module 11 obstructive lung disease

Question 1

PFT

Answer 1

spirometry
pt takes deep inhalation and then exhales as quickly as possible until maximal air exhaled
- differentiates between obstructive and restrictive lung disease

Question 2

normal PFT; FEV1, FVC

Answer 2

FEV1: forced expiratory volume in 1 second
- provides index for obstructive diseases
- 3.0L
FVC: forced vital capacity: total air exhaled
- 4.0L
FEV1/FVC = 75%
time of exhale determines flow

Question 3

FEV1/FVC ratio

Answer 3

75% or > : no obstruction
50-60% : moderate obstruction
< 50%: severe obstruction

Question 4

obstructive disease PFT

Answer 4

FEV1: less in 1st second than normal 
- 1.0L
FVC: can exhale same amount, but it takes longer
- 4.0L
FEV1/FVC: 25% : severe obstruction

Question 5

obstructive lung diseases

Answer 5

increased resistance to air flow within bronchi and bronchioles 
Wall lumen conditions: 
- asthma 
- acute/ chronic bronchitis
Loss of lung parenchyma
- Emphysema/COPD
Obstruction of airway lumen
- bronchiectasis
- cystic fibrosis
- acute trachobronchial obstructin 
- epiglottitis
- croup syndrome

Question 6

asthma

Answer 6

obstructive lung disease
associated with trigger
characterized by
- reversible airway obstruction 
- airway inflammation
- inc. airway reactivity to a variety of stimuli

Question 7

asthma pathogenesis

Answer 7

airway inflammation -> loss od epithelial tissue

• > collagen deposition under basement membrane
• > mast cell activation/ IgE mediated
• > mucosal edema
• > inc. secretions
• > smooth muscle contraction
• > PSNS: bronchial constriction

Question 8

intrinsic/nonallergic asthma

Answer 8

no history of allergies

• usually develops in middle age
• r/t resp. tract infections or psychological factors
• attacks severe
• variable response to therapy

Question 9

extrinsic/allergic asthma

Answer 9

history of allergies

Question 10

exercise induced asthma

Answer 10

bronchospasm occurs within 3 min after end of exercise, resolves around 60 min.
- heat loss, water, los, inc. osmolarity of lower resp. mucosa -> mediator release from basophil and mast cell -> smooth muscle contraction

Question 11

asthma s/s

Answer 11

wheezing 
tightness of chest
dyspnea
cough
inc. sputum 
SEVERE
- retractions
- dec. breath sounds
- orthopnea
- agitation 
- inc. RR
- inc. HR
- cyanotic

Question 12

bronchitis

Answer 12

obstructive disease
acute inflammation of trachea and bronchi 
- mucus accumulation 
- inflammation of epithelium 
- mucous plug
- hyperinflation of alveoli 
- enlarge submucosal gland

Question 13

acute bronchitis

Answer 13

inflammation of trachea and bronchi
- mild and self- limiting 
- capillary dilation 
- swlling from exudation of fluid 
- infiltration w/ inflammatory cells 
- inc. mucus production 
- loss of ciliary funtion 
- loss of ciliated epithelium 
commonly causes by a virus, sometimes bacteria 
highest incidence in smokers, young children, elderly
inc. prevalence in winter months

Question 14

acute bronchitis s/s

Answer 14

cough 
low fever
substernal chest discomfort
ST
postnasal drip 
fatigue

Question 15

chronic bronchitis

Answer 15

Type B COPD "Blue bloater"
dx symptomatically
- hypersecretion of bronchial mucus and
- productive cough of 
-- >3 mo. duration annually, x2 or more successive years
Bacterial colonization common

Question 16

chronic bronchitis s/s

Answer 16

males > females
excess body fluids
chronic cough
SOB on exertion 
inc. sputum 
cyanosis (late sign)
chills
malaise
muscle aches
fatigue
dec. libido
insomnia

Question 17

causes of chronic bronchitis

Answer 17

smoking
repeated infections
genetic predisposition
inhalation of physical or chemical irritants 
inc. neutrophils
inc. CD8 lymphocytes
inc. eosinophils 
often extends into alveoli
- narrowed airway
- mucus plugs

Question 18

chronic bronchitis pathogenesis

Answer 18

chronic inflammation and swelling of bronchial mucosa -> scarring, inc. fibrosis, hyperplasia of mucous glands and goblet cells, inc. wall thickness
-> worsened obstruction of airflow

Question 19

emphysema

Answer 19

obstructive disease
Type A COPD
destructive changes of alveolar walls and abnormal enlargement of distal air sacs
- develops over long period of time

Question 20

emphysema etiologies

Answer 20

smoking
air pollution
occupational exposure
a1-antitrypsin deficiency

Question 21

antitrypsin

Answer 21

protective enzyme that inhibits proteolytic breakdown of alveolar tissue

Question 22

emphysema pathogenesis

Answer 22

neutrophils release proteolytic enzymes -> alveolar destruction
smoking -> inflammation of parenchyma -> release of proteolytic enzymes -> damage to alveoli
– smoking inactivates antitrypsin
loss of alveolar walls and dec. pulmonary capillary bed -> dec. gas exchange
loss of elastic tissue -> dec. size of smaller bronchioles
-> loss of radial traction (nmlly holds airway open)
-> inc. pressure around outside of airway lumen
-> inc. resistance and dec. airflow
inhalation: air moves in
exhalation: bronchial walls collapse: air trapping -> Bullae

Question 23

bullae

Answer 23

large, thin called cysts in lungs

Question 24

3 classifications of emphysema

Answer 24

centriacinar (centrilobular)
- smoking and chronic bronchitis -> destroyed bronchioles
Panacinar (panlobular)
- destroys alveoli
Paraseptal
- affects peripheral lobules

Question 25

emphysema s/s

Answer 25

thin: inc. effort -> caloric expenditure
use of accessory muscles
pursed- lip breathing
minimal or absent cough
leaning forward to breath
barrel chest
digital clubbing
dyspnea on exertion (late sign)
bullae
risk of pneumothorax