Chapter 12 Flashcards
What is emphysema?
A permanent abnormal enlargement of the air
spaces distal to the terminal bronchioles
associated with destructive changes of the
What is panilobar emphysema?
The acinus is the involved and is the anatomic
unit of gas exchange for the lung. It involves the
respiratory bronchioles, alveolar ducts, alveolar
What is centrilobar emphysema?
The lesion is the center of the lobules and, which
results in enlargement of the and destruction of
the respiratory bronchioles. It involves the upper
What is Bollous emphysema?
Emphysematous changes are isolated and
accompanied by the development of bullae,
which are weak air spaces and susceptible to
What are bullae?
air spaces in their distended state, more than 1
cm in diameter
What are blebs?
air spaces adjacent to the pleura, usually less
than 1 cm in diameter in their distended state.
What is the cause of emphysema?
Smoking
a1-Antitrypsin deficiency (hereditary)
In emphysema air-trapping leads to chronic
hyperinflation of the lungs and an ______?
Increased FRC
_______ is increased as a result of the destruction
of elastic lung tissue?
Lung compliance
What are the signs and symptoms of
emphysema?
Elevated hemoglobin, hematocrit, and red
blood cell count.
chronic CO2 retention and
What will you see on a CXR for emphysema?
Hyperinflation
Reduced vascular markings
What PFTs will be seen with emphysema?
Decreased forced expiratory volume in 1
What is the treatment for emphysema?
Bronchodilators
Methylxanthines
What are some examples of a smoking
cessation program?
Group counseling
Nicotine replacement therapy
What are some examples of a SABA and what
patients are the used for?
Albuterol
Xopenex
Used for COPD patients
What is a short acting anticholinergic?
Atrovent
What are some examples of a LABA?
Serevent
Spiriva
What is an example of an ICS and what can it be
combined with to reduce acute exacerbations?
Inhaled Flonase
A LABA
What is an example of an methylxanthine?
Theophylline
What are some examples of breathing
exercises?
Diaphragmatic breathing
Pursed lip breathing
O2 therapy
PaCO2 begins increasing after a patient with
severe COPD starts receiving O2, what does that
The respiratory drive has been suppressed
Remain the PaO2 between what?
50-65 mmHG
What is chronic bronchitis?
chronic excessive mucus production, resulting
from an increase in the number and size of
mucus glands and goblet cells. Symptoms are a
cough and increased mucus production for at
least 3 months of the year for more than 2
Who is most commonly affected with chronic
bronchitis?
Males
What is the cause of chronic bronchitis?
Smoking
What is the pathophysiology of chronic
bronchitis?
Mucus plugs in peripheral airways
Loss of cilia
Emphysematous changes in advanced
stages of disease
What are the signs and symptoms of chronic
bronchitis?
CO2 retention and hypoxemia in advanced
stages
Increased pulmonary vascular resistance
(PVR) in advanced stages
What will you see on a CXR for chronic
bronchitis?
Not significant in early disease
Hyperinflation (in advanced stages)
What are some PFTs seen with chronic
Increased RV
bronchitis?
Decreased FEV1
What is the treatment for chronic bronchitis?
Smoking cessation program
An FEV1/FVC < 70% indicates what?
Obstruction
What is GOLD standard 1 Mild?
FEV1 > 80% predicted
What is GOLD standard 2 Moderate?
FEV1 50-79% of predicted
What is GOLD standard 3 Severe?
FEV1 30-49% of predicted
What is GOLD Standard 4 Very Severe?
FEV1 < 29% of predicted
What are the GOLD standard guidelines for drug therapy?
Inhaled ICS
therapy?
Phosphodiesterase-4 inhibitorS
Inhaled ICS will be beneficial for COPD patients
with an FEV1 of what?
< 60% predicted
Combining long-acting bronchodilators and
inhaled corticosteroids will be more effective
than using either drug individually but may
pneumonia
Roflumilast can be helpful with what patients?
GOLD 3 and GOLD 4 patients who have a history
of acute exacerbations and chronic bronchitis
Roflumilast can be combined with what?
LABAs
Theophylline added to ______ has been shown to
increase FEV1 more than with _____ by itself.
Salmeterol
What methylxanthine is not recommended for
chronic bronchitis?
Theophylline
What is asthma?
A clinical syndrome characterized by airway
obstruction, which is partially or completely
reversible either spontaneously or with
What are the characteristics of asthma?
airway hyperresponsiveness to various
stimuli
What are some causes of asthma?
