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MHD VI: Pulm > 11.24: Clinical Obstructive lung disease > Flashcards

11.24: Clinical Obstructive lung disease Flashcards

1
Q

What are general categories of dyspnea?

A
  1. Pulmonary:
    a. Restriction
    b. Obstruction
    c. Htn.
  2. Cardiac
  3. Renal acidosis
  4. Anemia
  5. NM
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2
Q

What are the big three obstruction diseases?

A
  1. Asthma
  2. COPD
    a. Emphysema
    b. Chronic Bronchitis
  3. Bronchiectasis
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3
Q

Categories of restrictive lung disease?

A
  1. Interstitial disease
    a. Sarcoid
    b. UIP/IPF
  2. Chest wall
    3 Neuromuscular
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4
Q

Main commonality / difference between restriction and obstructive lung disease?

A

Common: SOB, DOE, cough
Difference: Path / Prog / Treatment

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5
Q

Cause of obstructive v. restrictive?

A

Obstructive: increased airway resistance
Restrictive: abnormal elastic recoil

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6
Q

CXR diff. in obs. vs. rest?

A

Obs: Larger (hyperinflated lungs)
Rest: smaller lungs

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7
Q

Exam finding obs. vs. rest.?

A

Obs: Wheezing
Rest: Crackles

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8
Q

Difference in lung function in obs. vs. rest.?

A

Obs: Decreased FEV/FVC
Rest: Decreased TLC

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9
Q

Main cause of asthma?

A
  • Primarily a disease of inflammation
  • Submucosal edema seen
  • Mucous gland hyperplasia seen
  • Smooth muscle hypertrophy
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10
Q

Main difference in presentation between asthma and other obstructive disease?

A
  • Asthma is reversible: normal 99% of Days

- COPD ptns. will have symptoms every day

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11
Q

4 cardinal symptoms to include asthma in DDx?

A

EPISODIC……..

  1. SOB/DOE
  2. Wheezing
  3. Cough
  4. Chest tightness
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12
Q

How do asthmatics perform on PFTs?

A
  1. WHEN ASYMPTOMATIC: normal performance but can try to provoke symptoms w/ methacholine challenge test
  2. WHEN SYMPTOMATIC: obstruction that gets better with bronchodilator seen
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13
Q

4 Categories assessed in classifying type of asthma?

A
  1. x per week albuterol rescue inhaler needed
  2. x per month woken up by symptoms
  3. PEFR / FEV
  4. PEFR variability: bad if this is high
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14
Q

What is PND?

A

“Paroxysmal nocturnal dyspnea”

  • Often seen in heart failure
  • Often seen in asthmatics whose symptoms are usually worse at night
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15
Q

How is PF used in medicating asthmatic?

A

“Peak flow”
- Ptn. measures when feeling health and compares to when sick
-

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16
Q

2 categories of asthma treatments?

A
  1. Relievers: emergency bronchodilators

2. Controllers: daily use anti inflammatories

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17
Q

What are the relievers?

A
  • Beta agonist usually inform of “MD” metered dose inhaler
  • Can also be in nebulizers
  • **MD Albuterol 2 puffs as needed is common rx.
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18
Q

First/second line of asthma controllers?

A

First: Daily use inhaled corticosteroids (anti inflammatory)
- Must be used daily to maintain effects
- Even when feeling well
Second:
a. Long acting B agonist
b. Anti leukotrienes

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19
Q

Side effects of inhaled corticosteroids?

A
  1. Oral/Pharyn “Thrush:” Yeast infection

* *Spacer minimizes this

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20
Q

What is thermoplasty?

A
  • Heated probe placed in airway through bronchoscopy
  • Disables smooth muscle in airway so less likely to spasm
  • Very experimental
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21
Q

When can asthma therapy be stepped down?

A
  • Has been well controlled for at least 3 mos.
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22
Q

3 main diseases to think of in person with chronic cough?

A
  1. PND: Post nasal drip
  2. GERD: Acid reflux
  3. Asthma
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23
Q

What is cough variant asthma?

