Chronic respiratory disease Flashcards
COPD pathophysiology
Walls of alveoli are destroyed and bronchioles lose their structure and collapse –> tissue destruction, air trapping, excessive sputum
Chest hyperinflation from air trapping –> diaphragm flattening –> worse length tension relationship –> less efficient ventilation
COPD defenition
Group of chronic respiratory diseases characterized by progressive tissue degermation –> obstruction of airway
- Emphysema
- Chronic bronchitis
COPD risk factors
- Tabaco smoking
- air pollution
- Occupational exposure (dust, fumes)
- Genetic (alpha 1 antitrypsin)
- Age & sex (older and female)
- SEC
- Asthma
Chronic respiratory infections
COPD Clinical features
Chronic and progressive dyspnea, cough, sputum production
Accessory muscle use, pursed lip breathing
Increased A-P chest diameter
Central cyanosis (skin and mucus appear blue/purple)
Digital clubbing
COPD Diagnosis
PFT - FEV1/FVC <70 to confirm airflow limitation
Sputum culture, ABGs, CT scam
Based on symptoms and exposure to risk factors
Emphysema etiology
Genetic deficiency of alpha 1 antitrypsin (inhibits proteases that are destructive enzymes released during inflammation)
Cigarettes smoking (increases neutrophils and decrease effect of A1A)
Infection
Air pollutants
Emphysema pathophysiology
Destruction of alveolar walls and septae –> bullae (permanently inflated alveolar space) –>
- Loss of SA and pulmonary capillaries
- Fibrosis and thickening of bronchiole walls due to chronic irritation and infections limiting air flow and increasing mucus production
- Loss of tissue elasticity
- Collapse of small bronchi during expiration
- Gas trapping (behind bronchioles), increased residual volume, increase P-A diameter & hyperinflation
Advanced emphysema –>
- Bullae at risk of rupturing causing pneumothorax
- Hypercapnia and hypoxic drive to breathe
- Infection
Pulmonary hyper tension and cor pulmonale
Emphysema clinical factors
Insidious onset
Dyspnea on exertion & later at rest
Hyperventilation with prolonged expiratory phase& accessory muscle
Hyper resonant on percussion
Weight loss
Clubbed finger
Emphysema diagnosis
CXR
PFT - increased residual volume and TLC, decreased VEC and VC
COPD Treatment and prognosis
Goals: control symptoms, reduce exasperations, improve QOL
Smoking cessation
Pharmacological
- Maintenance: bronchodilators, mucolytic expectorants
- Acute: oral corticosteroids, antibiotics
Assessment of inhaler technique
Long term oxygen therapy
- 15hrs a day if chronically hypoxemic
- Oxygen concentrator takes in air and filters other gases to getO2
Surgery
- lung volume reduction: removes emphysematous tissue or 1 way valve in damaged area to reduced V/Q mismatch
- lung transplant: end state of COPD
Physio:
- pulmonary rehab
- dyspnea management
○ Breathing techniques, positioning
- Airway clearance
Increase exercise tolerance
Progressive chronic condition with acute perturbation
Emphysema treatment and prognosis
Avoid respiratory irritants and source of infection
Immunization against pneumonia and influenza
Adequate nutrition and hydration
Meds
LVR surgery to reduce air trapping
Physio:
- pulmonary rehab
- dyspnea management
○ Breathing techniques, positioning
- Airway clearance
- Increase exercise tolerance
Respiratory failure due to sever hypoxia or hypercapnia
Cor Pulmonale
Progressive
Chronic bronchitis patho
Changes in bronchi from chronic irritation from smoking or exposure to pollutants
Inflamation, obstruction, repeated infection & coughing –>
- Mucosa inflamed and edematous
- Increased mucus secretion
- Bronchial wall thickening–> difficult clearing secretions
- Hypoxia
- Severe dyspnea and fatigue
Pulmonary hypertension
Chronic bronchitis etiology
Cigarette smoking, environmental pollutants
Chronic bronchitis clinical features
Chronic cough with sputum
Tachypnea, shortness of breath
Airway obstruction –> hypoxia, cyanosis and hypercapnia
Weight loss
Secondary polycythemia
- Compensatory response to hypoxia causing increase in RBC, blood thickening
Increased thrombosis, stroke and right ventricle enlargement and failure (cor pulmonale)
Chronic bronchitis diagnosis
Based on assessment
Productive cough lasting 3 months of the year for 2 consecutive years
Chronic bronchitis treatment and prognosis
Avoid respiratory irritants
Prompt treatment of infection
Immunization against pneumonia and influenza
Bronchodilators, expectorants
Meds
LVR surgery to reduce air trapping
Physio: Airway clearance
Asthma definition
Chronic disorder characterized by reversible airflow obstruction and airway inflammation, persistent airway hyperactivity and airway remodeling
Asthma etiology
Genetics
Maternal factors (young, smoking)
Viral upper respiratory infection
Sedentary, often indoors
Air pollution
Exercise induced asthma
Asthma patho
Regardless of trigger, bronchi and bronchioles respond to stimuli w/
- Airway inflammation
- Bronchospasm/constriction
- Increase mucus secretion
This leads to partial or complete obstruction –> decreased airflow, air trapping, lung hyperinflation.