Environmental factors
Infection
What is intermittent asthma?
the least severe of the four classifications
What are the symptoms of intermittent asthma?
wheezing or coughing are experienced no more
than twice per week.
What are the PFT characteristics of intermittent
asthma?
The patients in this category generally have
FEV1 and peak expiratory flow (PEF) values of
at least 80% of predicted.
What medications are used for intermittent
asthma?
Routine management generally consists of beta-
2 agonists (SABAs), as needed.
What is the treatment for intermittent asthma?
emergency department treatment or
hospitalization
What are the symptoms for mild asthma?
Symptoms of coughing or wheezing are
experienced more than twice per week but less
How often do the symptoms for mild asthma
Symptoms affect the patient’s daily activity and
sleep during the night; nocturnal coughing,
occur?
wheezing, or dyspnea is experienced more than
What are the PFT characteristics for mild
asthma?
The patients in this category generally have
FEV1 and PEF values of at least 80% of
predicted.
What drugs are used for mild asthma?
Routine management generally consists of ICS
therapy to control symptoms and the use of a
What is the treatment for mild asthma?
Emergency department treatment for
exacerbations occurs periodically and may
What are the symptoms for moderate asthma?
Symptoms of coughing or wheezing are
experienced almost daily in this category.
How often do exacerbations occur for moderate
asthma?
Exacerbation of symptoms are experienced at
least twice per week and may persist for several
days.
How often do symptoms occur for moderate
asthma?
Symptoms affect the patient’s daily activity and
sleep during the night; nocturnal coughing,
wheezing, or dyspnea is experienced more than
What are the PFT characteristics for moderate
asthma?
The patients in this category generally have
FEV1 and PEF values of 60% to 80% of
predicted.
What are the medications for moderate asthma?
A SABA as needed for symptoms and not to
exceed 3 to 4 times per day; LABA for nocturnal
What is the treatment for moderate asthma?
Patients in this category routinely require
emergency department treatment or require
What is severe asthma?
This is the worst category of the four.
What are the symptoms for asthma?
Symptoms of coughing or wheezing are
experienced almost continually.
How often do exacerbations occur for sever
asthma?
Exacerbations are frequent and may last for
weeks.
How often do symptoms occur for severe
asthma?
Symptoms affect the patient’s daily activity and
sleep during the night; nocturnal coughing,
wheezing, or dyspnea is experienced almost
What are the PFT characteristics for sever
asthma?
The patients in this category generally have
FEV1 and PEF values of 60% or less of
predicted.
What medications are used for sever asthma?
3 to 4 times per day; LABA and oral
corticosteroids for nocturnal symptoms and
What is the treatment for severe asthma?
Patients in this category routinely require
emergency department treatment or require
What is the pathophysiology for asthma?
When the asthmatic inhales an allergen that he
or she is sensitive to, mast cells located in the
bronchial mucosa and submucosa and will
What are the chemical mediators for asthma?
Leukotrienes
Platelet-activating factor
What substances will the chemical mediators
release:
Increased mucus production
Accumulation of eosinophils in the blood
and
Measuring FeNO can help determine what?
airway inflammation
What is normal FeNO for adults?
25 ppb
What is normal FeNO for children?
20 ppb
FeNO levels greater than 50 ppb indicate what?
patient needs to increase his or her normal
medication
FeNO levels are usually increased with what?
patient’s noncompliance with corticosteroid use.
What are the signs and symptoms for asthma?
Paradoxical pulse
Tachycardia and tachypnea
What are the characteristics of a chest x-ray for
asthma?
Hyperinflation (hyperlucency of lung fields)
Atelectasis
Infiltrates
What are some characteristics of PFTs for
Decreased FVC
asthma?
Decreased FEV1/FVC
What are some asthma preventative drugs?
Cromolyn sodium (Intal): mast cell
stabilizer referred to as a noncorticosteroid
anti-inflammatory drug
What is the treatment for asthma during an
attack?
Xopenex
IV fluids
O2 therapy
What is status asthmaticus?
a severe asthmatic attack that responds poorly
to bronchodilator therapy and is associated with
What is the treatment for status asthmaticus?
Close monitoring of ABG levels and SpO2
Bronchodilating agents
What is nocturnal asthma?
Nocturnal (nighttime) symptoms are seen in up
to 75% of all patients with asthma and even in
those who have mild intermittent or mild
What are some causes uses of nocturnal
asthma?
b2-receptor function during sleep
aspiration
sleep apnea,
What is the treatment for nocturnal asthma?
First line management is ICS. May also be
managed by LABA.
