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1
Q

Name 5 of the anatomical changes that occur with chronic bronchitis.

A

Chronic inflammation & swelling
Excessive mucus production & accumulation
Partial or total mucus plugging
Smooth muscle constriction of bronchial airways, bronchospasm
Air trapping or hyper inflation of alveoli in late stage

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2
Q

Name 4 anatomical changes that occur in emphysema

A

Permanent enlargement and deterioration of air spaces distal to terminal bronchioles
Destruction of pulmonary capillaries
Weakening of distal airways, especially respiratory bronchioles
Air Trapping

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3
Q

In the outline of the definition per ATS the definition of emphysema is based on _____________ while the definition of chronic bronchitis is based on ______________.

A

pathology or anatomical alterations, clinical manifestations

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4
Q

What is the estimated total of people who suffer from COPD?

A

10-15 million or per Egan 24 million

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5
Q

According to GOLD, what are the risk factors for development of COPD?

A 
Cigarette smoking
Outdoor air pollution
Indoor air pollution
Genetics A1AT deficiency
Occupational exposure to dusts & chemicals
Conditions affecting normal lung growth
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6
Q

Per GOLD, what are key indicators for the diagnosis of COPD?

A

Chronic cough
Dyspnea
Chronic sputum production
History of exposure to risk factors

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7
Q

What is the difference between panlobular and centrilobular emphysema and which is most prevalent?

A

Panlobular is the genetic version can appear very serious by age 45, due to alpha 1 alphatrypsin deficiency; Centrilobular is the remaining type & most common in which blood still flows but airways ahead are damaged

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8
Q

What are the 3 main spirometry tests used for COPD?

A

FEV1
FVC
FEV1/FVC ratio

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9
Q

T or F: FVC requires minimal effort from the patient when performing the test?

A

False; FVC requires patient maximum effort

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10
Q

What is FEV1?

A

Amount of air a patient exhales in 1 minute

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11
Q

What is a normal FEV1, FVC, & FEV1/FVC ratio in health lung?

A

FEV1= 4 L; FVC = 5 L; FEV1/FVC = 80%

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12
Q

What pulmonary tests can confirm the presence of COPD?

A

Reduction in FEV1 and FEV1/FVC ratio

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13
Q

T or F; COPD is diagnosed when the FEV1/FVC ratio decreases.

A

False; Diagnosis of COPD occurs when both FEV1 and FEV1/FVC ratio is decreased

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14
Q

Name the 4 stages of COPD and their diagnosis on pulmonary testing.

A

Stage I–Mild; FEV1 > or = 80%
Stage II–Moderate: FEV1 50-80%–patient has shortness of breath with exertion; this is stage they may first seek medical attention
Stage III–Severe: FEV1: 30-50% of predicted; symptoms have impact on daily life
Stage IV–Very Severe: FEV1 less than 30% of predicted or less than 50% of predicted with chronic ventilator failure; Quality of life very impaired

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15
Q

T or F: Hypoventilation is a common and hallmark symptom of Emphysema

A

False; Only late stage emphysema is sees hypoventilation; It is common to see hyperventilation first in emphysema patients

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16
Q

T or F Hyperventilation is a common symptom in Emphysema & Chronic bronchits?

A

False; Hyperventilation normally occurs in emphysema but not chronic bronchitis

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17
Q

T or F Hypoventilation is a common symptom in chronic bronchitis?

A

True; Hypoventilation is a common symptom of chronic bronchitis

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18
Q

T or F: Hypoventilation when seen in chronic bronchitis often accompanies hypercapnia or high CO2?

A

True

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19
Q

T or F; Emphysema can only manifest itself with hyperventilation during end stages of the disease

A

False; Hyperventilation is common; Hypoventilation does not occur until late stage emphysema

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20
Q

Pursed lip breathing is commonly seen in which disease manifestation?
A. Emphysema
B. Chronic Bronchitis
C. Both

A

A. Emphysema

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21
Q 
A cough is commonly seen in which condition?
A.  Emphysema
B.  Chronic Bronchitis
C.  Both
D.  Neither
A

B. Chronic Bronchits

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22
Q 
Sputum is commonly seen in which condition?
A.  Emphysema
B.  Chronic Bronchitis
C.  Both
D.  Neither
A

A. Emphysema

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23
Q 
Cyanosis is a common feature in which condition?
A.  Emphysema
B.  Chronic Bronchitis
C.  Both
D.  Neither
A

B. Chronic Bronchitis

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24
Q 
Peripheral Edema is a common feature in which condition?
A.  Emphysema
B.  Chronic Bronchitis
C.  Both
D.  Neither
A

B. Chronic Bronchitis, with right heart failure is a common feature

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25
Q

Neck vein distension is a common feature in which condition?
A. Emphysema
B. Chronic Bronchitis
C. Both

A

B. Chronic bronchitis with right heart failure

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26
Q

Observing the use of accessory muscles is a common feature of which condition?
A. Emphysema
B. Chronic Bronchitis
C. Both

A

A. Emphysema

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27
Q

On auscultation, wheezing, crackles, rhonchi is mostly heard with which condition?

