Chapter 17- Obstructive Lung Disease Flashcards
What are the clinical features of COPD?
Chronic progressive dyspnea
What are the laboratory findings of COPD?
Decreased expiratory flow rates, hypoxia and hypercapnia in end-stage disease
What are the clinical features of emphysema?
Little or no sputum, end stage cachexia
What are the laboratory findings of emphysema?
Hyperinflation, increased compliance, low DLCO, rarely alpha1-antitrypsin deficiency
What are the clinical features of chronic bronchitis?
Sputum, history of smoking, industrial exposure
What are the laboratory findings of chronic bronchitis?
Nonspecific- rarely occurs in isolation without varying degree of emphysema
What are the clinical features of asthma?
Episodic dyspnea, cough, wheezing, with or without environmental triggers
What are the laboratory findings of asthma?
Airway hyperreactivity, response to bronchodilators
What are the clinical features of bronchiectasis?
Usually large volume of sputum
What are the laboratory findings of bronchiectasis?
Chest radiograph; dilated bronchi, thick walled, tram track shadows, obstruction with or without restriction on pulmonary function tests
What are the clinical features of immotile cilia syndrome?
Situs inversus, dextrocardia, sinusitis, infertility
What are the laboratory findings of immotile cilia syndrome?
Abnormal dynein in ciliated cells
What are the laboratory findings with hypogammaglobulinemia?
Decrease in one or more immunoglobulins
What are the clinical features of cystic fibrosis?
Sinusitis, bronchiectasis, meconium ileus, malabsorption, infertility
What are the laboratory findings in cystic fibrosis?
Increased sweat chloride, mutation in CFTR chloride channel, elevated fecal fat, abnormal nasal mucosal potentail difference
What are the three obstructive lung disorders that can make up COPD?
Chronic bronchitis
Emphysema
Chronic broncholitis
What is the algorithm for emergency department treatment of acute bronchospasm? What should you do if there is an inadequate response to this treatment?
Oxygen, inhaled B2 agonist, consider inhaled anticholinergic and oral or IV corticosteroids
If inadequate response- inhaled anticholinergics if not given already. If bronchospams persists admit to hopsital. If respiratory failure consider aminophylline, Heliox (hellium=oxygen), IV magnesium, endotracheal intubation and mechanical ventilation
What is the algorithm for emergency department treatment of acute bronchospasm? What should you do if there is a good response to this treatment?
Oxygen, inhaled B2 agonist, consider inhaled anticholinergic and oral or IV corticosteroids
Good response- discharge on inhaled B2 agonist +/- inhaled anticholinergic, corticosteroids x 5 days, arrange outpatient follow-up within 5 days
What is the algorithm for outpatient treatment of the chronic/stable bronchospasm in asthma?
Inhaled PRN short acting B2-Agonist
If continued sx add ICS
If continued sx increase dose of ICS add long-acting b2-agonist
If continued sx add leukotriene antagonist
if sx continued add oral corticosteroids
What is the algorithm for outpatient treatment of the chronic/stable bronchospasm in COPD?
Inhaled short acting b2-agonist and inhaled anticholinergic
If continued sx add trial of ICS
If continued sx add oral abx if chronic bronchitis is predominent component, and consider trial of theophylline
If continued sx trial of oral corticosteroids.
What are the organ systems involved in cystic fibrosis?
Pulmonary
Pancrease
Genitourinary
Gastrointestinal
What is the pulmonary involvement in cystic fibrosis?
Cough and sputum production Recurrent pneumonias Bronchial hyperreactivity Hemoptysis Pneumothorax Significant digital clubbing Cor pulmonale
What is the upper respiratory tract involvement in cystic fibrosis?
Nasal polyps
Chronic sinusitis
What is the gastrointestinal involvement in cystic fibrosis?
Meconium ileus in the neonate Distal intestinal obstruction Rectal prolapse Hernias Exocrine pancreatic dysfunction causing steatorrhea, malnutrition, and vitamin deficiency Acute pancreatitis (rare) Diabetes mellitus Cirrhosis and portal HTN Salivary gland inflammation Cholelithiasis
What is the genitourinary involvement in cystic fibrosis?
Azoospermia
Decreased fertility rate in women
Nephrolithiasis
What are the diagnostic studies used in asthma?
Routine pulmonary function test Special pulmonary function test Methacholine or cold-air challenge Challenge with specific agents: occupational, drugs Chest radiograph Skin tests Blood tests
What does routine pulmonary function test result in asthma?
