Common Chronic Pulmonary Diseases and Lung Cancer

Question 1

Obstructive lung disease

Answer 1

Occurs due to blockages or obstructions in the airways

Conditions that make it hard to exhale all the air in the lungs, causing air-trapping (COPD, asthma, CF)

Question 2

Restrictive lung disease

Answer 2

A decrease in the total volume of air that the lungs are able to hold; often due to a decrease in lung elasticity

Conditions that make it difficult to fully expand the lungs with air (Pregnancy, interstitial lung disease, sarcoidosis)

Question 3

Lung volume

Answer 3

Tidal Volume (TV) = amount of air moved in and out during one normal breath (500 mL)

Total Lung Capacity (TLC) = volume of air in lungs after biggest breath in (6 L)

Vital Capacity = volume of air that can be exhaled after biggest breath in (80% of TLC)

Question 4

Spirometry loop

Answer 4

Measures volume (L) and percent predicted by:

1. Forced Expiratory Volume in the 1st second (FEV1)
2. Forced Vital Capacity (FVC)

FEV1/FVC ratio helps determine lung health (to normal age and height):
1. Normal = 80%

2. Obstructed = less than 80%
3. Restricted = greater than or equal to 80%, and TV <500 mL

Question 5

COPD

Answer 5

Umbrella term for progressive lung diseases:

1. Chronic bronchitis
2. Emphysema
3. Refractory asthma (non-reversible with vasodilators)

Causes permanent, obstructive impairment of lungs and is the 4th leading cause of death in the U.S.

Risk factors: >40 yrs. old, FHX, smoking (most influential), environmental, obesity, rare “genetic COPD” alpha 1-antitrypsin deficiency; treatment: smoking cessation and weight-loss

Question 6

Chronic bronchitis

Answer 6

Chronic inflammation and irritation of the bronchial tubes

Hallmark: Cough with sputum production for at least 3 mos. per year for 2 consecutive yrs.

Chronic exposure to irritant resulting in inflammation and epithelial injury, coupled with dysmotility of cilia, **bronchial edema and narrowing (compromised airway), and mucous production

S/S: Bronchospasm, dyspnea, productive cough

“BLUE BLOATER”: Obese, cyanotic, clubbing, recurrent cough and sputum production, hypoxia, hypercapnic, pulmonary HTN resulting in RHF, cardiac enlargment, bilateral peripheral edema, JVD, use of accessory muscles

Question 7

Emphysema

Answer 7

Destruction of alveolar cell walls (septae); reduces lung surface area

Chronic exposure to irritant resulting in inflammation and epithelial injury, coupled with dysmotility of cilia, and **lung connective tissue breakdown (compromised airway)

S/S: Bronchospasm, dyspnea, productive cough

“PINK PUFFER”: Hypercapnic, pursed lip breathing, hyper-resonance on chest percussion, orthopneic, barrel chest, DOE, prolonged expiratory time, speaking in short sentences, anxiousness, use of accessory muscles, thin

Question 8

Asthma

Answer 8

Chronic inflammatory airway disease (type I humoral hypersensitivity) of bronchi mucosa, characterized by recurrent episodes of wheezing and/or breathlessness (exacerbation)

IgE mediates degranulation of mast cells and eosinophils; triggered by indoor and outdoor allergens, virus, lung diseases, cold weather, exercise, and stress

Can be confirmed with lung function test and methacholine challenge; an obstructive pattern

Risk factors: FHX, females, non-whites, >65 yrs old, low birth weight/premature, respiratory complications in infancy, smoking, obesity, allergies, occupation

S/S: Wheezing, dyspnea, anxiety, cough, chest tightness/pain, decreased FEV1

Question 9

Asthma characteristics

Answer 9

1. Degranulation of mast cells and eosinophils
2. Mucus accumulation and plug
3. Smooth muscle constriction
4. Hyperinflation of alveoli (air-trapping)

Question 10

Pulmonary Artery HTN (PAH)

Answer 10

Rare, progressive disorder characterized by high BP in the pulmonary artery

Worsened by: Hypoxia and pulmonary/metabolic acidosis

Etiologies: Lung disease, congenital heart disease, PE, LHF, sarcoidosis

Question 11

Cor pulmonale

Answer 11

A condition that most commonly arises out of PAH; also known as RHF because it creates pressure overload within the RV

Commonly caused by COPD (low oxygen level results in increased BP in the pulmonary artery which places excess strain on the RV in order to pump blood through the lungs)

Dx: ECHO, EKG, CXR, PE; treatment of the underlying cause (and PAH)

Question 12

Squamous cell carcinoma

Answer 12

SLOW growth; late metastasis (to hilar lymph nodes)

Dx: Biopsy, sputum analysis, bronchoscopy, electron microscopy, immunohistochemistry

S/S: Cough with sputum production, airway obstruction

Question 13

Small cell carcinoma

Answer 13

FAST growth; metastasizes very quickly (to mediastinum or distal areas of lung)

Dx: Sputum analysis, CXR, bronchoscopy

S/S: Excessive hormone production, airway obstruction; clinical manifestations: cough, dyspnea, hemoptysis, chest pain, localized wheezing

Question 14

Adenocarcinoma

Answer 14

Most common type of lung cancer; known genetic links, and can occur with squamous and small cell carcinomas

MODERATE growth; early metastasis

Dx: CXR, fibrobronchoscopy

Sx: Idiopathic pleural effusion

Question 15

Large cell carcinoma

Answer 15

FAST growth; RARE, widespread metastasis

S/S: Chest wall pain, pleural effusion, cough with sputum production, hemoptysis, airway obstruction, repetitive pneumonia