Clin Med: Pulm I Flashcards
What kind of disorder is asthma?
chronic inflammatory airway disorder w/ obstruction
What can predispose you to asthma? (endogenous)
- genetic predisposition
- atopy
- airway hyperresponsiveness
- gender
- ethnicity
- obesity
- early viral infx
What can predispose you to asthma? (environmental)
- indoor & outdoor allergens
- occupational sensitizers
- passive smoking
- respiratory infxs
- air pollution
- diet
- dampness & mold exposure
- acetaminophen
Asthma triggers
- allergens
- viral URI
- exercise & hyperventilation
- cold air
- sulfur dioxide & irritant gases
- drugs (B-blockers, aspirin)
- stress
- irritants
Asthma pathophysiology
1) trigger
2) airway inflammation
3) combo: hypersecretion of mucus, airway muscle constriction, swelling bronchial membranes
4) narrow breathing passages
— small & large airways
5) wheezing, cough, SOB, tightness in chest
Asthma: History
- recurrent wheezing
- difficulty breathing
- chest tightness
- cough
- can be WORSE AT NIGHT
- family history of asthma, allergy, atopy
It is unlikely asthma if
- lack of improvement after Tx w/ bronchodilator
- onset after 50
- Hx of >20 pack year history smoking
Asthma: clinical findings
- EXPIRATORY wheezing
- multiple pitches starting & stopping in the resp cycle
Asthma: clinical finding if severe airflow obstruction
- tachypnea
- tachycardia
- decreased 02 saturation
- accessory muscle usage
- tripod position
Asthma: signs of atopy
- cobblestone appearance of pharynx (allergic rhinitis)
- nasal polyps
- atopic derm
Which cell has an excessive reaction during asthma
TH2 cells (involved in atopic triad)
What does IL-4 do?
- activated IgE antibodies
- they bind to mast cells & release histamines, leukotrienes, & prostaglandins
What does IL-5 do?
- activates eosinophils
- stimulates release of cytokines & leukotrienes
With obstructive disorders, patients cannot fully ___.
exhale
With restrictive disorders, patients cannot fully ___.
inhale
Test to run when there is clinical suspicion of asthma.
- PFT or chest x-ray
Pulmonary Function testing involves___
- spirometry measuring FEV1 & FVC
- bronchodilator response
- Bronchoprovocation testing
What is spirometry measuring
how much air is being exhaled at any time
Chest x-ray involves___
- done if Dx is unclear
- CXR almost always normal in asthma
- Helpful if Pt. has fever, chronic purulent sputum, hemoptysis, weight loss (rules things in/out)
- Possible CT if CXR abnormal
Review: FEV1 & FVC
- forced expiratory volume in 1 sec
- forced vital capacity (total exhaled air)
Describe Asthma: intermittent
- symptoms </= 2x a week
- night symptoms </= 2x monthly
- rescue meds </= 2days/week
- asymptomatic b/t flares
- FEV1 > 80% of predicted
Describe asthma: mild persistent
- symptoms > 2x a week but not daily
- night symptoms 3-4x monthly
- rescue meds > 2 days/wk but not > 1x/day
- minor limitations b/t flares
- FEV1 > 80% predicted
Describe asthma: moderate persistent
- symptoms are daily
- night symptoms > 1x a week, but not nightly
- rescue meds daily
- some limitation b/t flares
- FEV1 > 60% predicted
Describe asthma: severe persistent
- symptoms throughout the day
- night symptoms several times per day
- rescue meds several times/day
- extremely limitations
- FEV1 < 60% predicted
GINA cycle of asthma care - 3 steps
- Assess: dx, inhaler comprehension, Pt. preferences, symptom control
- Tx: meds, non pharm strategies, Treat modifiable risk factors
- Review: symptoms exacerbations, SEs of meds, lung function, Pt. satisfaction
What are the two goals of asthma care?
