Emphysema, Chronic Bronchitis & Asthma, Lung Parenchyma Disorders, Disease of Pulmonary Vasculature Flashcards
EMPHYSEMA
EMPHYSEMA
Does COPD describe a single pathology?
No, it is an umbrella term for 3 different pathologies.
What 3 pathologies are under COPD?
- Emphysema
- Chronic Asthma
- Bronchitis
COPD is the _____ leading cause of death in America. Often, patients with emphysema have __________. ____ million US adults are estimated to have COPD. ____ million US adults have reported a physician diagnosis of chronic bronchitis.
- fourth
- lung cancer
- 12.7
- 10.1
- What is the most common risk factor of COPD?
- What are some others?
-SECONDHAND SMOKE
- exposure to air pollution
- occupational dusts and chemicals
- heredity
- Hx of childhood respiratory infections and socioeconomic factors
The 3 pathologies of COPD (emphysema, chronic obstructive bronchitis, chronic asthma) _______ air flow. These may occur ____________ or in combination with one another.
- obstruct
- independently
Is COPD a specific diagnosis?
NO
What are the presenting signs of COPD?
- dyspnea
- sputum production
- chronic cough
- reduced function
- What is the most basic and frequently performed test of pulmonary function?
- Emphysema is diagnosed when the FEV1/FVC ratio is
- Spirometry
- 0.70
What is Emphysema?
Pathological accumulation of air in the lungs.
Emphysema is a disease of ________ and is characterized by ___ _________ in the lungs.
- exhalation
- air trapping
Emphysema causes an ________ in residual volume (RV) and total lung capacity (TLC), and a decrease in the ____/_____ ratio.
- increase
- FVC1/FVC
What is the genetic cause of Emphysema?
1
Alpha-1 Antitrypsin:
- Alpha-1 antitrypsin (A-1AT) is a protein found in the ______ and synthesized in the _______.
- A-1AT protects the lungs from the degrading actions of powerful enzyme called ________ ________ (↑ elastin degradation) and other proteases. This elastase is produced and released by neutrophils.
- A-1AT coats cells and provides protection against the neutrophil elastase.
- Serum concentrations of A-1AT can rise many fold during periods of acute __________ providing protection from inflammatory damage.
- blood, liver
- neutrophil elastase
- inflammation
Cigarette smoke ___________ A-1AT leaving the lung susceptible to damage. Smoking causes a ____________ state which means that neutrophils are busy, lots of elastase and reduced effectiveness of A-1AT.
- inactivates
- hyperinflammatory
A-1AT Deficiency and Cigarette Smoking:
- Destruction of individual _______
- Development of “_____” alveoli
- Destruction of _____ supports for the very smallest airways allowing them to collapse during expiration
- alveoli
- “super”
- CT
1 in ___ cases of Emphysema are not linked to tobacco use.
7
Emphysema:
- Creates ________ lungs with _______ alveoli (super alveoli)
- __________ becomes problematic
- Forced expiration causes smaller airways to _________ during expiration
- Leads to “___ _______” in the alveoli
- Results in ↓ alveolar ____
- ________ disease
- FEV1/FEV < .5 = ___ ______
- hyperinflated lungs with enlarged alveoli
- Exhalation
- collapse
- air trapping
- PO2
- Progressive
- bad news
- What is the first complaint that presents itself in Emphysema?
- What are some other clinical manifestations?
-SOB at rest
- Apprehensive, anxious, addicted to O2
- Thin, cachectic
- Deformed chest with prolonged expiration
- Absent or non-productive cough
- Mild disease (mild hypoxemia)
- With progression hypoxemia worsens and CO2 is retained
- Chronic pulmonary metabolic acidosis
- Deconditioning
Emphysema patients can have accompanying ________ problems, more specifically ____ _______.
- cardiac
- cor pulmonale
Emphysema has a _____ prognosis. It is ________, ____________, and debilitating. It may present with lung _______.
- poor
- chronic, progressive
- lung cancer
Is PT of benefit to patients with Emphysema?
Yes
6 Emphysema Treatments Implications for the PT.
1) reducing airway edema secondary to inflammation and bronchospasm
2) facilitating the elimination of bronchial secretions
3) preventing and treating respiratory infection
4) increasing exercise tolerance
5) avoiding airway irritants and allergens
6) relieving anxiety and treating depression
Emphysema Medications.
- β2 agonists or anticholinergics
- Antiinflammatory agents
- Antibiotics
- Mucolytic expectorants
- Mast cell membrane stabilizers
- Antihistamines
- Glucocorticoids
In Emphysema, patients with PaO2 of 55 or less, or a resting O2 sat of 88% (2x 3 weeks apart) or less may be on long term ____ therapy.
O2
Emphysema Implications for the PT:
- Always use ______ __
- Monitor __, __ and __ frequently
- The first heart sound (closing of the tricuspid and mitral valves) is best heard under the sternal area. Hyper inflated lungs causes the heart to elongate, displacing the left ventricle downward and medially.
- pulse ox
- HR, RR, and BP
Those who retain CO2 may have a ________ hypoxic drive i.e. very low PO2 needed to help drive the respiration.
-decreased
What is a Metered-Dose Inhaler (MDI)?
Used to deliver drugs to the lungs.
- Users take in slow deep breath over 10s while maintaining seal and pressing on the device
- Evaluate the ability of the child or adult to correctly use the MDI
CHRONIC BRONCHITIS AND ASTHMA
CHRONIC BRONCHITIS AND ASTHMA
Emphysema = “____ _______”
Chronic Bronchitis = “______ ________”
- pink puffer
- blue bloater
What is Chronic Bronchitis?
Productive cough lasting at least 3 months per year for 2 consecutive years.
A FEV1/FEV
75%
What is Chronic Bronchitis characterized by?
- Inflammation
- Excessive mucous production
- Scarring of lining of the bronchial tubes
- Obstruction of bronchial air flow is caused by increased mucous production/reduced mucous clearance
- Chronic Bronchitis is caused by _______ exposure to irritants causes mucus hypersecretion and hypertrophy of mucous producing glands in the larger bronchi.
- It involves the destruction of ciliary cells lining ______.
- It is associated with _______ r4!
- chronic exposure
- airways
- decreased
- Chronic Bronchitis often begins with recurrent ______ ______ that brings mucus from the lungs. This increases over the course of the day and as the disease worsens.
- _________ is associated with narrowed airways.
- Symptoms are typically ___________.
- morning cough
- wheezing
- progressive
What can cause exacerbations of Chronic Bronchitis?
- Triggered by upper- or lower-airway infections.
- Triggered by exposure to environmental irritants such as dust, fumes, or air pollution.
Chronic Bronchitis patients tend to be polycythemic. What is this and why?
- Increased concentration of hemoglobin in the blood.
- If they are hypoxic, make more to transport more O2.
- Chronic Bronchitis patients tend to have _____, prolonged ________, persistent _________ with expectoraton, and recurring _________.
- These patients also tend to be _______.
- SOB, prolonged expiration, persistent cough, recurring infection
- obese
Blue Bloaters:
- Decreasing ___________
- Increasing ___ and decreasing expiratory flow
- Dreadful / mismatch with much shunting.
- Hypoxemia, hypercapnia, cyanosis, polycythemia
- ____ ________ secondary to chronic pulmonary HTN
- Pulmonary Rehabilitation Programs
- ventilation
- RV
- V/Q
- cor pulmonale