S1 L3.2: Chronic Lung Diseases Flashcards by Mind Med

A chronic inflammatory disorder of the airway mucosa associated with airway hyperresponsiveness

“Big form of allergy”

Bronchial Asthma

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Sx of Bronchial Asthma

○ Recurrent episodes of wheezing
○ Breathlessness d/t narrowed airway
○ Chest tightness
○ Mucus production d/t inflammation
○ Coughing d/t irritation of the airways eliciting asthmatic s/sxs

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Risk Factors for Asthma

Influence susceptibility to development of asthma in predisposed individuals, precipitate asthma exacerbations, and/or cause symptoms to persist

Environmental Factors

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Risk Factors of Asthma

Predisposed individuals to, or protect them from, developing asthma; could be genetic

Host Factors

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Inflammation makes the airway hyperresponsive → [?]

Develop sx

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Statement 1: Allergens, sensitizers, viruses, or air pollutants come in contact with our airways
Statement 2: Our immune system (+ eosinophils, inflammatory cells) is poised to react to these triggers, their interaction results to inflammation

a. TF
b. FT
c. TT
d. FF

c. TT

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With triggers, the normal airway’s muscular portion contracts (bronchoconstriction) → [?] → result to [?]

With triggers, the normal airway’s muscular portion contracts (bronchoconstriction) → will narrow down airways → result to limited airflow

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Statement 1: Asthmatic people, whenever they have attacks, become dyspneic or hypoxemic d/t bronchodilation
Statement 2: Wheezes are low-pitched sounds caused by narrowed airways

a. TF
b. FT
c. TT
d. FF

d. FF

1. Bronchoconstriction; 2: High-pitched

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Acute Signs and Sx of Asthma

Dyspnea
Wheezing (especially upon expiration)
Flaring of Nostrils
Interrupted Talking
Agitation
Chronic/recurrent cough

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Heart is not functioning well (not pumping well), therefore blood fluid that should move forward goes back and returns to the lungs.

Cardiac Wheeze

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Severity of Asthma Attack

Alert: Agitated
Breathlessness: Even at rest
Talks in: Words
Wheeze: Loud
Accessory Muscle: Used
RR: Often >30
PR: >120
PaO2: <60, possible cyanosis
PCO2: >45

Severe

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Severity of Asthma Attack

Alert: May show agitation
Breathlessness: On walking
Talks in: Sentences
Wheeze: Moderate
Accessory Muscle: Usually not Used
RR: Inc
PR: 100
PaO2: Normal
PCO2: <45

Mild

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Severity of Asthma Attack

Alert: Confused
Breathlessness: -
Talks in: -
Wheeze: Absent
Accessory Muscle: -
RR: -
PR: <60 (bradycardia)
PaO2: -
PCO2: -

Pending Arrest

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Severity of Asthma Attack

Alert: Agitated
Breathlessness: On walking
Talks in: Phrases
Wheeze: Loud
Accessory Muscle: Used
RR: Inc
PR: 100-120
PaO2: >60
PCO2: <45

Moderate

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Chronic Asthma Severity while on Treatment

Daytime Symptoms: Monthly
Nocturnal Awakenings: Less than monthly
Rescue Beta 2 Use: Less than weekly
PEF/FEV1: >80% of predicted
Tx needed: Occasional prn Beta 2 only

Intermittent

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Chronic Asthma Severity while on Treatment

Daytime Symptoms: Weekly
Nocturnal Awakenings: Monthly-Weekly
Rescue Beta 2 Use: Weekly-Daily
PEF/FEV1: 60-80% of predicted
Tx needed: Reg ICS + LABA combination

Persistent Mild/Moderate

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Chronic Asthma Severity while on Treatment

Daytime Symptoms: Daily
Nocturnal Awakenings: Nightly
Rescue Beta 2 Use: Several times/day
PEF/FEV1: <60% of predicted
Tx needed: Combination of ICS + LABA + OCS

Persistent Severe

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Medications

Used regularly to control chronic symptoms and prevent asthma attacks

Long-term-control medications

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Medications

Used as needed for rapid, short-term relief of symptoms during an asthma attack

Quick relief medications

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Medications

Decrease sensitivity to allergens

Allergy Control

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Modified T/F
Facts about COPD

A. In 2010, the WHO estimated 2.74 million deaths worldwide from COPD
B. COPD is the 2nd leading cause of death in the US

A. WHO estimated this in 2000
B. 4th leading cause of death in the US

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What is the primary cause of COPD?

Cigarette smoking

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T/F

Vape is safer in terms of cardiac & lung problems

False. Vape may be safer in terms of cardiac problems, but in the lungs it is not.