- decrease impairment
- decrease risk of severe attack
Non-pharm Tx for asthma
- encourage exercise
- stop smoking
- Pt. edu
- control triggers
What are the starting points for treatment in asthma: stages and which severity stage
Stage 1: mild intermittent
Stage 2: mild persistent
Stage 3: moderate persistent
Stage 4: severe persistent
Asthma: stage 1 Tx
- mild intermittent
- low dose ICS - formoterol OR
low dose ICS
-control & rescue are the same b/c this is the mild intermittent asthma
Asthma: stage 2 Tx
- mild persistent
- Con: low dose inhaled corticosteroid (ICS)
- Res: ICS - formoterol
Asthma: stage 3 Tx
- moderate persistent
- Con: low dose ICS-LABA
- Res: ICS formoterol or SABA
Asthma: stage 4 Tx
- severe persistent
- Con: medium dose ICS-LABA
- Res: ICS - formoterol or SABA
Asthma: stage 5 Tx
- Con: high dose ICS-LABA
- Res: ICS-formoterol or SABA
Asthma is being controlled if…
- daytime symptoms None (</= 2/wk)
- no limits to activities
- no night awakenings
- rescue meds (</= 2/week)
- normal lung function
Asthma is partially controlled if…
- daytime symptoms >/= 2/week
- any limits to activities
- any night awakenings
- rescue meds >2x/wk
- < 80% predicted
Asthma: w/ kids, what is the preferred method of rescue?
SABA (albuterol)
Say you are in a primary care office and a patient comes in with the following symptoms, what would your treatment be?
broken sentences, not agitated, inc RR, HR 100-120, no acc. m. use, RA = 90-95%
- mild/moderate asthma
- SABA via MDI or neb
prednisolone: oral or IV
O2 if needed - reassess at 1 hour: if improved discharge with at home instructions
Say you are in a primary care office and a patient comes in with the following symptoms, what would your treatment be?
speaking in words, tripoding, rr>30, acc. m. use, HR= > 120
-severe asthma
- call 911
- SABA
- ipratropium
- O2
- prednisolone
Asthma: mild (dyspnea w/ activity) Exacerbations Tx
- SABA (inhaled or nebulizer)
- short course oral corticosteroids
Asthma: moderate (dyspnea interferes w/ activity–> symptoms improve in 1-2 days) exacerbations Tx
- SABA (may add ipratropium)
- Oral corticosteroids
Asthma: severe (dyspnea at rest) last longer than 3 days exacerbations Tx
- req hospitalization
- SABA/ipratropium hourly or continuously
- oral corticosteroids
- adjunctive tx (02 therapy, IV MgSO4, intubation/mechanical ventilation)
When do you refer a patient w/ asthma to a specialist?
- S/S are atypical
- Difficulty achieving or maintaining control of asthma
- Persistent asthma requiring step 4 care or higher
Asthma: Pt. Edu
- smoking cessation
- avoid triggers
- pneumococcal/flu vaccine recommended
- caution w/ NSAIDS/ASA (esp. aspirin)
- asthma diary
- properly use inhalers
- clear asthma tx plan w/ an emergency care plan in place
Risk of asthma related death increased if ___
- previous severe exacerbation
- 2 or more hospitalization in the past year
- 3 or more ED visits in the past year
- 2 or more canisters of SABA per month
- low socioeconomic status or inner-city resident
COPD is characterized by
persistent respiratory symptoms & airflow limitation that is not fully revisible
COPD includes what 3 conditions? (that occur together)
- chronic bronchitis
- emphysema
- small airway disease
Chronic bronchitis clinical dx is defined by___
excessive secretion of mucous & daily cough for 3 months or more in 2 consecutive year
Emphysema is a pathologic dx with ___
abnormal enlargement of air spaces distal to the terminal bronchiole, w/ destruction of alveolar walls
(Look at lung tissue itself. can be seen on CT)
Risk factors for COPD
- cigarette smoking
- occupational exposures
- ambient air pollution
- 2nd hand smoke
- genetic (alpha 1 antitrypsin deficiency)
Chronic bronchitis large airways pathophys
oxidants from cigarette smoke cause mucous gland hyperplasia –> increased mucous production–> chronic cough
chronic bronchitis small airways pathophys
edema/increases mucous production/fibrosis–> airway narrowing/airway resistance
Chronic bronchitis alveoli pathophys
- macrophages release enzymes that digest alveolar walls–> decreases area for gas exchange–> damage to capillaries
- damage to elastin fibers causes airway collapse
Emphysema pathophys
- structural changes in alveoli
- inflammatory reaction in the alveoli attract immune cells, release chemicals/enzymes–> breaks down collagen & elastin
- airways collapse during exhalation, causing air trapping
- alveoli eventually coalesce into large air filled spaces (reduced surface area for gas exchange)
Chronic bronchitis: pink puffer s/s
-CO2 retention*
-min cyanosis*
-pursed lip breathing*
-dyspnea
-hyperressonance
-barrel chest*
-prolonged expiration
-anxious
-accessory muscle use
-thin
Chronic bronchitis: blue bloater s/s
-airway flow problem
-cyanotic
-recurrent cough and sputum
-hypoxia
-hypercapnia
-resp. acidosis
-inc Hgb
-digital clubbing
-enlarged heart
-accessory m use
-right side heart failure: bilateral pedal edema, JVD
Age when COPD presents…
40-50 years old
COPD Hx symptoms that may be present for months-years…
- cough
- sputum production
- exertional dyspnea
- physical activity changes?
