Chronic Lung Disease (6)-Leah* Flashcards
What is included in the umbrella term “COPD”?
- emphysema
- adult asthma (to some extent)
- bronchitis
Main cause of COPD?
“exposure to particles”
- mostly smoking in US
- may be other “smoke” sources in foreign counties –> ie stoves in honduras
Chronic bronchitis diagnostic criteria
- chronic productive cough 3/12 months for at least 2 consecutive years
- no other cause
Chronic Bronchitis PE findings:(4)
- wheezing
- rhonchi
- prolongation of the expiratory phase***
- cough +/- purulent sputum during infection
Chronic Bronchitis- pathologic findings: (3)
*Remember this is an AIRWAY phenomenon:
- mucous gland hypertrophy + cilliary dysfunction
- neutrophilic inflammation –> airway scaring
- obstruction of airway via reactivity (swelling) + mucous (and they cant clear it)
What is emphysema?
Whats the result?
Enlargement and destruction of terminal bronchioles–> Air sac destruction/detachment from respiratory bronchioles–> decreased elastic recoil + gas exchange surface
- results in hyperinflation + air trapping (obstruction)
- may be imbalance of protease/ antiprotease (esp. in the case of pure emphysema; rare)
Emphysema PE Findings (3)
- Increased AP diameter
- wheezing (may not be audible in severe disease due to inabiliry to mobilize air at all)
- prolonged expiration**
What is asthma? (3)
Chronic intermittent airway destruction secondary to mostly inflammation
- *pure asthma usually not caused by smoking
- may be part of COPD spectrum
Common cause of asthma exacerbation (3)
URI
Allergies/ Irritants
OBESITY*** (All obese asthmatics have ^^er IL6, and other cytokines that make their asthma MUCH more difficult to control!)
Asthma PE findings (3)
- wheezing
- prolongation of the expiratory phase.
- May have ^^ AP diameter
Symptoms of asthma (4)
-cough, dyspnea, chest tightness, wheezing
What is restrictive bronchiolitis?
May be on a spectrum of asthma
*May be true diagnosis in case of severe asthma refractory to corticosteriods
What is interstitial disease? How does in present on PFT?
inflammation and fibrosis of the pulmonary interstitium restrictive findings
Causes of interstitial disease? (3)
- idiopathic
- work/ social exposures
- rheumatic diseases
Symptoms of interstitial disease? (2)
cough and dyspnea
PE findings for interstitial disease? (4)
- dry crackles
- finger clubbing
- NOT wheezing/ prolonged expiratory phase
*More similar to a restrictive disease
Describe the O2 sat levels in chronic lung disease: What is the most sensitive test to assess gas exchange in the lung?
Usually NORMAL
O2 sat 90%++ doesn’t indicate normal lung function
***PO2 is a more sensitive test****
Describe the correlation between PO2 and O2 sat
At PO2 75, you can saturate to 100% (O2 sat)
So remember, normal O2 sat doesnt = normal PO2
*within the range of sat70-90 there is a linear relationhsip between sat and PO2
*Sats below 90 are unilaterally BAD.
Metacholine test is positive in?
asthma; rules out asthma if NEGATIVE
Positive doesn’t suggest PURE asthma
COPD patients may have positive methacholine test, because remember, COPD is a “spectrum”
What are PFT results like in COPD/ asthma? (3)
- obstructive defect
- low FEV1/ FVC
- increased lung volumes
How to treat mild COPD/asthma exacerbations
bronchodilators + steroids 1-2 weeks
severe cases may need hospitalization and IV steroids
Describe blood gas findings in an acute COPD exacerbation:
- O2 sat may be normal or respond well to oxygen
- life threatening problem= CO2 ^^ and acidosis
*May require mechanical ventilation
(termed “CO2 narcosis”)
Marker of severe baseline COPD
High CO2 levels at baseline
What defines “decompensated” respiratory failure?
pH below 7.35
