Common Respiratory and Pulmonary Conditions Flashcards
Respiratory
Broader term encompassing entire respiratory system including airways, lung tissue, and lung circulation.
Pulmonary
Specifically refers to lungs and lung circulation
Restrictive Lung Conditions
Reduced lung compliance and lung volume = difficulty expanding lungs
Difficulty with inspiration due to low volume.
More pressure needed to expand lungs.
Ie. Obesity, interstitial lung disease, scoliosis, neuromuscular conditions.
Obstructive Lung Conditions
Reduction in airflow.
Difficulty in expiration due to obstructed airways.
Lung hyperinflation due to air being trapped in lungs.
Ie. COPD, Asthma, Chronic bronchitis
Asthma
Widespread reversible airway obstruction (bronchoconstriction).
No cure but controllable and preventable with medications (bronchodilators).
Broncho-obstruction occurs through…
-smooth muscle contraction in bronchioles
-inflamed bronchioles (depends more on triggers).
-increased mucus production
-over inflation of lungs which increases work of breathing and respiratory muscle fatigue leading to respiratory distress (in an acute state this can lead to an asthma attack).
Airway obstruction leads to resistance in expiration which leads to increased stale air entrapment, leading to lower oxygen levels in blood and tissue hypoxia.
Neural Physiology of Asthma
Vagal reflex increases bronchoconstriction.
SNS beta2 increases bronchodilation = mimicked medications.
Inflammatory Physiology of Asthma
Increased bronchoconstriction through vagal reflex, histamine, leukotriene PGF2a
Specific inflammatory cells react to stimulus or antigen and trigger inflammatory mediators via capillaries (widespread response).
Treatment for Asthma
Avoiding triggers
Medications
-rescue medications
-long-term control medications
Rescue (Quick Acting) Medications
Short-acting beta agonists = inhaled bronchodilators that quickly open airways (ie. ventolin).
Anticholinergic agents = bronchodilators that relax airways
Long-term Control Medications
Inhaled corticosteroids = reduce airways inflammation.
Leukotriene modifiers = oral medications that relieve symptoms.
Combination inhalers = contain both a long-acting beta agonist and a corticosteroid.
Exercise Induced Asthma
80% of asthmatics.
Occurs in or after exercise.
Caused by increased inspiration and expiration, cold air, pollution.
Best exercises include swimming, walking, sometimes cycling.
Asthmatics should always carry ventolin.
Mild EIA = 70-85% pre FEV1
Moderate EIA = 55-70% pre FEV1
Severe EIA = <55% pre FEV1
Clinical Assessments for Asthma
Spirometry
Rating of perceived breathlessness (RPB)
-modified dyspnea scale = keep within blue or green sections
Pulse oximetry
Chronic Obstructive Pulmonary Disease (COPD)
Chronic, irreversible obstruction of airway.
-combination of chronic bronchitis and emphysema.
-commonly caused from smoking or very poor air quality.
-is associated with destruction of lung tissue.
Leads to bronchoconstriction in both large and small airways.
-mucus production, over inflation, chronic inflammation, increased infection risk, decreased ciliary function, dysfunction of alveoli.
-all leads to poor gas exchange and lower O2
Chronic Bronchitis
Increased mucus production and inflammation of bronchioles.
Occurs in larger airways mostly.
Defined as a positive cough with mucus for most days of a month or 3 months per year for 2 consecutive years.
Leads to poor gas exchange and low oxygen levels.
Emphysema
Destruction and dysfunction of alveoli and anacus.
Destruction due to toxins which increases inflammatory cytokines.
Occurs in smaller airways mostly.
Leads to poor gas exchange.
-those with emphysema tend to increase ventilation rate to reach normoxia.
-this leads to respiratory muscle fatigue because of increase metabolic costs.
Treatment for COPD
Lifestyle changes
Medications
Oxygen therapy (severe COPD)
Pulmonary rehabilitation
-combines exercise, education, and counselling to improve breathing and overall health.
Lifestyle Changes in the Treatment of COPD
Nutrition
Exercise
Smoking cessation
Regular vaccinations
Avoiding air pollution or other triggers
Medications for COPD
Bronchodilators = short-acting bronchodilators or long-acting bronchodilators.
Inhaled corticosteroids
Combination of inhalers
Oral steriods
Antibiotics
Clinical Assessments of COPD
Vitals (HR, BP, pulse)
Pulse oximetry (SpO2%)
RPB/dyspnea scales
ECGs if applicable (normally cardiac related co-morbidities)
Exercise tests
Spirometry
Also take into account history
Spirometry and COPD
Condition is irreversible even after bronchodilators.
-FEV1 <70% FVC
-FEV1 <80% of predicted FEV1
Spirometry is used to help diagnose COPD along with medical and smoking history, hyperinflation, hyperresonance, tachypnoea, and tachycardia.
Spirometry Interpretation and COPD
Mild COPD = FEV1 60-80% of predicted FEV1 post bronchodilator.
Moderate COPD = FEV1 40-60% predicted FEV1 post bronchodilator, increased dyspnea, lower ADL function, sleep apnea.
Severe COPD = FEV1 <40% predicted FEV1 post bronchodilator, increase dyspnea, lower ADL function, hypoxia, increased pulmonary hypertension or presence of cor pulmonale
Cystic Fibrosis
Fatal hereditary disorder (recessive gene) characterized by lung congestion and infection, and malabsorption of nutrients by the pancreas.
Increase secretion/excretion of thick and sticky mucus, which draws excess salt through exocrine ducts (primarily lung and pancreas) which blocks and obstructs these ducts.
Treatment for Cystic Fibrosis
Respiratory care
Medications
Oxygen therapy
Pulmonary rehabilitation and exercise
Nutrition counselling
Lung and pancreatic transplants (only cure for condition).
Respiratory Care in the Treatment of Cystic Fibrosis
Clients taught how to expel mucus efficiently through breathing techniques or devices such as vibrating vests or positive expiratory pressure (PEP) devices
Medications in the Treatment of Cystic Fibrosis
Focus on thinning mucus and preventing infections.
Pancreatic enzymes for digestive function.
Clinical Assessments for Cystic Fibrosis
Pulse oximetry
Spirometry
Breathing reserve index
-BRI = VE/MVV at lactate threshold
-MVV (maximal voluntary ventilation) taken with spirometry
-used a predictor of mortality for cystic fibrosis patients waiting for lung transplant (helps to decide on urgency for transplant)
-the lower the BRI at lactate threshold, the higher risk of mortality.