- smoking?
Symptoms in Hx for advanced COPD
- hypoxemia
- pneumonia
- pulmonary HTN
- Cor pulmonale
- Respiratory failure
PE findings in early stages of COPD
usually normal exam
PE findings in later stages of COPD
- prolonged expiratory phase
- expiratory wheezing
- signs of hyperinflation
- accessory muscle use/ cyanosis in acute exacerbation
PE findings in advanced COPD
cachexia (very poor Px factor)
PE findings in acute exacerbation of COPD
- wheezing, tachypnea, decreased mental status
Most acute exacerbations of COPD are triggered by___
resp infx
Dx testing for COPD
- PFT
- Chest x-ray
- CT
Dx results of PFT for COPD
reduction in FEV1 & FEV1/FVC
Dx results for chest x-ray in COPD
normal or show hyperinflation w/ emphysema
Why run a CT in pt. with COPD
more sensitive/specific for dx of emphysema
What is used to assess the severity of COPD
“CAT” score
Describe the “CAT” score
used to assess progression, decline in functional status, & gauge effectiveness of pulm rehab
COPDL: initial Tx is based on
GOLD classification:
this is the CAT score + number of exacerbations
COPD: what is the Tx for a pt. w/ a CAT <10 & >2 moderate exacerbations w/ 1 leading to hospitalizations?
LAMA
Group C
COPD: what is the tx for a pt w/ a CAT <10 & 1 or 2 exacerbations w/o hospitalization?
bronchodilator
Group A
COPD: what is the Tx for a pt. w/ a CAT of 10 or more & >2 exacerbations w/ a hospitalization?
LAMA + LABA or
ICS + LABA
Group D
COPD: what is the Tx for a pt. w/ a CAT of 10 or more & 0-1 exacerbations leading to no hospitalizations?
LABA or LAMA
Group B
Describe the group categories for COPD.
- Group A: less symp, low risk
- Group B: more symp, low risk
- Group C: less symp, high risk
- Group D: more symp, high risk
Describe COPD: Group A
less symp, low risk
Describe COPD: Group B
more symp, low risk
Describe COPD: Group C
less symp, high risk
Describe COPD: Group D
more symp, high risk
COPD: medications for acute exacerbations
- albuterol (SABA) (inhale or neb)
- ipratropium (anticholinergic)
- prednisone (oral glucocorticoids)
- Abx (mod or severely ill patients)
- O2, bipap, intubation if needed
COPD: Abx that can be used to treat acute exacerbations
- levofloxacin
- moxifloxacin
- doxycycline
COPD: Pt. Edu
- smoking cessation
- get flu & pneumococcal vaccine
- careful exercise programs
Make a COPD referral if…
- onset before 40yo
- 2+ exacerbations/year
- severe or rapid progression
- need for long term O2 therapy
Make a COPD admission to hospital if…
- failing to respond to outpatient tx
- worsening hypoxemia, peripheral edema
- can’t maintain nutrition/hydration due to symptoms
With COPD, what is alpha 1 antitrypsin (A1AT)deficiency?
an autosomal dominant genetic disorder that leads to an overproduction of elastace
COPD: What is elastace?
an enzyme that breaks down elastin in the lungs & liver
When to suspect A1AT deficiency in a Pt?
develop COPD earlier than age 40
COPD: Dx test for A1AT deficiency
- serum level of A1AT
- genetic testing
COPD: Tx for A1AT deficiency
- COPD Tx + infusions of A1AT
- Lung transplant
Bronchiectasis is a disease of what?
