8 - Obstructive Lung Disease Cases Flashcards
What are the three types of lung disease?
Obstructive: air goes in and can’t go out easily; air trapping and hyperinflation; FEV1/FVC ratio
Restrictive: lungs very scarred so you can’t get in easily; low TLC; normal FEV1/FVC ratio
Combination of both
How do we diagnose obstructive lung disease?
History: 85% of coming to the correct diagnosis is by obtaining a history
Exam: changes in chest wall configuration, noises heard, or lack of noises heard, clubbing
Diagnostic tests: pulm function test, imaging, lab work.
What does asthma do to your airway?
Causes bronchial constriction and airway wall inflammation
How do you make an initial diagnosis of asthma?
- Episodic symptoms of airflow obstruction
- Airflow obstruction that is at least partly reversible
- Alternative obstruction that’s at least partly reversible
- Requires detailed history, physical exam, and spirometry.
What are two spirometry effects that are seen in asthma?
Low FEV1/FVC indicates obstruction (could be asthma)
Reversibility with bronchodilator: >12% change in FEV1 after bronchodilator AND 200 ccs.
Describe the scoring of ACT vs the ATAQ questionnaire?
On the ACT scoring, a higher score = better control
On ATAQ, lower score = better control
How is asthma classified?
Based on symptoms, nighttime awakenings, how often they use short-actining B2 agonists for symptoms control, and their lung function.
Describe the severity of symptoms seen in intermittent, mild, moderate, and severe asthma?
Intermittent: <2 days/week
Mild: >2 days/week but not daily
Moderate: daily
Severe: throughout the day
Describe the nighttime awakenings frequency seen in intermittent, mild, moderate, and severe asthma?
Intermittent: <2x/month
Mild: 3-4x/month but not daily and not more than 1x on any day
Moderate: >1x/week but not nightly
Severe: often 7x/week
Describe the interference with normal activity seen in intermittent, mild, moderate, and severe asthma?
Intermittent: none
Mild: minor limitation
Moderate: some limitation
Severe: extremely limited
Describe the lung function seen in intermittent, mild, moderate, and severe asthma?
Intermittent: nomal FEV1 between exacerbations, FEV1 >80% predicted, ratio is normal
Mild: FEV1 >80% predicted, FEV1/FVC normal
Moderate: FEV1 >60% but <80% predicted; FEV1/FVC reduced
Severe: FEV1 <60% predicted; FEV1/FVC reduced
When should you consider the diagnosis of COPD?
When you have a patient with dyspnea, chronic cough, or sputum.
and/or
>40 years of age with a history of exposure to risk factors or a family history of COPD
Spirometry required to confirm diagnosis (post-bronchodilator FEV1/FVC <.70 – ie it does NOT get better with a bronchodilator)
What is chronic airflow limitation?
A mixture of small airways disease (obstructive bronchiolitis) and parenchymal destruction (emphysema).
Don’t always occur together and can evolve at different rates.
What are clinical symptoms of COPD?
Dyspnea - at rest and/or with exertion
Cough - cough with or without sputum
Wheezing
Frequent chest illnesses/cold/bronchitis
What is considered chronic bronchitis?
Chronic productive cough for 3 months in each of 2 successive years.
- other causes of cough have been ruled out
- may proceed or follow development of air flow limitations (obstruction)
Describe the COPD classifications based on FEV1?
What are the treatments for the four types of COPD (A-D)?
What is the pathophysiolocy of CF lung disease?
It’s a vicious cycle of that leads to progressive, irreversible lung disease.
What are seen with severe mutations causing CF and mild mutations causing CF?
Severe: result in pancreatic insuff. and decreased survival
Mild: pancreatic SUFFICIENCY
What is seen in classic CF?
What is seen in non-classic CF?