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Modified T/F
Facts about COPD

A.Characterized by airflow limitation that is fully reversible
B. Usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gasses

A. Characterized by airflow limitation that is not fully reversible. You can alleviate worsening only.

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What are the 3 classifications of COPD?

CHRONIC BRONCHITIS EMPHYSEMA SMALL AIRWAYS DISEASE

Matching type 1. Destruction and enlargement of the alveoli, Anatomically defined 2. Cough and sputum production for at least 3 months in a row of 2 of consecutive years, Clinically defined 3. A condition in which small bronchioles are narrowed but pathology is same A. CHRONIC BRONCHITIS B. EMPHYSEMA C. SMALL AIRWAYS DISEASE

1. B 2. A 3. C

Matching type MANIFESTATIONS 1. Inflamed small airways; bronchioles are destroyed 2. Airflow narrowing is structural and permanent 3. “Pink puffer” 4. Alveolar destruction 5. Blue bloaters A. CHRONIC BRONCHITIS B. EMPHYSEMA

1. A 2. B 3. B 4. B 5. A

Matching type RISK FACTORS OF COPD 1. Genes 2. Lung growth 3. Tobacco smoke 4. Hyperresponsiveness 5. Education A. HOST FACTORS B. EXPOSURE

1. A 2. A 3. B 4. A 5. B

Modified T/F COPD PATHOGENESIS A. You are predisposed to COPD because of your genes and you have the environment to culture it B. Disease particles in gasses promote lung inflammation

TF B. Noxious particles in gasses promote lung inflammation

COPD PATHOGENESIS Depending on how the body reacts to inflammation, excessive reaction can lead to _______

Fibrosis - scars / dead tissues

Matching type COPD PATHOGENESIS 1. Loss of alveolar attachments 2. Airway inflammation 3. Airway remodeling 4. Decrease of elastic recoil A. Small airway disease B. Parenchymal destruction

1. B 2. A 3. A 4. B

Modified T/F COPD A. Irreversible causes of airflow limitation include accumulation of inflammatory cells, mucus, and plasma exudate in bronchi B. Reversible causes of airflow limitation include fibrosis and narrowing of the airways, loss of elastic recoil due to alveolar destruction, & destruction of alveolar support that maintains patency of small airways

FF A. Accumulation of inflammatory cells, mucus, and plasma exudate in bronchi - REVERSIBLE B. Fibrosis and narrowing of the airways, loss of elastic recoil due to alveolar destruction, & destruction of alveolar support that maintains patency of small airways - IRREVERSIBLE

Matching type COPD PATHOGENESIS 1. Smooth muscle construction in peripheral and central airways 2. Loss of elastic recoil due to alveolar destruction 3. Destruction of alveolar support that maintains patency of small airways 4. Fibrosis and narrowing of the airways A. REVERSIBLE B. IRREVERSIBLE

1. A 2. B 3. B 4. B

T/F Common symptoms to aid in the diagnosis of COPD are cough, sputum, & fever.

FALSE. Cough, sputum, & DYSPNEA.

Modified T/F Diagnosis of COPD A. Symptoms (cough, sputum, dyspnea) are the only thing to look out for when doing a patient's subjective examination. B. Diagnosis of COPD is similar to asthma

FT A. Symptoms (cough, sputum, dyspnea) and history of exposure to risk factors (tobacco, occupation, indoor & outdoor pollution)

T/F Diagnosis of COPD The patient cannot be subjected to spirometry without the s/sx.

FALSE The patient can be subjected to spirometry even without the s/sx.

T/F FEV1 is fast in COPD patients.

FALSE. FEV1 is slow in COPD patients

Matching type COPD CLASSIFICATION BY SEVERITY 1. With or w/o symptoms of smoker’s cough, little or no breathlessness 2. Breathlessness on exertion 3. Chronic cough, sputum production 4. Breathlessness on any exertion/at rest 5. Polycythemia in advanced disease, especially during 6. Variable abnormal signs (general reduction in breath sounds, presence of wheezes) A. Stage 0 B. Stage 1 C. Stage 2 D. Stage 3 E. Stage 4

1. B and C 2. D 3. A 4. E 5. E 6. C and D

Modified T/F Goals of therapy for COPD a. Cure disease b. Improve quality of life

FT a. COPD is irreversible; goal is to prevent disease progression

Matching type COPD therapy 1. Beta agonists 2. Pulmonary rehabilitation 3. Smoking cessation 4. Vaccination 5. Lung volume reduction surgery A. PHARMACOTHERAPY B. NONPHARMACOLOGIC THERAPY