A

Chronic bronchitis

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28
Q

When you percuss and hear hyperresonance which disease is this common with?

A

Emphysema

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29
Q

What sounds are heard with chronic bronchitis during percussion?

A

Normal sounds are heard at percussion

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30
Q

T or F: When viewing a chest xray of a chronic bronchitis patient you would expect to find a smaller, vertical heart on the xray.

A

False; When viewing an xray of emphysema the heart will appear smaller & vertical

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31
Q

T or F: It is common to see a diaphragmatic change with it appearing flat or low with emphysema

A

T: The diaphragm may appear low, flat on xray

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32
Q

T or F: The mediastinum in a chronic bronchitis patient will appear enlarged due to inflammation factor in the airways.

A

False; The mediastinum in chronic bronchitis will appear narrow on chest xrays on an emphysema patient, not chronic bronchitis

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33
Q

T or F: Vascular markings is a common feature on xrays of emphysema patients.

A

False: Vascular markings are commonly seen on xrays of chronic bronchitis patients

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34
Q

T or F: Hyperinflation can be seen on an xray and is normally common with emphysema patients?

A

True

35
Q

Polycethemia is commonly seen in which condition?
A. Emphysema
B. Chronic Bronchitis
C. Both

A

B. Chronic Bronchitis

36
Q

Infections will occur in which condition?
A. Emphysema
B. Chronic Bronchitis
C. Both

A

C. Both; Infections are common with chronic bronchitis and also occasionally occur in emphysema

37
Q

What is cor pulmonale & in what condition is it commonly seen?

A

Right heart failure; Commonly seen in chronic bronchitis

38
Q

Digital clubbing is a common feature of this disease and may appear in this disease late stage?
A. Emphysema, Chronic Bronchitis
B. Chronic Bronchitis, Emphysema
C. Hypoxic Emphysema, Bronchiectasis

A

B. Digital clubbing is common in chronic bronchitis and may even be seen in late stage emphysema

39
Q

Cyanosis is common in which disease?
A. Emphysema
B. Chronic Bronchitis

A

B. Chronic bronchitis

40
Q

T or F; Cyanosis is sometimes seen in late stage in emphysema

A

False; Digital clubbing is seen late stage in emphysema but cyanosis is only commonly seen in chronic bronchitis so is not normally seen in emphysema.

41
Q

T or F: Use of accessory muscles while uncommon in chronic bronchitis is sometimes seen in late stages whereas it is a common feature of emphysema.

A

True

42
Q

Hoover signs is seen in which disease in the severe stages?
A. Emphysema
B. Chronic bronchitis

A

A. Emphysema

43
Q 
When hoover signs are seen this is a sign of:
A.  ARDS
B.  diaphragmatic failure
C.  Need of Bipap therapy
D.  Hyperinflation
A

D. Hyperinflation

44
Q

Describe what is observed in Hoover Signs

A

Inward movement of inner chest wall during inflation; a visible indenture is often seen

45
Q

Decreased diffusion capacity is a classic sign of what condition?
A. Emphysema
B. Chronic Bronchitis
C. Asthma

A

A. Emphysema

46
Q

In PFT testing, what happens to lung volumes on Vt with COPD?

A

Tidal volume will increase

47
Q

With COPD, does the RV increase or decrease?

A

Residual volume will increase

48
Q

Will the VC increase or decrease?

A

Decrease

49
Q

Can the tidal volume stay the same with COPD?

A

yes, VT can either stay normal or increase

50
Q

What will happen to the IC with late severe COPD?

A

Decrease in IC

51
Q

T or F: Decreased diffusion capacity (DLCo) is a common diagnostic sign of emphysema.

A

True; Decreased diffusion capacity is a common feature of emphysema & is normal in chronic bronchitis.

52
Q

T or F: Small amounts of carbon monoxide can be used in testing the diffusion capacity to determine if a person has emphysema?

A

True; Carbon dioxide diffuses faster and can be in minute amounts for testing without harm

53
Q

Name 4 components per GOLD of a COPD management plan?

A

Assess & Monitor disease
Reduce risk factor
Manage stable COPD
Manage exacerbations

54
Q

What is the protease-antiprotease hypothesis of emphysema

A

Lung structure is protected by A1AT
A1AT is a protein that opposes the degradative threat of neutrophil elastase which is released when neutrophils attracted to lung in infection or inflammation
–Under normal conditions the A1AT amounts which would be at normal level would protect lung structure
–With deficiency of A1AT the neutrophil elastin is unchecked causing breakdown of elastin & alveolar walls

55
Q

What is the normal threshold of A1AT?

A

11 umol/L

56
Q

What are the mechanisms of airflow obstruction in COPD, why do airways become inflamed? List 3 things anatomically that happen.

A

Inflammation & Obstruction of small airways (< 2mm)
Loss of elasticicity that keeps small airways open which has been destroyed by elastin
Active bronchospasm

57
Q

T or F: In COPD some airway damage be reversible

A

T: COPD is not reversible but some damage can be reversed by as much as 2/3

58
Q

Name some symptoms of COPD

A 
Wheezing
Cough
Phlegm production
Shortness of breath, especially with exercise
Dyspnea
Cor pulmonale, end stage
59
Q

How can you distinguish COPD from asthma?