A
  • SOB, wheezing, tightness are not a complaint

- Cough is only complaint

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24
Q

What is exercise induced asthma?

A
  • Increased ventilation dehydrates mucosa and leads to mast cell degranulation and bronchospasm
  • Dehydration occurs because more of moisture is pulled to hydrate increase respiratory volume
  • Worse in cold air
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25
Q

How is exercise induced asthma different from exercise induced SOB?

A
  • W/ asthma person is find with exercise w/ symptoms after
  • During exercise we have inc. catecholamines to help bronchodilator
  • **Treatment is albuterol pre exercise, exercise in water/humid environment
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26
Q

Impact of PND / GERD on asthma?

A
  • Will not respond well to asthma treatment if these two not well controlled
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27
Q

Indication of occupational asthma?

A

Symptoms worse when on vacation

28
Q

What is RADS?

A

“Reactive Airways Dysfunction Syndrome”

  • Never have asthma until BIG BANG environmental exposure
  • Most people feel fine next day, this person has asthma triggered
29
Q

What is Churg-Strauss?

A
  • Inflammation of small vessels: vasculitis
  • Presents with:
    1. Asthma
    2. Hyper EOS
    3. Mononeuropathies: individual nerves don’t work
30
Q

What is Samter’s Triad?

A 
"Aspirin sensitivity"
1. Asthma
2. Nasal polyps
3. ASA sensitivity exacerbating asthma 
RX: antileukotrienes
31
Q

What is APBA?

A

“Allergic Bronchopulmonary Aspergillosis”
- Aspergillosis: Fungus in soil normally not problematic
- Ptn. with asthma plus demonstrated reactivity to aspergillus can demonstrate this
RX: steroids

32
Q

Asthma summary?

A 
EPISODIC:
1. Cough
2. Tightness
3. Weeze
4. Dyspnea
Cause: Inflammation 
RX: inhaled corticosteroids w/ emergency bronchodilators
33
Q

2 types of COPD?

A
  1. Emphysema: permanent distention of distal airspace w. destruction of alveolar septa
    “Pink puffer”
  2. Chronic Bronchitis: Excessive sputum production
    “Blue Bloater”
34
Q

Etiology of pink puffer?

A
  • Able to maintain normal pCO2 by huffing and puffing
  • Burns calories so keeps them thin
  • Huffing allows normal O2 to stay “pink”
35
Q

Etiology of blue bloater?

A
  • Accepts hypercapnia so Co2 creeps up
  • This is because they are not breathing as hard
  • Leads to less O2 in blood
  • Hypoxia develops leading to hypoxic vasoconstriction, cor pulmonale, and bloated appearance
36
Q

What is hypercapnia?

A

Excessive CO2 in blood, typically caused by inadequate respiration

37
Q

COPD presentation?

A
  • Insidious onset of SOB, DOE, Cough

- There IS day to day variability but likely they will not have felt up to running after a bus for a very long time

38
Q

PFTs in COPD?

A
  • Obstruction without bronchodilator response
  • Hyperinflation; high TLC
  • Reduced diffusion capacity
39
Q

COPD treatment?

A
  1. STOP SMOKING
  2. Start with short acting bronchodilators used when needed
    a. B agonist
    b. Anticholinergic
  3. Add in long acting bronchodilator
  4. If O2 is low while sitting still or at night give O2
    - If low while walking, only use when walking
40
Q

SE of long acting bronchodilators?

A
  • Increased mortality

- Need to add in inhaled cortico to prevent this

41
Q

Pathology of bronchiectasis?

A
  • Inflammation destroying integrity of airway so when ptn. exhales / coughs airways collapse trapping more mucus leading to more inflammation
  • Suppurative characterized by abnormal dilation of bronchi
  • Cups of mucus / day coughed up
42
Q

What does suppartive?

A
  • Pus producing

Think “PUS backwards = SUP”

43
Q

What is cycle of inflammation in bronchiectasis?

