18

what do you need to monitor when a pt has hypoxic drive

Answer 18

respiration rate

Question 19

metered-dose inhaler

Answer 19

• emphysema
• used to deliver drugs to the lungs
• evaluate the ability of the child/adult to correctly use the MDI
• a spacer can remove coordination of hand movement and respiration

Question 20

chronic bronchitis

Answer 20

• productive cough lasting at least 3 months per year for 2 consecutive years
• FEV1/FEV <75%

Question 21

chronic bronchitis characteristics

Answer 21

• inflammation
• excessive mucous
• scarring of bronchial lining
• obstructed air flow caused by increased mucous
• decreased radius

Question 22

causes of chronic bronchitis

Answer 22

• chronic exposure to irritants; mucus hypersecretion
• destruction of ciliary cells lining airways occurs
• smooth muscle hypertrophy, atrpohy of epithelial cells
• reduced radius

Question 23

symptoms of chronic bronchitis

Answer 23

• recurring morning cough that brings up mucus
• increased production of phlegm
• symptoms worsen over the day
• wheezing, SOB
• cyanotic
• hypoxia

Question 24

chronic bronchitis pt’s tend to have what also?

Answer 24

• polycythemic
• cor pulmonale
• SOB
• prolonged expiration
• persistent coughing with expectoration
• recurrent infection

Question 25

PT implications for chronic bronchitis

Answer 25

reduce irritants
bronchodilators
mucolytics
NSAIDs

Question 26

asthma

Answer 26

episodic, reversible, obstructive lung disease characterized by bronchospasms resulting from an exaggerated inflammatory response of the airway smooth muscles to various stimuli

Question 27

asthma is clinically manifested by

Answer 27

episodic dyspnea
coughing
wheezing

Question 28

extrinsic asthma

Answer 28

• allergic reaction to specific triggers

- release histamines

Question 29

intrinsic asthma

Answer 29

• no known allergic cause
• adult
• secondary to chronic or recurrent infxns of the bronchi, sinuses or tonsils

Question 30

pathogensis of ashtma

Answer 30

• inflammatory response consisting of cellular infiltration, epithelial disruption, mucosal edema and mucous plugging airways
• inflammatory mediators produces bronchial smooth muscle spasm, vascular congestion, increased vascular permeability, edema formation, production of thick, tenacious mucus and impaired mucociliary function

Question 31

bronchial provocation test

Answer 31

• static pulmonary function test
• evaluates airway sensitivity
• methacholine causes smooth muscle contraction which reduces pulmonary airflow
• positive test: 20% decrease in FEV1

Question 32

clinical course of asthma

Answer 32

• attack by dyspnea with wheezing
• upper airway obstruction occurs
• difficulty with expiration
• air trapping in distal alveoli
• hypercapnia
• repeated attacks
• age can determine severity, younger the worse it is

Question 33

treatment for ashtma

Answer 33

• avoid triggers
• bronchodilators and anti-inflammatory agents
• low dose corticosteroids

Question 33

exercise induced bronchospasm

Answer 33

• airway hyperactivity
• acute, reversible, usually self-terminating airway obstruction
• develops 5-10 mins after vigorous intensity exercise
• lasts 30-60mins
• warm up is important

Question 34

symptoms of exercise induced bronchospasm

Answer 34

• coughing
• chest tight
• wheezing / SOB
• tachypnea
• symptoms linked to exercise intensity
• take inhaler 20-30 mins before exercise