Sputum blocks flow of air –> non aeration (atelectasis)
Thickening of bronchiole walls
Fibrous tissue from chronic inflammation
Asthma clinical features
Wheeze
Cough (often worse at night)
SOB
Chest tightness
Signs of obstruction
- Increased RR, use of accessory muscles
Tachycardia and/or pulse paradox (HR differs on inspiration and expiration)
Hypoxia
Asthma diagnosis
PFTs and history
Variable airflow limitation or hyper responsiveness to triggers
Airflow limitation that reverses with bronchodialato
Asthma treatment and prognosis
Goals: control symptoms, reduce exasperations
Pharmacological
- Acute: : bronchodilators
- inhaled corticosteroids,
Education
- Assessment of inhaler technique, action plan, peak flow monitoring
Physio:
- dyspnea management
○ Breathing techniques, positioning
Increase exercise tolerance
Can be well managed
Adult onset more likely to become life long
Not progressive
Bronchiectasis
Irreversible abnormal dilation primarily of medium sized bronchi
Bronchiectasis patho
Requires 2 factors:
- Infectious insult
- Impaired airway drainage, airway obstruction or reduced host defense
Host response created inflammation and mucosal edema
Persistent inflammation and neutrophil presence results in progressive airway destructions –> weakening of muscle and elastic fibres in bronchial wall
Fibrous adhesions form and dilate bronchial wall
Fluid accumulates in dilated area and becomes infected
Infection causes loss of cilia, more fibrosis and progressive obstructi
Bronchiectasis etiology
Infectious trigger
Airway obstruction (e.g foreign bodies)
Anatomical defects
Poor host defense
CF, asthma
Pulmonary infections
Systemic disease
Bronchiectasis clinical features
Chronic cough and production of purulent sputum
Dyspnea, wheeze, hemoptysis
Chest pain, fever
Weight loss, fatigue
Bronchiectasis diagnosis
Cough on most days with tenacious sputum
One or more exasperations a year
Bronchial airway dilation on CT scan
Bronchiectasis treatment and diagnosis
Medical
- Bronchodilators, antibiotics
Physio
- Airway clearance
- Exercise
Pulmonary rehab
Normal life expectancy
Progressive but can be managed
Cystic fibrosis definition
Multi system disorder arising from mutation of CFTR gene on 7th chromosome cause defect in exocrine gland
cystic fibrosis etiology
Autosomal recessive disorder from CTFR gene mutation
Many carriers
Cystic fibrosis patho
CFTR mutation –> decreased secretion of chloride and increase Na reabsorption –> reabsorption of water resulting in thicker mucus on epithelial lining and more viscous secretions
Thickened secretions affect sinuses, lungs, hepatic system, intestine, sweat gland and reproductive system
Sinus - increased secretion viscosity impairs cilia, increased bacterial colonization and infections
Sweat gland - Increased sodium loss via sweat
Lungs - secretions obstruct airflow causing air trapping and atelectasis
Stagnant secretions –> infections
Obstruction –> respiratory failure or cor pulmonale
Cystic fibrosis diagnosis
Newborn screening
Sweta chloride test
Genetic test
Cystic fibrosis clinical features
In kids
- Meconium ileus at birth
- Respiratory symptoms
- Failure to thrive - malnutrition
Common sx
- Sinusitis
- Persistent productive cough
- Pancreatic insufficiency
- Ileal obstruction
- MSK disorder (less BMD)
- Malnutrition
- Infertility (males)
Decreased fertility (female)
Cystic fibrosis treatment and prognosis
Interdisciplinary approach
Meds
- CTFR modulators that improve CTFR function
- Inhaled airway clearance agents
- Bronchodilators
- Anti inflammatory
- Antibiotic for acute exasperations
Allied professionals
- Pancreatic enzyme replacement
- Heart/lung transplant
- Prevention. And aggressive treatment of infections
Physio
- Airway clearance
Exercise
Respiratory failure Life expectancy around 50 years
Interstitial lung disease
Group of conditions that causes inflammation and scarring of lungs
Interstitial lung disease patho
Often begin in interstitial but also associated with alveolar and airway structure
Interstitial lung disease etiology
Idiopathic
Exposure related
- Environment or occupational pollutants
- Meds
- Radiation
Autoimmune related (e.g. connective tissue)
Idiopathic pulmonary fibrosis
Idiopathic specific form of chronic fibrosis interstitial pneumonia limited in the lung
IPD patho
Inflammatory cells are released when lungs are injured releasing reactive oxygen species, cytokines, growth factor –> fibrosis
This alters lung structure and mechanical properties –> restriction and decreased gas exchange
Inflammation also affects alveoli, airway and circulation –> more dyspnea on exertion, decreased exercise tolerance and deconditioning
IPF clinical features
Gradual onset of dyspnea and non productive cough over month
Dry cough
Extreme fatigue, loss of weight and appetite
Weakness
IPF Diagnosis
Based on clinical features
Biopsy to look at histopathalogical pattern
Sarcoidosis
Multisystem disorder of unknown etiology characterized by abnormal inflammatory cells that form lungs called granulomata
Sarcoidosis clinical features
Cough, dyspnea, chest pain, eye or skin lesion
Sarcoidosis diagnosis
Clinical and radiograph signs
Excluding other illnesses
histopathalogical detection of non-necrotizing granuloma
Pneumonitis
General term describing inflammation of lung tissue caused by irritant
Pneumonitis etiology
Airbourne irritant or medications that cause body to mount strong immune response
Working in grain or wood warehouse
Pneumonitis clinical features
Difficulty breathing, dy cough, fatigue, loss of appetite, fever
Pneumonitis diagnosis and prognosis
Clinical exam, allergy blood test, bronchoscopy, CT, lung biopsy
Long term exposure or insufficient treatment can cause fibrosis and pulmonary hypertension
