Exam #3: Obstructive & Restrictive Disorders Flashcards
What are the three classifications of obstructive pulmonary disorders?
1) Obstructions from conditions in the wall of the lumen
2) Obstruction related to loss of lung parenchyma
3) Obstruction of the airway lumen
List examples of obstructions from conditions in the wall of the lumen.
Asthma
Acute bronchitis
Chronic bronchitis
List examples of obstruction related to loss of lung parenchyma.
Emphysema
List examples of obstruction of the airway lumen.
Bronchiectasis Bronchiolitis Cystic Fibrosis Acute tracheobronchial obstruction Epiglottitis Croup Syndrome
Comparing the three major obstructive lung diseases: asthma, chronic bronchitis, & emphysema how are the three distinguished from each other?
- Asthma is the most reversible of obstructive lung diseases
- Chronic bronchitis is hallmarked by increased sputum production
- Emphysema involves the most damage to the alveolar wall
What are the classic features of asthma.
- Diffuse airway inflammation
- Increased airway responsiveness
- Partially or completely reversible bronchoconstirction
What are the two main types of asthma?
Allergic vs. non-allergic asthma
What are the characteristics of allergic asthma?
Extrinsic
Pediatric onset
What are the characteristics of Non-allergic asthma?
- Intrinsic
- Adult-onset
- Allergen- specific immunotherapy & environmental control measures NOT helpful
Outline the pathophysiology of allergic asthma.
In response to an allergen, a myraid of inflammatory cells release inflammatory mediators that result in:
1) Bronchoconstriction
2) Plasma exudation
3) Edema
4) Vasodilation
5) Mucus hypersecretion
6) Activation of sensory nerves
Chronic inflammation leads to structural changes including:
1) Thickening of the basement membrane
2) Smooth muscle hypertrophy & hyperplasia
3) Angiogenesis
4) Hyperplasia of mucus-secreting cells
What are the clinical manifestations of asthma?
Dyspnea accompanied by:
- Cough
- Wheezing
- Anxiety
What are common triggers of allergic asthma?
- Exercise
- Aspirin
- Extrinsic factors i.e. allergens
- Intrinsic factors i.e. no identifiable
- rapid changes in temperature & humidity
What is seen on physical examination of an asthmatic patient?
Wheezing
- Rapid breathing
- Tachycardia
- Pulsus Paradoxus
- Accessory muscle use
- Active & prolonged expiratory phase
- Hyperresonance to percussion
Why is there tachycardia in acute asthma?
Increased work of breathing requires increased HR
What is pulsus paradoxus?
- Decrease in blood pressure with inspiration, which is the opposite of normal
- Alveolar hyperinflation constricts pulmonary capillaries & causes an increase in afterload on RV–>pushes the ventricular septum into the LV & decreases the SV ejected
How is asthma manifested on PTF?
Decreased airflow rates throughout the vital capacity
- Decreased PEFR
- Decreased FEV1
- Decreased MMEFR
Draw the schematics of flow-volume curves in acute asthma, early resolution, and late-resolution.
N/A
What are the four therapeutic goals in asthma?
1) Allow patient the pursue ADLs
2) Allow the patient to sleep without awakening b/c of symptoms
3) Minimize bronchodilator use
4) Prevent unscheduled medical care
What are the therapeutic options in asthma?
Acute reliever
Controller
What are the receptors for rescue treatments?
- B-2 adrenergic (bronchodilation)
- Anticholinergics (M3)
List the controller treatments used for asthma.
Inhaled corticosteroids Antileukotrienes Long-acting B-agonists Theophylline Systemic corticosteroids Anti-IgE
What are the classifications of the restrictive lung disorders?
Lung parencymal
Pleural
Neuromuscular
Infection
What are the two subclasses of lung parenchymal disorders?
Fibrotic Interstitial Lung Disease
Atelectatic Disorder
List examples of Fibrotic Interstitial Lung Diseases.
1) Diffuse interstitial lung disease
2) Sarcoidosis
3) Hypersensitivity pneumonitis
4) Occupational lung disease
List examples of Atelectatic Disorders.
ARDS
Infant RDS
List examples of pleural space disorders.
Pneumothorax
Pleural Effusion
What are the two classes of neuromuscular, chest wall, and obesity disorders?
Neuromuscular Disorders
Chest Wall Deformities
List examples of neuromuscular disorders.
Poliomyelitis ALS Muscular Dystrophy Guillain Barre Syndrome Myasthenia Gravis
List examples of chest wall deformities.
Kyphoscoliosis
Ankylosing Spondylitis
Flail Chest
Obesity
List the examples of inflammation of the lung.
Pneumonia
Severe ARDS
Pulmonary Tuberculosis
What is ARDS?
Adult Respiratory Distress Syndrome
What is ARDS characterized by?
- Damage to the alveolar-capillary membrane
- Widespread alveolar infiltrates & dyspnea
What is ARDS accoiated with?
Trauma Sepsis Aspiration of gastric acid Fat emboli sydrome Shock
How is ARDS diagnosed?
Decreased Pa)2 that is refractory to supplemental to O2 therapy
What are the three key pathological features of ARDS?
1) Noncardiogenic pulmonary edema= damage to the capillary membrane increases permeability
2) Atelectasis associated with lack of surfactant
3) Fibrosis associated with inflammatory deposition of proteins
What are the common findings in ARDS?
1) Severe hypoexmia
2) Decreased compliance from deposition of plasma protein & fluid
3) Decreased FRC
4) White out CXR
5) Non-cardiogenic pulmonary edema (not following the distribution of the vascular tree)
How is ARDS treated?
- Mostly supportive
- Identify & correct underlying cause
- Maintain fluid & electrolyte balance
- Block system inflammatory cells
- Adequate oxygenation
- High-frequency jet ventilation
- Inhaled nitric oxide
What is absorption atelectasis?
100% oxygen= no Nitrogen
- Body uses O2
- In ARDS that O2 in residual volume is used
- Causes atelectasis
