Chronic Lung Disease (6)-Leah*

Question 1

What is included in the umbrella term “COPD”?

Answer 1

• emphysema
• adult asthma (to some extent)
• bronchitis

Question 2

Main cause of COPD?

Answer 2

“exposure to particles”

• mostly smoking in US
• may be other “smoke” sources in foreign counties –> ie stoves in honduras

Question 3

Chronic bronchitis diagnostic criteria

Answer 3

• chronic productive cough 3/12 months for at least 2 consecutive years
• no other cause

Question 4

Chronic Bronchitis PE findings:(4)

Answer 4

• wheezing
• rhonchi
• prolongation of the expiratory phase***
• cough +/- purulent sputum during infection

Question 5

Chronic Bronchitis- pathologic findings: (3)

Answer 5

*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)

Question 6

What is emphysema?

Whats the result?

Answer 6

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)

Question 7

Emphysema PE Findings (3)

Answer 7

• Increased AP diameter
• wheezing (may not be audible in severe disease due to inabiliry to mobilize air at all)
• prolonged expiration**

Question 8

What is asthma? (3)

Answer 8

Chronic intermittent airway destruction secondary to mostly inflammation

• *pure asthma usually not caused by smoking
• may be part of COPD spectrum

Question 9

Common cause of asthma exacerbation (3)

Answer 9

URI

Allergies/ Irritants

OBESITY*** (All obese asthmatics have ^^er IL6, and other cytokines that make their asthma MUCH more difficult to control!)

Question 10

Asthma PE findings (3)

Answer 10

• wheezing
• prolongation of the expiratory phase.
• May have ^^ AP diameter

Question 11

Symptoms of asthma (4)

Answer 11

-cough, dyspnea, chest tightness, wheezing

Question 12

What is restrictive bronchiolitis?

Answer 12

May be on a spectrum of asthma

*May be true diagnosis in case of severe asthma refractory to corticosteriods

Question 13

What is interstitial disease? How does in present on PFT?

Answer 13

inflammation and fibrosis of the pulmonary interstitium restrictive findings

Question 14

Causes of interstitial disease? (3)

Answer 14

• idiopathic
• work/ social exposures
• rheumatic diseases

Question 15

Symptoms of interstitial disease? (2)

Answer 15

cough and dyspnea

Question 16

PE findings for interstitial disease? (4)

Answer 16

• dry crackles
• finger clubbing
• NOT wheezing/ prolonged expiratory phase

*More similar to a restrictive disease

Question 17

Describe the O2 sat levels in chronic lung disease: What is the most sensitive test to assess gas exchange in the lung?

Answer 17

Usually NORMAL

O2 sat 90%++ doesn’t indicate normal lung function

***PO2 is a more sensitive test****

Question 18

Describe the correlation between PO2 and O2 sat

Answer 18

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.

Question 19

Metacholine test is positive in?

Answer 19

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”

Question 20

What are PFT results like in COPD/ asthma? (3)

Answer 20

• obstructive defect
• low FEV1/ FVC
• increased lung volumes

Question 21

How to treat mild COPD/asthma exacerbations

Answer 21

bronchodilators + steroids 1-2 weeks

severe cases may need hospitalization and IV steroids

Question 22

Describe blood gas findings in an acute COPD exacerbation:

Answer 22

• O2 sat may be normal or respond well to oxygen
• life threatening problem= CO2 ^^ and acidosis

*May require mechanical ventilation

(termed “CO2 narcosis”)

Question 23

Marker of severe baseline COPD

Answer 23

High CO2 levels at baseline

Question 24

What defines “decompensated” respiratory failure?

Answer 24

pH below 7.35

Question 25

What should CO2 levels be like in a pure asthmatic patient?

Answer 25

low CO2 because increased respiratory rate

-high CO2 in asthma is an ominous sign

Question 26

When can smoking cessation improve lung disease?

Answer 26

always, never too late

Question 27

Many chronic lung disease patients use steroids chronically.

What is one important assc risk esp in the elderly?

Answer 27

osteoporosis

Question 28

Important preventative measure to be taken in chronic lung patients

Answer 28

!!!!!!!!!!!!!!ALWAYS VACCINATE!!!!!!!!!!!!!!

Three people in my family have died of COPD + pneumonia –> sepsis.

For the love of God, vaccinate your old people against strep pnuemo and flu (give ‘e flu, strep nemumo, +/- prevnar 13)

Question 29

What is disease state is more commonly found in patients also suffering from COPD?

Answer 29

lung cancer

Question 30

What should be considered in early emphysema?

Answer 30

a1 antitrypsin deficiency

Question 31

How might the pulmonary PE of a patient in acute CHF exacerbation appear? (3)

What does chronic CHF classically present with?

Answer 31

acute: rhonchi, wheezing, restrictive like findings on PFT
chronic: “crackles at the base”

Question 32

Describe the PE findings of a patient with CONTROLLED asthma

Answer 32

normal

Question 33

How do COPD and asthma differ in their inflammatory mediators?

Answer 33

Pure asthmatics have ^ IL4, IL5, CD4 lymphs

COPD patients hace ^ PMNs and CD8 lymphs

*This is why there is significant overlap in these patients but they pathogeneis differs between the two diseases*

Question 34

Patients with emphysema caused by aa-antitrypsin deficiency also commonly suffer from coexistent…

Answer 34

liver cirrhosis