1. A 2. B 3. A 4. A 5. B

Modified T/F COPD PULMONARY REHAB IS AIMED AT IMPROVING QUALITY OF LIFE BY A. Decreasing respiratory symptoms and complications B. Increasing hospitalizations

TF B. Reducing hospitalizations

Give the 6 components of pulmo rehab programs

Medical management Exercise Breathing retraining Education Emotional support Nutrition counseling

Modified T/F A. Asthma is related to a noxious agent B. COPD is related to a sensitizing agent

FALSE Asthma is related to a sensitizing agent COPD is related to a noxious agent

Modified T/F A. Both asthma and COPD can present with wheezing B. COPD is common in older age usually d/t smoking

Matching type 1. Dyspnea w/ exertion (progressive over time) 2. Trigger: Occupational antigens 3. Pursed lip breathing 4. Prolonged expiration 5. Eosinophilia in CBC A. Asthma B. COPD

1. B 2. A 3. B 4. A 5. A

Matching type 1. Reduced FEV1 & FEV1/FVC 2. Spirometry values usually do not return to normal values even w/ treatment 3. Early inspiratory crackles 4. Alpha-1 antitrypsin level is normal A. Asthma B. COPD C. Both

1. C 2. B 3. B 4. A

Main pathology in chronic restrictive lung diseases

Reduced lung compliance (Lungs have difficulty in expanding)

Modified T/F A. In chronic restrictive lung diseases, less pressure needed to expand the lungs B. In chronic restrictive lung diseases, the lungs are stiff

FT A. MORE pressure is needed to expand the lungs

Modified T/F Chronic restrictive lung diseases - Pulmonary function test A. ↑ TLC, FRC, RV, FEV1, FVC B. The ratio FEV1/FVC usually normal

FT A. ↓ TLC, FRC, RV, FEV1, FVC

The basement membrane, interstitial tissue, endothelial cell, & epithelial cell are part of the ______ barrier.

Gas Exchange Barrier (membrane where O2 and CO2 exchange)

Explain the mechanism of chronic restrictive lung diseases

Damage to epithelium and vessels → abnormal VQ → hypoxia → cyanosis

Modified T/F Chronic restrictive lung diseases A. Chest wall abnormality is a primary lung disease B. Primary lung diseases can be further categorized to acute and chronic

FT A. Chest wall abnormality is NOT a primary lung disease

Modified T/F Chronic restrictive lung diseases A. Chest wall abnormalities can be caused by deformities or neuromuscular diseases B. Neuromuscular diseases that can cause chronic restrictive lung diseases are MG, ALS, MS, muscular dystrophy, myopathy

T/F Patients with acute respiratory distress syndrome (ARDS) live about 5 years after diagnosis.

FALSE. Most die immediately

Occupational hazards for chronic primary lung disease include: A. Asbestosis B. Silicosis C. Theophylline D. Coal worker pneumoconiosis

A, B, & D only

What represents 15% of non-infectious diseases of lungs?

CHRONIC RESTRICTIVE LUNG DISEASES

TRUE about chronic restrictive lung diseases? 1. End-stage: diffuse interstitial pulmonary fibrosis (Honeycomb lung) 2. It is a group of different diseases with similar clinical, pulmonary function test, and pathological findings

Diffuse interstitial pulmonary fibrosis is also called

Honeycomb lung

Radiation can also burn the lungs, creating ________ in the lungs

Fibrosis

Most common form of idiopathic interstitial lung disease, also called usual Interstitial pneumonia

IDIOPATHIC PULMONARY FIBROSIS

Modified T/F IDIOPATHIC PULMONARY FIBROSIS A. 60% idiopathic, but 40% is associated with collagen vascular diseases B. Affectation: Male < female

FF A. 80% idiopathic, but 20% is associated with collagen vascular diseases B. Male > female, 60 y/o

Modified T/F IDIOPATHIC PULMONARY FIBROSIS A. Dx takes time. Usually undergoes numerous rule-outs before being dx c IPF B. Idiopathic Pulmonary Fibrosis is considered to be a diagnosis during the early stages of the condition

FF A. 80% idiopathic, but 20% is associated with collagen vascular diseases B. MDs consider a lot of diseases first. If there is no other possible diagnosis, then it can be Idiopathic Pulmonary Fibrosis

CLINICAL PRESENTATION OF THIS DISEASE IS - Gradual, non-productive cough - Progressive dyspnea, cyanosis - Inspiratory crackles - Finger clubbing - Poor response to therapy - Bad prognosis (worst) - Mean survival 2-4 years