Decreased FEV1; hyperinflation; improvement with bronchodilator
What does the methacholine challenge or cold-air challenge result in asthma?
Indicates the presence of nonspecific bronchial hyperreactivity; bronchoconstriction occurs at lower doses in asthma
When is the challenge with specific agents: occupational and drugs done for asthma?
Occasionally performed
What does the chest radiograph result in asthma?
Fleeting infiltrates and central bronchiectasis in ABPA (allergic bronchopulmonary aspergillosis)
What do skin tests result in asthma?
Demonstrate atopy; little value except prick test to Aspergillus fumigatus positive in ABPA (allergic bronchopulmonary aspergillosis)
What do blood tests result in asthma?
Eosinophils and IgE are usually increased in atopy; levels may be very high in ABPA (allergic bronchopulmonary aspergillosis); Aspergillus preciptins increased in many but not all patients with ABPA
Slowly progressive dyspnea characterized by abnormalities of airway and lung structure occuring in response to noxious inhaled substances
COPD
What is the hallmark of COPD?
irreversible airflow inflammation
Is there a genetic component to COPD?
Yes, less than 1% of COPD cases are linked to alpha-antitrypsin deficiency, a genetic disorder
Permanent enlargement of the air spaces distal to the terminal bronchiole due to destruction of lung parenchyma in the absence of significant fibrosis
Emphysema
Persistent cough resulting in sputum production for more than 3 months in each of the past 2 years
Chronic Bronchitis
Is chronic bronchitis a disease of small or large airways?
Large airways and not lung parenchyma
Slow progressive dyspnea first noted during exertion that progresses over years until it is evident at rest. Exercise intolerance and fatigue, weight loss, depression, anxiety, chronic cough
small airways disease
What are the late stages of small airways disease?
Skeletal muscle wasting, accessory muscle use, pursed-lip breathing, weight loss, flattened diaphragm, TV decreases while RR increases
What are PE findings of small airways disease?
hyperresonant to percussion, diminished breath sounds with rhonchi, wheezes, or faint crackles, barrel chest
Caused by a virus that is common in infants during winter. Caused typically by RSV. Typical symptoms are wheezing and dyspnea that resolve without treatment
Acute bronchiolitis
Common in Japan. Cough with purulent sputum, sinusitis, dyspnea
Diffuse panbronchiolitis
Seen with connective tissue disease. Azithromycin increases FEV1
Bronchiolitis obliterans
Abnormal dilation of the bronchi resulting from inflammation and permanent destructive changes in the elastic and muscular layers of the bronchial walls. Frequent in middle aged to older
Bronchiectasis
Is Bronchiectasis localized or diffuse?
both
S/S of bronchiectasis
chronic cough, FOUL SMELLING SPUTUM, SOB, abnormal chest sounds, fatigue
Can see blood streaked sputum or clubbing
What is the classic finding of bronchiectasis on radiograph?
tram tracks (parallel lines in peripheral lung fields)_
How should you treat bronchiectasis?
Treat underlying problem Bacteria: broad spectrum ABX Allergic: corticosteroids Bronchodilators for symptoms Hemoptysis: angiography with embolization
An autosomal recessive disorder that affects lungs, pancreas, reproductive organs
Cystic Fibrosis
What is the most common lethal genetic disorder in white population?
Cystic Fibrosis
What is the mutation in for CF?
gene that encodes for CFTR
What are the common symptoms of CF in infants?
Meconium ileus or FTT with steatorrhea
Salty tasting skin
Symptoms of CF
chronic cough with thick sputum, wheezing, dyspnea, pancreatic insufficiency, diabetes, azoospermia, nasal polyps, clubbing
What does PFT show with CF?
hyperinflation, bronchial wall thickening, bronchiectasis
How do you diagnose CF?
sweat test and genotyping
What is the treatment of CF?
aggressive airway hygiene, nutritional support, ABX, bronchodilators, inhaled hypertonic saline, TOBI, anti-inflammatory agents
Characterized by airway inflammation, hyper-reactivity, reversible airflow obstruction
Asthma
What is the asthma triad?
wheezing, chronic episodic dyspnea, chronic cough
What is included in the evaluation of asthma?
Bronchoprovocation challenge
Blood tests that may reveal eosinophilia and increased IgE levels
Documentation of hyperactivity and reversible airway obstruction to flow
