Obstructive Pulmonary Diseases Flashcards by Katie Keller

This condition is defined as an inflammatory disease of the airways characterized by hyperresponsiveness of the tracheobronchial tree to various stimuli (largely reversible)

Asthma

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Asthma is an obstructive airway disease with what 3 components?

Inflammation (treat this first)
Airway hyper-responsiveness
Allergic or immunologic mediated

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The strongest identifiable factor for someone developing asthma is what?

atopy

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What are the components of the atopic triad?

Asthma
Eczema
Seasonal rhinitis

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List some asthma triggers

Allergens (seasonal and environmental)
Infection
Exercise
Pharmacological Stimuli
Occupational Factors
Emotional Stress

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80% of asthma cases are which type?

Slow-Onset Asthma

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What is typically the first sign in asthma?

Cough – worse particularly at night

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What is the standard testing used for diagnosing asthma?

Spirometry (Pulmonary function studies)

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What tool is used for monitoring in asthma patients?

Patients can take home and keep track of their own flow rates (handheld devices)

Peak Expiratory Flow meters

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What if you suspect patient has asthma but the PFT is normal? What test can you run?

Obtain a bronchial provocation test

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What are the types of asthma?

Allergic (extrinsic)
Idiosyncratic (Intrinsic)
Exercise-Induced
Industrial and Occupational

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What are the classifications in asthma?

Intermittent asthma
Mild persistent asthma
Moderate persistent asthma
Severe persistent asthma

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What is the importance of classifying asthma?

to know where they are to guide treatment

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Which asthma classification is described below?

Intermittent daytime symptoms occurring less than twice a week

Brief exacerbations

Nocturnal symptoms occurring less than twice a month

Asymptomatic with normal lung function between exacerbations

Intermittent Asthma

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Which asthma classification is described below?

Symptoms occurring more than once a week but less than once a
day

Exacerbations affect activity or sleep

Nocturnal symptoms occurring more than twice a month

Mild Persistent Asthma

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Which asthma classification is described below?

Daily symptoms

Exacerbations affect activity and sleep

Nocturnal symptoms occurring more than once a week

Moderate Persistent Asthma

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Which asthma classification is described below?

Continuous symptoms

Frequent exacerbations

Frequent nocturnal asthma symptoms

Physical activities limited by asthma symptoms

Severe Persistent Asthma

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These results show what classification of asthma?

FEV1 or PEF rate greater than 80% predicted with less than 20%
variability

Less than 80% = obstructive pattern

Intermittent Asthma

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These results show what classification of asthma?

FEV1 or PEF rate greater than 80% predicted with variability of
20-30%

High variability

Mild Persistent Asthma

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These results show what classification of asthma?

FEV1 or PEF rate 60-80% predicted with variability greater
than 30%

Moderate Persistent Asthma

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These results show what classification of asthma?

FEV1 or PEF rate less than 60% predicted with variability greater
than 30%

Severe Persistent Asthma

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What is the goal of treatment in asthma?

to gain control - only manage to make their lives as normal as
possible

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All of the levels will have what type of medication/treatment?

albuterol inhaler for rescue

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How often should you review asthma treatment?

every 1-6 months

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General exacerbation Disposition in asthma: when can you discharge an asthma patient home? What factors must be met generally?

Discharge home if FEV1>70% and symptoms minimal or absent – monitor first to ensure stability (if less than 70, admit patient)

A patient being discharged from the hospital after asthma exacerbation should go home with what?

steroid prescription 3-10 days short acting bronchodilator scheduled dosing 24-48 hours increase oral corticosteroid dose follow up and action plan instructions

What is a late sign in asthma that is worrisome?

cyanosis

Patient’s taking their meds but still have wheezing, an exacerbation – we call it what?

Asthma Attack

What are the initial treatment/goals of an Asthma Attack?

Maintain the airway at all times Maintain SaO2 >90% - Give supplemental O2 Intubate if respiratory failure - Be prepared to intubate at any moment

What medication class is contraindicated in an asthma attack?

NSAIDs

Severe bronchospasm that does not respond to aggressive therapies within 30-60 minutes

Status Asthmaticus

What is the most concerning complication of an asthma attack?