A
  • Neutrophil / protease inflammation of airway making harder to fill
  • Inflammation destroys airways
  • Destruction makes mucus clearance hard
  • Low mucus clearance leads to bacterial colonization
44
Q

Bacteria often involved in bronchiectasis?

A
  1. Staph aureus
  2. Pseudomonas
  3. Non TB mycobacterium
45
Q

Symptoms of bronchiectasis?

A
  1. SOB / DOE

2. Daily copious sputum production

46
Q

Bronchiectasis Causes?

A
  1. CF
  2. Kartagener’s: ciliary problem
  3. Pneumonia
  4. RA
47
Q

CXR/CT presentation of bronchiectasis?

A

“Signet Ring Sign”
- Internal diameter of bronchus > accompanying vessel
- Normally same size
“Tram Tracking”
- Bronchus fails to taper in periphery of chest

48
Q

What are “Signet Ring Sign” and “Tram Tracking” characteristic of?

A

Bronchiectasis, seen on cxr / ct

49
Q

Treatment of bronchiectasis?

A

Break cycle of mucus formation

  1. Airway therapy
    a. Chest percussion
    b. Bronchodilators
    c. Hypertonic saline
  2. Antiinflammatory
  3. Antibiotics
  4. Transplant needed in CF
50
Q

What is Lymphangioleiomyomatosis?

A

“LAM”

- Obstructive airway disease ONLY seen in women of childbearing age

51
Q

What is Bronchiolitis Obliterans

A
  • Idiopathic narrowing of airway that mirrors COPD in lack of response to bronchodilators but have never smoked, not AT1 deficiency
52
Q

Definition of restrictive lung disease and three causes?

A

Low TLC

  1. Interstitial lung disease: most common
  2. Chest wall disease
  3. NM disease
53
Q

What is Interstitial lung disease?

A
  • Chronic inflammatory lung disease with stuff deposited in interstitium
  • Increased elastic recoil
54
Q

What are IIPs?

A

“Idiopathic Interstitial Pneumonia”
1. UIP/IPF
2.

55
Q

What is UIP?

A

“Usual pulmonary pneumonia”

  • Pathologic term for Idiopathic pulmonary fibrosis
  • Normal alveoli, next to inflammatory, next to scared in imaging all in same biopsy
  • Patient will thus present with clinical syndrome of “IPF”
56
Q

What is NSIP

A

“Nonspecific interstitial pneumonia”

- Expect connective tissue disorder, hypersensitivity

57
Q

What would exam show in interstitial lung disease?

A
  1. Small lungs
  2. SOB
  3. Crackles
  4. Low TLC
  5. Clubbing of fingers
  6. CXR with interstitial markings
58
Q

Causes of interstitial lung disease?

A 
"SHIT FACED"
Sarcoid
Hypersensitivity pneumonitis
Idiopathic pulmonary fibrosis 
TB
Fungal
Aspiration/asbestos
Connective tissue disorder
EOS granuloma 
Drugs 
Pneumoconioses
59
Q

What is sarcoid?

A
  • Giant cells, non caseating granulomas
  • Non specific tissue reaction: idiopathic
  • Lymphadenopathy or interstitial disease in lung
  • Can involve eyes, skin as well
60
Q

What are non caseating granulomas indicative of?

A

Sarcoid

61
Q

Sarcoid treatment?

A

Corticosteroids to everyone that has symptoms

62
Q

Who is IPF usually seen in?

A

“Idiopathic pulmonary fibrosis”

  • Insidious DOE in Middle aged/ elderly male
  • Cough
  • Crackles
  • Low TLC
  • Lower lobe, peripheral, ILD “Reticulonodular infiltrates / lines and dots “
  • **Biopsy if atypical presentation
63
Q

What is ILD?

A

“Reticulonodular infiltrates / lines and dots “

- Seen on CT of IPF

64
Q

IPF prognosis?

A

2.5 - 5 years

65
Q

IPF treatment?

A
  1. Pirfenidone
  2. Nintedanib
    * **Transplant

MHD VI: Pulm (20 decks)

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