IDIOPATHIC PULMONARY FIBROSIS

SALIENT FEATURES OF THIS DISEASE IS - Bilateral hilar lymphadenopathy (kulani) - Lung involvement, lung nodules - Other organs: skin, eye, any tissue

SARCOIDOSIS

T/F ABOUT SARCOIDOSIS 1. Multisystem diseases 2. Known etiology 3. Affects adults younger than <50 y/o 4. Common in asians 5. Common in non-smokers

1. T 2. F - UNKNOWN ETIOLOGY 3. F - Adult, younger than <40 y/o 4. F - Common in US blacks; not common in PH 5. T

T/F Sarcoidosis has better prognosis compared to IPF

TRUE

Sarcoidosis progression type

Progressive or relapsing remitting disease

Sarcoidosis immunologic factors

- Activated CD4 T-cells - Increase number of CD4 T-cells - High level of IL-2, Interferon-gamma, IL-8, TNF

Sarcoidosis genetic factors

- Familial, racial clustering - Association with HLA-A1, HLA-B8

Sarcoidosis Environmental factors

- Viral infection, mycobacteria - Unsure but typically associated with viral infection

- IMMUNE MEDIATED DISEASE - Inflammatory disease - Affect alveoli mainly (allergic alveolitis) - Restrictive disease

HYPERSENSITIVITY PNEUMONITIS

Acute hypersensity pneumonitis presents with

4-6 hours following exposure to the pathogen: Fever, cough, dyspnea

Chronic hypersensity pneumonitis presents with

Cough, dyspnea, weight loss

Matching type HYPERSENSITIVITY PNEUMONITIS CAUSES 1. Pigeon breeder lungs 2. Humidifier lung 3. Farmer lung A. Fungal/ bacterial B. Animal product

1. B 2. A 3. A

Morphology of what disease: - Particles: not usually sEEN - Inflammation, edema, peribronchial - Fibrosis

HYPERSENSITIVITY PNEUMONITIS

COLLAGEN VASCULAR DISEASE is similar to what other restrictive lung disease?

Idiopathic pulmonary fibrosis

CAUSES OF COLLAGEN VASCULAR DISEASE?

Scleroderma Polymyositis/ dermatomyositis Systemic lupus erythematosus Rheumatoid arthritis Ankylosing spondylitis

MODIFIED T/F A. WEGENER GRANULOMATOSIS affect upper respiratory tract only B. Wegener's granulomatosis is a necrotizing vasculitis

FT A. Affect both upper and lower respiratory tract

Matching type WEGENER GRANULOMATOSIS SYMPTOMS 1. sinusitis 2. hemoptysis 3. Nasal perforation 4. Cough A. UPPER RESPIRATORY TRACT B. LOWER RESPIRATORY TRACT

1. A 2. B 3. A 4. B

Matching type 1.Nitrofurantoin 2. Amiodarone 3. Gold 4. Dilantin 5. Bleomycin A. Anti-seizure drug B. Used for cancer C. Antibiotic D. Cardiac drug that controls cardiac arrhythmia E. Disease-modifying antirheumatic drug (DMARD)

1. C 2. D 3. E 4. A 5. B

Work-up MD may ask for in pts with Chronic lung diseases

Pulmonary function test Chest X-ray (CXR) High resolution CT Scan Lung Biopsy Blood tests directed by clinical assessment Bronchoalveolar Lavage

When is steroids given as treatment?

If you don’t know the cause, but you know the pathomechanics

Matching type 1. Cyclophosphamide 2. Antibiotics 3. Steroids 5. Oxygen supplementation A. Anti-fibrosis/anti-inflammatory B. If there is a superimposed infection or pneumonia C. Very effective anti-inflammatory agent but has many side effects D. Required due to fibrosis

1. A 2. B 3. C 4. D

MODIFIED T/F A. Prognosis for collagen vascular diseases, eosinophilic pneumonia, BOOP, and drug-induced lung diseases is still unfavorable even with treatment B. Sarcoidosis has better prognosis that other restrictive lung diseases

FT A. Prognosis for collagen vascular diseases, eosinophilic pneumonia, BOOP, drug-induced lung diseases is generally favorable with treatment

What severity of COPD needs avoidance of risk factors and education?

Stage 1-4

What severity of COPD needs smoking cessation?

Stage 1-4

What severity of COPD needs vaccination?

Stage 1-4

What severity of COPD needs short-acting bronchodilator PRN?

Stage 1-4

What severity of COPD needs regular use of single or combined long-acting bronchodilators?

Stage 3-4

What severity of COPD needs inhaled steroids?

Stage 3-4

S1 L3.2: Chronic Lung Diseases Flashcards

(90 cards)