Status Asthmaticus

Rule of thumb in asthma: Who Needs Preventative Care? Rule of twos - list them

Two beta agonist canisters a year (each bottle contains 70 pumps) Two doses of beta agonists per week Two nocturnal awakenings per month Two unscheduled visits to the doctor per year (3-4 scheduled visits with a doctor per year is expected for asthma – unscheduled/more visits because of flare ups is a concern) Two prednisone bursts per year

List the risk factors for death from asthma

Asthma history Previous severe exacerbation (ICU or intubation) Two or more hospitalizations for asthma in the past year Hospitalization or an ED visit for asthma in the past month (The majority of people who die from asthma have been in the ER within the previous 30 days) Current use of or recent withdrawal from systemic corticosteroids Use of >2 MDI short-acting beta2 agonist canisters per month Social history (Low socioeconomic status or inner-city residence, serious psychosocial problems) Comorbidities (CV disease, COPD, Emphysema, etc)

What condition is an all inclusive and nonspecific term applied to a spectrum of disease (most patients have mixed disease)?

COPD

In the US, what disease is the most rapidly increasing health problem?

COPD

What are the two classic forms of COPD?

Chronic bronchitis is a clinical condition Emphysema is a pathological entity

What is a major difference between COPD and asthma?

COPD -you have irreversible damage/changes Asthma - has reversible components

Disease state characterized by airflow limitation that is not fully reversible, is usually progressive, and is associated with abnormal inflammatory response of the lungs to inhaled noxious particles or gases (chronic smoking)

COPD

What is the hallmark of COPD?

Expiratory flow limitation (Can bring the air in but can’t get out)

What is the major risk factor for COPD that accounts for 80-90% of risk in US?

Cigarette smoking

What is the hereditary risk factor for COPD?

Alpha-1-antitrypsin deficiency

What is the autosomal recessive condition that affects mostly Northern European whites, causes lung and liver disease, and accounts for 2-3% of patients with COPD?

Alpha-1-antitrypsin deficiency

What is the pathophysiology of Alpha 1 Antitrypsin Deficiency?

Abnormally decreased levels of protease inhibitor

Patients with Alpha 1 Antitrypsin Deficiency are also at risk for developing this non-lung disease?

hepatocellular carcinoma

List some co-morbid conditions of COPD

Pneumonia Multifocal atrial tachycardia Ventricular dysfunction (Cor pulmonale) Pulmonary hypertension Secondary pneumothorax Respiratory failure Bronchogenic lung cancer

What are the three major categories of COPD?

Chronic bronchitis Emphysema Asthma

What stage of COPD is described below? Chronic cough and sputum production, some SOB FEV1 ≥ 80% predicted

Stage I - Mild COPD

What stage of COPD is described below? Chronic cough and sputum production; SOB may limit exertion FEV1 50-79% predicted

Stage II - Moderate COPD

What stage of COPD is described below? Involves progressive airway limitation 🡪 clinical signs and symptoms worsen, more frequent exacerbations FEV1 30-49% predicted

Stage III - Severe COPD

What stage of COPD is described below? Chronic respiratory failure Hypercapnia and hypoxia with severe, recurrent exacerbations 🡪 affects quality of life and threaten survival These are the patients will see walking around with oxygen tanks FEV1 <30% predicted or FEV1<50% predicted PLUS chronic respiratory failure

Stage IV - Very severe COPD

In early disease in COPD, what is the typical first complaint/manifestation?

decreased exercise tolerance

In COPD, what is felt to be a better predictor of mortality than spirometry?

exertional dyspnea

COPD typically presents with what characteristic symptoms?

chronic cough (85%) dyspnea copious expectoration (45%) wheeze (40%) fatigue

Pink Puffer

Emphysema

Blue Bloater

Chronic Bronchitis

Type of COPD: Abnormal permanent enlargement of air sacs distal to terminal bronchioles, with destruction of alveolar walls and no obvious fibrosis Degradation of lung matrix by lung proteases – released by neutrophils attracted by cigarette smoke Decrease in elastic recoil and collapse of airways during exhalation

Emphysema

Type of COPD: Presence of chronic productive cough occurring on most days for at least three months in each of two successive years “smoker’s cough” Diagnosis can only be made when ALL other causes of chronic cough are excluded (TB, lung cancer, congestive heart failure, etc)

Chronic Bronchitis

What testing should be done on all suspected patients of COPD to assess and stage disease state?

spirometry

What is the main diagnostic strategy that quantifies airflow obstruction in COPD?

spirometry

Why is spirometry important in COPD?

