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
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)
What are two patterns in advanced COPD?
Blue bloater and pink puffers
What are charactertics of blue bloaters in COPD?
- “stocky” build
- wheezy on exam
- signs of right heart failure
- CXR normal or possible increased lung markings
- ABG findings: PaO2 markedly reduced , PaCO2 increased, increased hematocrit
What are charactertics of pink puffers in COPD?
- Dominant symptom is dyspnea
- Thin biuld, hyperinflated chest
- CXR can be normal or hyperinflated with decreased markings, possible bullae
- ABG: slightly reduced PaO2, normal CaCO2.
What are some host risk factors for COPD?
- a-1-antitrypsin deficiency
- airway hyperresponsiveness
- lung growth impairement: low birth weight, childhood respiratory infections
What are some environmental risk factors for COPD?
- Tobacco smoke
- Occupational dusts and chemicals
- Indoor air pollution: biomass fuels and ETS
- Outdoor air pollution from inhaled particulates
- Socioeconomic status
Describe the COPD classifications based on FEV1?
What are the treatments for the four types of COPD (A-D)?
What is the difference between COPD and asthma?
COPD: onset in mid-life, slowly progressive symptoms, risk factor exposures, prominent sputum, no nocturnal predominance.
Asthma: early onset, day to day symptom variability, allergies and eczema, minimal sputum, nocturnal worsening, family Hx.
What are the inflammatory cells involved in asthma and COPD?
Asthma: eosinophil predominance (PMN in severe).
- mast cells, CD4+ Th2 lymphocytes
- LTD4, IL4, IL5, IL13
COPD: PMN predominance (eosinophils in exacerbation)
- macrophages, CD8+ T lymphocytes
- LTB4, IL8, TNFa
What is the classic triad seen on CF?
Recurrent sinopulmonary disease, elevated sweat chloride, and pancreatic insufficiency.
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
How would you diagnose CF?
Clinical findings + biochemical or genetic confirmation
Cystic fibrosis transmembrane conductance reulgator (CFTR) dysfunction
- Sweat chloride test: elevation >60 mmol/L on two occaisions
- 2 disease-causing mutations in CFTR
- Abnormal nasal potential difference
What is seen in classic CF?
What is seen in non-classic CF?
What type of treatment do patients with CF recieve?
- Antibiotics
- Nutrition (high calorie diet)
- Chest physiotherapy
- Bronchodilators
- Antiinflammatory agents
- Mucolytics
- Excellent glycemic control
COPD is a mixture of the triad of what three things?
Asthma, emphysema, and chronic bronchitis.
Emphysema is a pathologic diagnosis
Chronic bronchitis is defined as a cough for more than 3 months in 2 consecutive years.