- bronchi & bronchioles
- permanent dilation & destruction of bronchial walls
Bronchiectasis: focal development
obstruction (aspirated foreign body, mass)
Bronchiectasis: diffuse development
infection
immunodeficiency (AIDs)
genetic
autoimmune
recurrent aspiration
idiopathic (most common)
Bronchiectasis: infectious pathophysiology
poor mucociliary clearance results in microbial colonization
Bronchiectasis: non infections pathophysiology
immune mediated reactions that damage the bronchial wall
Bronchiectasis: biggest pathophys concern
IMPAIRED SECRETION CLEARANCE
Bronchiectasis: History
persistent productive cough w/ ongoing production of thick sputum
Bronchiectasis: Physical
- crackles & wheezing on lung auscultation
- In later stages, may have clubbing of digits
Bronchiectasis: Dx labs/imaging
- CXR: “tram tracks”–> lacks sensitivity
- Chest CT: “tram tracks” or “signet ring” appearance–> more more sensitive & specific
Bronchiectasis: treatment
-treat underlying disease
-hospitalization if tachy, hypotensive, fever, hypoxemia, failure to improve with abx
-mucolytic agents/airway hydration
-bronchodilators, oral/inhaled glucocorticoids
Bronchiectasis: acute exacerbation Tx
(based on culture results)
fluoroquinolone empirically (levofloxacin, moxifloxacin)
CF: genetic factor
autosomal recessive exocrinopathy
CF is a ___, ___, & ___ disease
respiratory, pancreatic, hepatobiliary
CF: which gene regulates chloride
CFTR
CF: pathophys
CFTR gene is affected–> Cl- channels don’t function right–> abnormal transport of Cl- & NA+ across epithelium–> results in abnormal secretions in the lungs & GI tract
CF: clinical findings
- resp findings: productive cough, very thick sputum, wheezing, recurrent pneumonia, exercise intolerance, dyspnea
- chronic airway infx begin in infants leading to bronchiectasis
- severe sinus disease
CF: What is the cause of chronic airway infx?
- S. aureus
- pseudomonas
- h. influenzae
CF: acute exacerbations hx/PE
increased cough, sputum production
CF: Dx - labs/imaging
- ** Elevated sweat chloride (>60mmol/L)
- genetic testing: presence of 2 dz causing mutations
- abnormal nasal potential difference if other results are inconclusive
CF: Tx for airway clearance
- inhaled tx (albuterol, hypertonic saline, Dnase)
- Chest PT
- Exercise
CF: prevention of infx tx
- seasonal flu vaccine
- pneumococcal vaccine
Influenza A & B cause seasonal epidemics during what time of the year?
October to May
Flu: Pathophys has what two types of glycoproteins in the outer membrane?
- Hemagglutinin
- Neuraminidase
Flu viruses are exceptionally good at:
- Antigenic drift: mutations during replication that occur in HA & NA
- Antigenic shift: complete change in HA, NA, or both
How is the flu spread?
via air droplets or contaminated hands
The flu virus ____ viscosity of ___, promoting _____.
lowers; mucous, spread of the virus
Flu: incubation time & viral shedding time
Incubation: 1-4 days
Viral shedding: from one day prior to sx to day 5
Flu: History/Physical
- Sudden onset fever, chills, fatigue, myalgia, malaise
- appears ill w/ sweating, coughing, diffuse pharyngeal erythema
- lung exam w/ scattered rales, rhonchi, wheezes
- may have muscle pain elicited w/ pressure
Flu: Dx - Labs/Imaging
- largely based on clinical findings
- nasal swab for rapid test
- nasal swab for PCR
Flu: tx
oral oseltamivir
Who should get vaccinated for the flu?
Everyone
How is pertussis spread
- aka whopping cough
- caused by Bordetella pertussis
- Lasts 6 wks
- vaccine preventable, immunity decreases overtime
How is pertussis spread?