Help determine the severity of disease to tailor treatment and predict/follow course

What is the primary importance for treatment in COPD?

Smoking Cessation

What are the treatment goals of COPD?

Prevent further damage Prevent and treat acute exacerbations Maximize current function

Why is smoking cessation so important even in COPD patients with current damage?

Will halt further damage to lungs

What is the only treatment in COPD that prolongs survival?

Correct hypoxia with O2 therapy

The mainstay of drug therapy for COPD

Inhaled Bronchodilators

First line treatment in COPD

Anticholingerics (inhaled)

What is the most common etiology of acute exacerbations of COPD?

Infectious: 70-80%

In COPD, what is the BEST intervention shown to slow disease progression?

Smoking cessation

Condition that is both restrictive and obstructive (but for our purpose we’ll consider it obstructive) Multisystem autosomal recessive disorder that leads to abnormalities in membrane chloride channel (CFTR) 🡪 altered chloride transport and water flux across epithelial cells (affects all exocrine tissue)

Cystic Fibrosis

Genetic – autosomal recessive disorder Abnormality is CFTR

Cystic Fibrosis

What is the most common cause of severe chronic lung disease in young adults?

Cystic Fibrosis

What is the most common fatal hereditary disorder of whites in US?

Cystic Fibrosis

What is the pathophysiology of Cystic Fibrosis?

Abnormal membrane chloride channels result in altered chloride and water transport across epithelial cells Inadequate hydration results in impaired mucociliary clearance Exocrine glands produce abnormal amounts of mucus that obstructs glands and ducts – resulting in obstruction and tissue damage

What extrapulmonary condition of Cystic fibrosis is virtually pathognomonic?

Meconium ileus

What pathogen is associated with Cystic Fibrosis in pneumonia cases?

Pseudomonas

What diagnostic method is used to diagnose cystic fibrosis?

Pilocarpine iontophoresis sweat test

What is a positive result for pilocarpine iontophoresis sweat test?

Increase in sodium chloride (>60 meq/L) in the sweat of a patient on two occasions

What is important to keep in mind when interpreting a Pilocarpine iontophoresis sweat test?

Normal sweat test doesn’t rule out CF 🡪 CFTR mutation analysis for patients with normal or borderline sweat chloride levels

What is the definitive diagnostic testing for cystic fibrosis?

Genetic Testing

True or false: All states now mandate newborn screening for CF

True

Congenital or acquired disorder of the large bronchi characterized by permanent, abnormal dilation and destruction of bronchial walls Key: permanently enlarged or dilated

Bronchiectasis

A complication of cystic fibrosis (Other causes but mainly see with CF)

Bronchiectasis

What is the most common cause for Bronchiectasis?

Cystic Fibrosis

What is the HALLMARK sign of Bronchiectasis?

Chronic cough, copious foul smelling purulent sputum (“3-phase sputum”)

What is the key to telling apart COPD from bronchiectasis?

imaging

CXR finding is seen in what condition? Show dilated and thickened bronchi that appear as “tram tracks” Dilated bronchi with ring-like markings

Bronchiectasis

What is the diagnostic study of choice in bronchiectasis?

breath cessation for at least 10 seconds

Apnea

Airway becomes obstructed during sleep (various etiologies) Pathologic if obstruction lasts >10 seconds and occurs >7-10x/hr (start to get concerned) Characterized by loud snoring punctuated with episodes of silence leading to microarousals

Obstructive sleep apnea

Obstructive sleep apnea is more common in which patients with?

Obesity Adenotonsillar enlargement Craniofacial dysmorphogenesis (ex: Down Syndrome and macroglossia)

List some risk factors for obstructive sleep apnea

Micrognathia Macroglossia Obesity Tonsillar hypertrophy EtOH Sedatives before going to bed Large neck hypothyroidism Cigarette smoking Common cold

List some conditions and situations that patient's with obstructive sleep apnea are at risk for

Accidents HTN IND Cardiac ectopy CVA Cardiac arrhythmias Severe hypoxemia during sleep Excessive daytime sleepiness Pulmonary hypertension Cor pulmonale

In suspected obstructive sleep apnea, what should be obtained?

a polysomnography (PSG) 🡪 “sleep study”

What is the best treatment for obstructive sleep apnea?

CPAP

Obstructive Pulmonary Diseases Flashcards

(95 cards)