Dubin COPD Flashcards
Four PFTs
Which can be done in office? (*)
- Lung Volumes
- Lung Flow (volume v. time)
- Responsiveness to bronchodilators
- Lung Flow (volume v. time)
- Possibly DLCO
What is Lung Flow test called?
List the five parameters that are tested.
spirometry
- FVC
- FEV1
- FEV1/FVC
- FEV(25-75%)
- PEF (peak flow)
Exhaled NO test:
- What is normal ppb for adult and child.
- What is high normal or increased for adult and child What does this indicate?
- What is elevated for adult and child. What does this indicate?
- Normal - Adult (5-20), Child (5-15)
- High normal or increased - Adult (20-35), child (15-25). Indicates underlying airwya inflammation
- Elevated - Adult (35+), Child (25+). Indicates ongoing eosinophilic inflammation.
Obstructive v. Restrictive lung disease - name the differences in TLC, RV, and VC from normal
Obstructive - TLC and RV increases, FEV1/FVC
Definition of FEF25-75%
Average expiratory flow over the midportion of the FVC.
- “Mid-Max-Expiratory flow rate”
- “Effort independent”
- May be early sign of disease
Name three categories of restrictive lung disease.
- Intrinsic (parenchymal - Pulmonary Fibrosis).
- Extrinsic (pleural - pleural effusion).
- Neuromuscular (muscular weakness - myasthenia gravis or Guillian Barre)
Carbon Monoxide test - describe
“Single breath test” - take VC breath of 0.1% CO and hold 10 sec, then measure CO in expiratory gas.
Carbon Monoxide test in Emphysema and Pulmonary fibrosis.
- Emphysema - low due to reduced surfactant.
- Pulmonary Fibrosis - low
FEV1/FVC in Obstructive - what percentages classify mild v. moderate v. severe OPD
- Mild=60-70%
- Moderate=50-60%
- Severe=less than 50%
If bronchodilator response to B2 agonist is greater than 15%, think what?
asthma
What does intrapulmonary restrictive disease see increased FEV1/FVC?
Because of lung Drecoil and airway resistance.
Define emphysema pathology
Loss of alveolar structure by increased proteolytic breakdown, destruction of elastic tissue in alveolar walls.
Define emphysema PTFs
- Decreased FEV1/FVC.
- Increased air trapping, RV/TLC
- Decrased capillary SA for gas exchange - V/Q mismatch
- No response to Bronchodilator challenge
Age group where emphysema normally seen/
Old smokers
Clinical Presentation of Intrapumonary Fibrosis
- DOE, velcro crackles, clubbing, cyanosis (later stages)
“Velcro crackles” are heard when and indicate what
Are dry crackles heard at end of inspiration. Indicate IPF
Hallmark of Restricted lung disease is what change in lung volume?
DECREASED
Name four drug induced pulmonary injuries.
- Cryptogenic Organizing pneumonia
- Acute interstitial pneumonia with non-cardiogenic pulmonary edema
- Pulmonary Fibrosis
- Pleural effusion and symptomatic pleuritis (infrequent)
Name for BOOP
Bronchiolitis Obliterans with Organizing Pneumonia - BOOP.
- now called Cryptogenic Organizing Pneumonia
Pulmonary Fibrosis - slow or rapid onset
(may be rapidly progressive)
Describe the five factors that will shift oxygen dissociation curve left or right.
- Temperature - R(high), L(low)
- 2-3DPG - R(high), L(low)
- PaCO2 - R(high), L(low)
- CO - R(low), L(high)
- pH - R(acidosis), L(alkalosis)
Four factors in IRDS
- Alveolar surface tension - dec surfactant=inc. surface tension
- Alveolar ventilation - fl in proportion to atelectasis occurring
- Arterial oxygen saturation - fl in proportion to hypOventilation (but SaO2 won’t until very low PaO2)
- Arterial oxygen content - fl in proportion to hypOventialtion
Fever and pulmonary infiltrates that are unresponsive to antibacterial therapy. Often have cough with mucous plug expectorant, possibly forming bronchial casts, and possible hemoptysis.
ABPA
ABPA occurs in what pts and why?
Asthmatics and CF patients.
Due to hypersensitivity reaction to Aspergillus colonization of tracheobronchial tree.
ABPA may occur in conjunction with what?
Allergic fungal sinusitis, with symptoms including chronic sinusitis with purulent sinus drainage.
Clinical and pathological manifestation of chronic bronchitis
Clinically, persistent coughing and sputum due to abnormal enlargement of mucous glands.
Blue bloater is what?
Chronic Bronchitis
# increase in the reid index ratio indicates what?
5+ increase indicates Chronic Bronchitis - increased mucus gland to membrane ratio.
Clinical and pathological manifestation of emphysema.
Abnormal enlargement of air space due to destruction and deformation of alveolar walls DISTAL to terminal bronchioles.
SOB, DOE, PND, but too young for emphysema.
Alpha 1 antitrypsin.
Genetic component to alpha 1 antitrypsin.
Autosomal homozygous dominant PiZZ.
PFTs in alpha 1 antitrypsin.
FEV1/FVC decreased
RV/TLC increased
DLCO in alpha 1 antitrypsin.
low
What does every chronic lung-er need?
Pneumococcal vaccine (most common strep pneumo pneumonia).
What do you not EVER give chronic bronchitis or emphysema patients?
Inhaled steroids
Interpret and treat:
63yo with hx of XOPD. Moderate respiratory distress and trouble speaking in full sentences. O2 sat 88%. RR 28/min. ABG: ph7.3, PaCO2 65, PaO2 55.
- He is hyperventilating and PaCO2 is still high. O2 sat is low.
- Treat with 1) ALBUTEROL and IPRATROPIUM and 2) VENTURI MASK
Function/use of Venturi mask
O2 titration to prevent acute increase in PCO2 in and COPD exacerbation.
What type of emphysema is alpha 1 antitrypsin associated with?
Panacinar Emphysema - A1A is an inhibitor of neutrophil elastase/proteinase. Without A1A, there is a decreases destruction and elasticity of alveolar walls.
Best PFT indicator of COPD severity.
amount of FEV1 reduction
Significance of elastic recoil in the lungs.
The lung’s intrinsic ability to deflate after inflation. Maintains patency of small airways (get air out).
Emphysematous loss of lung elastic recoil accelerates FEV1 decline (normal in age) from damage to elastic fibers and loss of alveolar SA.
53yoM with PND, SOB, 60 pack years, pursed lip breathing, hypertrophy of accessory muscles, prolonged expiratory phase.
Early emphysema, punk puffer.
He cannot get air OUT
What air flow should you put on a chronic emphysema/chronic lung-er? What may prevent and acute increase in PCO2?
LOW FLOW (2L) because he is relying on his chronic hypoxic drive to breathe. If he is put on high flow, he stops having to work to breath and he will stop breathing - intubation will follow.
Treatment of COPD
- Smoking cessation
- Bronchodilators (SABA, LABA, Anticholinergics, theo)
- CS (not inhaled)
- Oxygen
- Pneumococcal vaccine
- surgical