via respiratory droplets
Pertussis: pathophys
bacteria attach to ciliated cells & causes destruction of the cilia
leads to cough & inability to clear secretions
PT: pertussis toxin
TCT: tracheal cytotoxin
LPS: lipopolysaccharides
Pertussis Stage 1: catarrhal stage length
1-2 weeks
Pertussis Stage 1: catarrhal stage symptoms
runny nose, low-grade fever, mild, occasional cough
Highly contagious
Pertussis Stage 2: Paroxysmal stage length
1-6 weeks, may go up to 10
Pertussis Stage 2: Paroxysmal stage symptoms
numerous fits, rapid coughs w/ whoop sound; vomiting & exhaustions after coughing
Pertussis Stage 3: Convalescent stage length
2-3 weeks
Pertussis Stage 3: Convalescent Stage symptoms
recovery is gradual, cough lessens, but fits may return
Pertussis Dx - labs/imaging
- nasopharyngeal swab or nasopharyngeal aspirate (PCR) or culture
- serologic testing
Pertussis Tx: within 3 wks of onset
- Azithromycin, Clarithromycin
- eradicates bacteria , helps to prevent spread
Pertussis Tx: after 3 wks:
- no tx needed - cough is related to tissue damage
Pertussis: Tx for cough
dextromethorphan (DM)
Pertussis: post exposure prophylaxis Tx
- household contacts, regardless of vaccination history
- same medication as tx
(azithromycin, clarthromycin)
Pertussis: vaccine recommendations for infants & children
- 5 doses DTaP 2mo, 4mo, 6mo, 15mo, 18mo, & 4-6 yo
Pertussis: vaccine recommendations for adolescents
single dose of Tdap, 11-12 yo
Pertussis: vaccine recommendations for pregnant women
single dose of Tdap during, 27-36 wks
Pneumonias is what type of dz?
infx of the lung paranchyma
Pneumonias classifications
Infecting organism
- bacteria, viral, fungal
Community acquired vs healthcare/hospital acquired
Lung parenchyma defintion
the portion of the lung involved in gas transfer
the alveoli, alveolar ducts, & respiratory bronchioles
Organisms that cause typical pneumonia.
S. pneumoniae, H. influenzae, S. aureus, Group A strep, Moraxella catarrhalis, anaerobes, & aerobic gram (-) bacteria
Organisms that causes atypical pneumonia
Legionella spp, M. pneumoniae, C. pneumoniae, & Chlamydia psittaci
Pneumonia: pathophys
infection of lung–> inflammatory response–> alveolar edema + exudate formation–> Alveoli & resp bronchioles fill w/ serous exudate, blood cells, fibrin, bacteria–> consolidation of lung tissues
Pneumonia: How is the sterile lower respiratory tract exposed to pathogens?
- aspiration
- inhalation of infective resp droplet or aerosols
Pneumonia: What should you ask pt. about?
- occupation
- animal exposure
- travel history
- tobacco & alcohol
- immune suppressive drugs (steroids & biologics)
- malignancy
- chronic lung disease
Pneumonia: symptoms
- acute or subacute onset of fever, cough, w/ or w/o sputum, & dyspnea
- rigors, sweats, chills, pleurisy, chest discomfort, & hemoptysis
- fatigue, anorexia, HA, myalgias , & abdom pain
Pneumonia: physical findings
- fever or hypothermia
- tachypnea
- tachycardia
- arterial O2 desaturation
- altered breath sounds or rales
- dullness to percussion may be found in lobar consolidation
Pneumonia: Dx - labs/imaging for all patients & what will it show?
chest x-ray( will show infiltrate)
Pneumonia: Dx - labs/imaging for admitted patients
- CBC
- chemistries
- arterial blood gases
- sputum/blood cultures
- UA assay for legionella & strep pneumo
Pneumonia: Treatment Protocol
Slide 96 & 97 notes
Pneumonia: Pt. Edu
Prevention:
- Pneumococcal vaccine
–>PCV13 for children 2-59 mo
–> PPSV23 for all 65+
Quit smoking, early mobilization, flu vaccine
Pneumonia: When to admit?
based on age, comorbidities, altered mental status, vital signs
Pneumonia: complications
- effusion
- empyema
- sepsis
- HF
- increase risk of PE
Hyaline membrane disease key factors
- aka respiratory distress of the newborn
- pulmonary insufficiency in neonates due to surfactant deficiency & structural immaturity of the lung
- most common in infants <28 weeks gestation, males, mothers w/ DM
Hyaline membrane disease clinical findings/history
consider RDS in any neonate with early respiratory distress symptoms, especially in premature neonates, including
- retractions
- tachypnea
- nasal flaring
- stridor
- cyanosis
- grunting
Hyaline Membrane Dx: labs & imaging
chest x-ray
– ground glass appearance
evidence of oxygen requirement
Hyaline Membrane disease Tx
Delivery room stabilization:
- oxygen
- positive end airway pressure (PEEP)
Surfactant (instilled in the trachea or via endotracheal tube)
How can PEs be classified
- gross appearance (blood, serous, pus)
- underlying process (infectious, malignant)
- characteristics of the fluid (transudative or exudative)
Describe transudative pleural effusion
- too much fluid leaves capillaries b/c either increased hydrostatic pressure or decreased oncotic pressure in BVs
Example of where hydrostatic pressure creates transudative PE
HF causes blood to back up into the pulm vessels–> increased pressure–> fluid leaves capillaries & goes into pleural space
Example of where oncotic pressure creates transudative PE.
