Geri: Lungs Flashcards
Age relayed changes in the lungs?
- Structure changes = less elastics
- less chest wall compliance and less respiratory muscle strength
- Less cough and muscous clearance (impaired
- Brain leas responsive to hypoxia
Name the 3 airway diseases
Asthma
copd
Bronchiectasis
Name on parenchymal disease
Pneumonia
Define asthma
Chronic inflammatory disease or the airways
Asthma in the elderly…
- Increased morbidity
- Difficulties with med delivery
How are lungs affected long term?
Remodelling and reduced lung function
Define COPD
Preventable and treatable disease
Airway limitation in the ling that is usuay partially reverse and generally progressive
Does COPD have extrapulmonary manifestations?
Yes!!
Muscle wasting
Osteoporosis
Depression
Anaemia
Hepatomegaly
How do we determine COPD severity? Which test?
Spirometry (breathlessness = FEV1%)
OTHER Symptoms:
sputum
Fatigue
Decreased mobility
Muscle wasting
Low self esteem
COPD phenotypes
All link…
Chronic bronchitis
Emphysema
Asthma
Describe Emphysema
Destruction of lung tissue
Loose alveoli number and function
What is COPD-X (Australian guidelines )
C: on firm diagnosis
O: OPTIMSIE FUNCTION
P: PREVENT DETERIORATION
D: DEVELOP SUPPORT NETWORK/ SELF MANAGE
X: EXACERBATIONS MANAGED
How can we reduce risk of COPD
Stop smoking
Non pharmacological management strategies for COPD
Counselling
VACCINATIONS
Pulmonary Rehab
Bronchial hygiene
Oxygen therapy
Surgery
Vaccinations for COPD
- Influenza
- Pneumonococcal
Both prevent exacerbations, hospitalisations
What is pulmonary Rehab?
What dose it include
Exercise training
Nutritional assessment
Patient education
Proven benefits of pulmonary Rehab?
Improves dyspnoea and fatigue
Improves Max workload, oxygen uptake and endurance
Decrease hospitalisations
Increases adherence to meds
Who needs Long Term Oxygen Therapy? (LTOT)
For stage 4 COPD (SEVERE HYPOXIA)
more than 15 hours per day to patients with chronic respiratory failure
Side effect of LAMAS (ipratorpium and tiotropium
Dry mouth
Morbidities common in COPD
Depression/anxiety
Chest infections
Right heart failure
Osteoporosis
Management of coexistent ASTHMA & COPD
- TRIAL ICS 6-8 weeks
To determine if significant airway inflammation - Consider ICS+LABA/LAMA
- Pulmonary Rehab
What is bronchiectasis
Abnormally dilated medium sized airway bronchi
Causes of BRONCHIectasis
Inherited (CF)
Post infection
Tumour
Describe BRONCHIectasis
- Chronic sputum production
- Mucus plugging
- Bronchial wall thickening
- Repeated episodes of infection
- Airflow obstruction
Common cause of pneumonia (bug)
10-15% strep pneumoniae
Who does community acquired EXCLUDE?
Patients who had been in hospital in previous 10 days
Clinical features of pneumonia may include FEVER?
Absence of fever in elderly doesn’t exclude pneumonia!!!
Confusion may be the only symptom….
What can go wrong with pneumonia…?
Pleural effusion
Empyema (pus in a cavity)
Abscess (localised collection of pus in an organ or tissue)
Septicaemia (severe infection due to spread into blood)
Respiratory failure (hypoxia and multi organ failure)
Scarring
Methods used to test severity in CAP
CURB 65
PNEUMONIA SEVERITY INDEX (PSI)
SMART-COP
***CORB (severe CAP is 2+ features):
C: acute Confusion
O: OXYGEN SAT 90% lesss?
R: RESPIRATORY RATE 30+ breaths per min
B: systolic BLOOD PRESSURE <90mmHg or diastolic <60mmHg
Physiological changes with aging cause?
Increase or decrease pulmonary reserve?
Decrease
