Obstructive Pulmonary Disease

Question 1

what does air trapping result in?

Answer 1

hypoventilation and hypercapnia

Question 2

what are present in all obstructive diseases?

Answer 2

dyspnea and wheezing

Question 3

what is air trapping?

Answer 3

–person is not able to fully exhale
–CO2 is higher since air can’t escape
–air is trapped in alveoli –> person works harder to breathe and lungs are hyperinflated
–normal exhalation is obstructed

Question 4

asthma

Answer 4

chronic inflammation of bronchial airways

Question 5

risk factors for asthma

Answer 5

–usually starts in childhood
–familial link
–levels of allergen exposure
–urban residency
–exposure to indoor and outdoor air pollution
–tobacco exposure/smoke
–recurrent respiratory tract viral infections and GERD

Question 6

early asthmatic response

Answer 6

cellular responses are activated immediately and cascade of release of inflammatory mediators occurs within minutes

Question 7

late asthmatic response

Answer 7

4-8 hours after early response

Question 8

two responses of asthma

Answer 8

1. bronchoconstriction (#1 symptom)
2. inflammation (biggest problem; causes seriousness)

Question 9

status asthmaticus

Answer 9

–severe symptoms
–unrelenting asthma attack (silent chest, pCO2 > 70)
–life threatening

Question 10

chronic bronchitis

Answer 10

hypersecretion of mucus and chronic productive cough for at least 3 months of the year for at least 2 consecutive years

Question 11

simple bronchitis

Answer 11

inflammation of bronchi and bronchioles

Question 12

etiology of simple bronchitis

Answer 12

bacterial or viral infection
NO AIRWAY OBSTRUCTION

Question 13

etiology of chronic bronchitis

Answer 13

–cigarettes
–+ airflow obstruction = form of COPD

Question 14

prognosis of chronic bronchitis

Answer 14

premature morbidity and mortality

Question 15

patho of chronic bronchitis

Answer 15

–inhaled irritants result in airway inflammation
–continual bronchial inflammation
–thick, tenacious mucus produced and cannot be cleared

Question 16

why can’t secretions be cleared in chronic bronchitis?

Answer 16

–damaged cilia bronchial walls become inflamed/thickened secondary to edema
–accumulation of inflammatory cells
–thickened smooth muscle secondary to chronic bronchospasm

Question 17

late clinical manifestations of chronic bronchitis

Answer 17

pulmonary hypertension

Question 18

patho of pulmonary HTN

Answer 18

increase in pulmonary artery pressure d/t elevated pulmonary venous pressure, increased pulmonary blood flow, pulmonary vascular obstruction, or hypoxia

Question 19

s/s of pulmonary HTN

Answer 19

syncope, DOE, and fatigue

Question 20

cor pulmonale

Answer 20

right sided heart failure

Question 21

treatment of chronic bronchitis

Answer 21

–bronchodilators
–expectorants/prophylactic antibiotic therapy
–CPT
–steroids late in disease
–home O2

Question 22

emphysema

Answer 22

abnormal, permanent enlargement of gas exchange airways, accompanied by destruction of alveolar walls

Question 23

major effect of emphysema

Answer 23

major mechanism of airflow limitation is loss of elastic recoil with collapse of the airways during expiration

Question 24

characteristics of emphysema

Answer 24

–loss of elastic recoil
–abnormal permanent enlargement of air spaces
–lung hyperinflation
–destruction = tissue changes

Question 25

causes of loss of elastic recoil in emphysema

Answer 25

–smoking
–air pollution
–childhood respiratory infections
–genetic emphysema

Question 26

symptoms of emphysema

Answer 26

–gradual increase in breathlessness
–eventually SOA at rest
–wheezing
–malnourished
–decreased muscle mass
–barrel chest
–pursed lip breathing
–decreased breath sounds

Question 27

diagnosis of emphysema

Answer 27

–PFTs (FEV1 decreased)
–CXR (hyperinflation)
–ABGs
–decrease in alpha1-antitrypsin

Question 28

treatment of emphysema

Answer 28

–smoking cessation
–bronchodilators and anti-inflammatory agents
–O2 supplementation
–breathing retraining
–relaxation techniques
–antibiotics for acute infections

Question 29

chronic bronchitis vs. emphysema

Answer 29

CB: overweight, cyanotic, elevated Hgb, peripheral edema, rhonchi, wheezing

Emphysema: older and thin, severe dyspnea, quiet chest, hyperinflation with flattened diaphragms