COPD & Asthma Flashcards
VS findings in Asthma
RR often 25-40 breaths/min
tachycardia
pulsus paradoxus
SpO2 near 90% on RA
What is Pulsus Paradoxus?
What value suggests moderate severity of exacerbation?
Exaggerated inspiratory decrease in systolic BP
15mmHg
Thoracic Exam findings in asthma:
Inspection
accessory muscle use
hyperinflation
prolonged expiratory phase
Thoracic Exam findings in asthma:
Percussion
hyperresonance w/ loss of normal variation in dullness d/t diaphragmatic movemtn
tactile fremitus is diminished
Thoracic Exam findings in asthma:
Auscultation
wheezing (often louder during expiration)
Loss of intensity or absence of breath sounds known as Silent Chest (signs of severe airway obstruction)
Physical findings in COPD include?
Cyanosis may occur
pursed lip breathing
Thoracic Exam findings in COPD
Inspection
use of accessory muscles
hyperinflation
increased/large anteroposterior thoracic dimension
use of arms to fix shoulder girdle to allow the use of accessory muscled (tripod position)
retraction of the low rib cage w/ inspiration d/t altered biomechanics of the flattened diaphragm (hoover sign)
What inspection finding may suggest respiratory muscle fatigue in patients w/ COPD?
paradoxical abdominal wall motion w/ inspiration
Thoracic Exam findings in COPD
Percussion
Shows increased resonance
Thoracic Exam findings in COPD
Auscultation
Rhonchi w/ inspiration
Wheezes ww/ forced exhalation
decreased breath sounds in those w/ emphysema
asymmetry raises possibility of pneumothorax
Thoracic Exam findings in COPD
Cardiac findings include?
Diminished heart sounds d/t increased retrosternal space
Elevated JVP
Accentuated pulmonic valve closure (P2)
R ventricular heave
hepatic congestioin
peripheral edema
raises the possibility of pulmonary HTN
Differential diagnosis for Asthma
Chronic Upper Airway Cough Syndrome
Inducible Laryngeal Obstruction
Hyperventilation, dysfunctional breathing
Bronchiectasis
Cystic Fibrosis
Congenital Heart Disease
Alpha1-antitrypsin deficiency
Inhaled Foreign Body
COPD
Cardiac Failure
Medication related cough
Parenchymal lung disease
PE
Central airway obstruction
Tuberculosis
Pertussis
Differential Diagnosis for COPD
Asthma
Lung CA
Tuberculosis
Bronchiectasis
L Heart Failure
Interstitial Lung Disease
Cystic Fibrosis
Idiopathic Cough
Chronic Allergic Rhinitis
Post Nasal Drip Syndrome
Upper Airway Cough Syndrome
Gastroesophageal Refulx
Medication Induced Cough
Diagnostic requirements for asthma
Positive post-bronchodilator response defined as 12% and at least 200 ml increase in FEV1
PFT findings c/w asthma
PEFR, FEV1, MMEFR, are all decreased
After exacerbation PFTs may show low FEV1, low forced vital capacity and slightly elevated total lung capacity and residual volume
Exhaled NO findings c/w asthma
A concentration of 20-25 parts/billion is a convenient and reliable level that can be used to distinguish people w/ asthma
ABG findings in patients w/ asthma
PAO2 at sea level is 55-70 mmHg usually
PaCO2 usually between 25-35 mmHg
What is concerning when a patient w/ a hx of several days of moderate to severe airflow obstruction reason to be concerned?
It may indicate the mechanical load on the respiratory system is greater than can be sustained by the ventilatory muscles and that respiratory failure is imminent.
Other blood findings in patients w/ asthma?
Blood eosinophilia is common but not universal
Chest radiograph of a patient w/ asthma?
often normal
severe asthma is associated w/ hyperinflation (indicated by depression of the diaphragm and abnormally lucent lung fields)
Complications of severe asthma found on radiographs?
subQ emphysema
pneumomediastinum
pneumothorax
Diagnostic criteria for COPD
Post-Bronchodilator ratio of FEV1/FVC < 0.7
Recommended screening for all patients COPD
alpha-1 antitrypsin deficiency
Radiograph findings in patients w/ COPD?
hyperinflation evidenced by flattened diaphragmatic silhouette
Increased retrosternal air space on the lateral image
decreased parenchymal markings
bullae in pts w/ emphysema