cirrhosis–> liver makes less albumin–> decreased oncotic pressure in the BVs–> fluid moves into the pleural space
Describe exudative pleural effusion
- inflammation of the pulmonary capillaries makes them “leaky” allowing protein, immune cells, large proteins to leak out of the capillaries
- could be due to infx, inflammation, malignancy
General Pleural effusion pathophysiology
accumulation of fluid within the pleural space
Examples of pleural effusion transudative
CHF, cirrhosis, nephrotic syndrome, PE, hypoalbuminemia
Examples of pleural effusion exudative
- e.g. pneumonia, cancer, TB, viral infection, PE, autoimmune
Pleural effusion: clinical findings - History/Physical
- Hx & symptoms depend on etiology
- Pts will complain of dyspnea, cough, pleuritic chest pain
- Ask about:
–> Dyspnea on exertion (CHF)
–> Sharp chest pain (pericarditis)
–> Abdominal pain (pancreatitis)
–> Hemoptysis (malignancy, PE, TB) - chest exam finding may include
–> dullness to percussion
–> decreased or absent tactile fremitus
–> decreased breath sounds - other exam finding pertinent to underlying cause
Pleural effusion Dx: labs & imaging
- chest x-ray
- thoracentesis w/ US guidance
- pleural effusion evaluation
What’s included in a Dx pleural effusion evaluation?
- gross appearance
- RBC
- WBC
- Protein
- LDH
- Glucose
- Cytology for malignancy
- Culture
Pleural effusion: transudates appearance
clear, straw colored
Pleural effusion: transudates protein
< 3g/100mL
Pleural effusion: transudates pH
> 7.2
Pleural effusion: transudates glucose
> 40 mg/dL
Pleural effusion: transudates LDH
Low, < 200IU/L
Pleural effusion: transudates number of cells
< 1000/mm3
Pleural effusion: exudates appearance
cloudy, purulent, opalescent
Pleural effusion: exudates protein
> 3g/100mL
Pleural effusion: Exudates pH
< 7.2
Pleural effusion: Exudates glucose
<40 mg/dL
Pleural effusion: Exudates LDH
high, >200 IU/L
Pleural effusion: Exudates number of cells
> 1000/mm3
Pleural effusion: Tx
- treat underlying disease
- thoracentesis can be diagnostic & therapeutic
What is a potential complication of thoracentesis?
Obstructive Sleep Apnea: Overview
sleep disorder causing repetitive complete (apnea) or partial (hypopnea) upper airway obstruction during sleep, w/ recurrent arousals & sleep fragmentation
Describe excessive daytime sleepiness associated w/ obstructive sleep apnea
- drowsiness
- decreased concentration & memory
Obstructive Sleep Apnea: Epidemiology/ Etiology
high-risk patients include those w/:
- obesity
- HF
- Afib
- HTN
- Type II DM
- Stroke
- Pulm HTN
Obstructive Sleep Apnea: pathophysiology
Obstructive Sleep Apnea: History clinical findings
- sleep problems
- excessive daytime sleepiness
- morning headaches
- nocturia
- motor vehicle accidents
Describe sleep problems associated w/ obstructive sleep apnea.
- restless non refreshing sleep
- snoring
- awakenings (w/ gasping or paroxysmal nocturnal dyspnea)
- witnessed apneas
- sleep fragmentation
Obstructive Sleep Apnea: Physical clinical findings
- evaluate for obesity
- evaluate for oropharyngeal anatomy associated w/ OSA
Obstructive Sleep Apnea Dx: labs/imaging
Lab polysomnogram; it measures:
- respiratory effort
- oxygen saturation
- EKG, EEG, EOG, chin EMG
- body position
- anterior tibialis EMG
Tx: Gen considerations for Obstructive Sleep Apnea
- lifestyle modifications
- weight reduction
- positional therapy to keep patient in nonsupine position
- oropharyngeal exercises may help snoring
- continuous positive airway pressure (CPAP)
Obstructive Sleep Apnea Pt. Edu
- weight loss, ideally to BMI < or equal to 25 kg/m2
- exercise
- positional therapy
- avoidance of alcohol & sedatives before bedtime