A

Asthma is revesible, COPD is not;
Chronic daily phlegm production
Diminished vascularity on xray
Decreased diffusion capacity, but if FEV1 normalizes after bronchodilator may be asthma

60
Q

Define Exacerbation as it pertains to COPD:

A

Event that occurs during normal course of disease which is characterized by onset in which the patients baselines for dyspnea, cough or sputum worsen beyond normal day to day variations, normally acute in onset and may require change in medications

61
Q

What are the indications for Long Term O2 therapy?

A 
I  Continuous:  PaO2 below 55 at rest or
PaO2 56 - 59 or SaO2 at 89% or below with one additional condition to include:  Dependent edema, p pulmonale, erythrocytosis
II Non Continuous
During exercise which is mild exertion:
PaO2 less than 55 SaO2 less than 88%
During Sleep:
PaO2 less than 55 Sat less than 88 
with complications to include pulmonary hypertension or cardiac arrhthmias
62
Q

Name the 3 forms of bronchiectasis?

A

Cylindrical Bronchiectasis
Varicose Bronchiectasis
Sacular Bronchiectasis

63
Q

What are changes that happen anatomically in the lungs during bronchiectasis?

A

Bronchodilation of bronchial airways causing distortion of airways
Bronchoconstriction of smooth airway muscle
Excessive sputum
Hyperinflation of alveoli
Atelectasis, consolidation, parenchymal fibrosis
Hemorrhage secondary to bronchial arterial erosion

64
Q

T or F: Bronchiectasis can be either acquired or genetic

A

True

65
Q

What is a leading cause of acquired bronchiectasis?

A

Repeated lung infections in same area, especially as child

66
Q

Define bronchiectasis.

A

Abnormal, irreversible dilation of bronchi caused by destructive & inflammatory changes in airway wall

67
Q

Name some genetic causes of bronchiectasis:

A

Kartageners syndrome
Cystic Fibrosis
Hypogammaglobulinemia

68
Q

Name some important general causes of bronchiectasis.

A

Chronic respiratory infections
TB lesions
Secondary to CF patients
Bronchial obstruction

69
Q

Explain what happens to the ciliary in bronchiectasis.

A

Epithelial lining becomes damaged due to airway remodeling from results of chronic infection. This lining used to contain cilia but no longer does so now part of the muco-ciliary escalator is gone & phlegm cannot move up. The missing cilia and normal dilation of airways from disease cause secretions not to be transferred and to pool

70
Q

What are some clinical symptoms you may present with bronchiectasis

A

Hemoptysis
Productive cough, with thick, purulent often foul smelling phlegm
Change in vitals
ABG changes: Respiratory Alkalosis can result or acute alveolar hyperventilation with hypoxemia

71
Q

What are the strategies to managing bronchiectasis?

A

Controlling pulmonary infections
Controlling airway secrtions
Preventing complications

72
Q

Name some methods of treatment for bronchiectasis

A 
Bronchial hygiene to include PEP therapy, Chest PT
Aerosol therapy
Bronchodilator therapy
Mucolytics
Antibiotics
O2 Therapy
Pulmonary Rehab/Home Care
73
Q

What are 2 main pathological changes you will see in patients with bronchiectasis.

A

Chronic dilations resulting from changes caused by inflammation
Damage to cilia which hinders the mucociliary escalator causing pooled secretions

74
Q

T or F: Bronchiectasis is irreversible

A

True

75
Q

Name some effects you might see on xray with bronchiectasis.

A

Dark lung fields
Flattened diaphragm
Long, narrow heart
Enlarged heart

76
Q

What happens to the vital capacity and airflows in PFT testing?

A

They will both decrease

77
Q

What is the evidence that cigarette smoking is linked to COPD?

A

COPD symptoms more common in smokers than non
Impaired lung function with evidence of obstructive pattern is more common in smokers
Pathological changes of airflow obstruction are evident in smokers lungs
For susceptible smokers which is about 15% will experience rapid rate of decline

78
Q

What is the treatment for A1AT

A

Intravenous Augmentation Therapy

79
Q

T or F During mild stage of COPD you will normally see a slight rise in levels of CO2

A

False, during early stages PaCO2 is normally not affected until airway obstruction becomes severe

80
Q

What percentage of patients with stable COPD demonstrate a reversible component?

A

12%

81
Q

T or F: Anticholinergic and bronchodilators cannot improve airflow in COPD; they can only provide a lessening in dyspnea symptoms

A

False; They can improve airflow in COPD

82
Q

T or F: Systemic Corticosteroids produce a significant improvement of symptoms in COPD patients.

A

False, they are only modest at 6-29% of patients

83
Q

T or F: Stopping smoking will restore the FEV1 back to the normal range after 1 year

A

False; stopping smoking can slow rate of decline of FEV1 and restore rate of lung decline to that seen in healthy age matched smokers

84
Q

T or F: O2 therapy is desirable for patient comfort and also because it can prolong survival

A

True: O2 can prolong survival

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