Obstructive Lung Disease
Terms in this set (66)
Dyspnea & Airflow Obstruction
What are Obstructive Lung Dz?
COPD, Emphysema, Bronchiectasis, Bronchiolitis, Asthma, Cystic Fibrosis
Consequences of Obstructive Lung Dz
1) Breathing @ higher lung volumes requires higher changes in pressures for same changes in lung volume & increased work of breathing; 2) Larger lung volumes place inspiratory muscles @ mechanical disadvantage; 3) Lung volumes are increased, smaller airways tethered/ collapsed
Hallmark of COPD
IRREVERSIBLE airflow obstruction
Emphysema, Chronic Bronchitis, Small Airways Dz
Most common cause of COPD
Other causes of COPD
Cooking fires, Air Pollution, Occupational Exposure
What percentage of smokers develop clinically significant COPD
20% (Genetic predisposition)
FEV1 decline in susceptible smokers
Double (70-120mL) nonsmoking men: 35-40mL
Exacerbations of COPD
Rapidly worsening resp function, dyspnea, cough, sputum production
Poss Etiology of COPD
Alpha-1 Antitrypsin Deficiency (patients under 40)
Pathology of Emphysema
permanent enlargement of air spaces distal to terminale bronchiole
Emphysema is disease of
Result of Emphysema
Impaired gas exchange
2 types of Emphysema
Centriolobar & Panlobular
Most common type of Emphysema
Centriolobar Emphysema involves
Panlobular emphysema involves
Alpha-1 Antitrypsin Deficiency
What are the inflammatory changes with Emphysema?
Protease release, Macrophage activation, release of enzymes, elastase, MMPs, Oxidative chemicals, cytokine induction
Is there a cure for emphysema?
Definition of Chronic Bronchitis
2+ consecutive years w/ at least 3 mos cough, sputum production
What is the most common cause of Chronic Bronchitis
Chronic Bronchitis is disease of?
Dominant symptom of Chronic Bronchitis
Excess sputum production
Chronic Bronchitis inflammation =
1) excess mucus production 2) impaired mucociliary clearance
Physiologic Changes in COPD
diaphragm flattens (loss of elasticity)
How to Dx Chronic Bronchitis
CXR, PFTs (Spirometry, DLCO), Labs- CBC
What is Cor Pulmonale
R Sided Heart Failure from COPD
COPD leads to what kind of heart failure
right sided (vascular compromise, Inc pulm bed resistance)
Characteristics of Small Airway Dz (ie Emphysema)
smooth muscle remodeling, fibrosis, mucus plugs, exudates
Sx of COPD
Dyspnea & Cough/ Sputum Production (rare under 40)
Physical Exam in COPD shows:
longer expiration, hyperresonance to percussion, barrel chest, accessory muscle use, clubbing
Spirometry of COPD
decreased FEV1 (+airflow obstruction)
What is distinction between COPD/ Asthma?
COPD is not completely reversible; Asthma is reversible
Mortality predictor of COPD
BMI, Degree of Obstruction, Dyspnea, Exercise capacity (BODE)
Smoking Cessation priority
Medications for COPD
Anticholinergics: Spiriva, SABA, ie Albuterol, LABA, inhaled steroid
Is there an advantage of nebulizer vs MDI?
Not if MDI is used with good technique
When is O2 indicated for COPD?
Surgical tx for COPD
Bullectomy, Lung Volume Reduction, Lung Transplant
Hallmarks of Bronchiolitis (infants)
Acute Bronchiolitis is predominantly in
infants w/ respiratory synctitial virus
What is Bronchiectasis?
abnl dilation of bronchi 2nd to infections**
What are common sx of Bronchiectasis?
Foul Sputum, chronic cough, SOB, hemoptysis
What is common sign on CXR for Bronchiectasis?
Tx for Bronchiectasis?
tx underlying, bronchodilators, pulm drainage, interventional tx if massive hemoptysis
What organs does Cystic Fibrosis affect?
lungs, pancreas, reproductive organs, sweat glands
Clinical Manifestations of Cystic Fibrosis?
, chronic cough, thick sputum, wheezing, dyspnea, diabetes, azoospermia
How do you dx Cystic Fibrosis
Sweat Chloride Test
What are CF treatment?
infections (Abx), Recominant Human DNAse (Dornase), inhaled hypertonic saline, anti-inflammatories (NSAIDS)
Ultimate tx for CF
Bilateral lung transplant
What is def of Asthma?
Acute airway hyperactivity, REVERSIBLE, bronchoconstriction, inc mucus secretion, inc airway resistance
Who has the highest incidence of Asthma?
children, low socioeconomic levels
How much of US population has asthma?
What provokes Asthma?
allergens, airway temp changes, exercise, infections
What kind of condition is Asthma?
What is most common cause of wheezing?
What is goal of tx in Asthma?
prevent/ limit exacerbations
When are Asthma sx worse?
night & early morning
What are Asthma symptoms?
wheezing, cough, dyspnea, chest tightness
What will you find on phys exam between attacks of asthma patient?
What signs on phys exam will find during asthma attack?
wheezing w/ long expiratory phase, acc muscle use, pulsus paradoxus (pulse changes w/ insp/exp)
How do you dx asthma?
1st: PEFR; provocation test- uses methacholine, DLCO: nml; ABGs: nml (hypercarbia), CXR to RO infection
How do you manage Asthma?
SABA, inhaled corticosteroids, LABA, oral steroid for acute attack, LTRI
What is Status Asthmaticus
severe bronchospasm unresponsive to std tx, excessive bronchodilator use; MEDICAL EMERGENCY
How do you tx status asthmaticus?
IV steroid, NIPPV, mech vent