Obstructive Disorders Flashcards
What are the obstructive pulmonary disorders?
- asthma
- COPD
- bronchiectasis
- cystic fibrosis
What is asthma?
- airway is hyperreactive
- happens in small airways
- REVERSIBLE w/tx
RF of asthma?
- atopy (hereditary)
- obesity
What are cx of asthma?
precipitants:
- exercise/weather (cold air that cannot be warmed up enough cxing wheezing)
- GERD (b/c the esophagus is close to the trachea so when GERD happens it irritates the trachea cxing wheezing)
- the air (pollution, etc)
- post nasal drip (b/c it can go into the trachea, irritating it, wheezing happens)
PE of asthma?
- wheezing (d/t the cxs)
- prolong expiration (can also come w/reduced breath sounds)
- coughing
- +/- sputum (d/t post nasal drip)
Labs for asthma?
- PFT BEFORE and AFTER bronchodilator
- diagnostic: FEV1/FVC is lower than 0.7 (meaning it’s obstructive)
- using methacholine challenge/bronchial provocation but ONLY USE if FEV1 is greater than 65%
- IgE MIGHT be elevated
What is methacholine challenge?
used to diagnose asthma:
- normal: airways will NOT react
- asthma: airways will constrict b/c methacholine is a muscarinic agonist and bronchodilator will help them
How to diagnose asthma pt as intermittent vs persistent?
- intermittent: less than 2x/wk (sx, nighttime waking; use of SABA, interference of normal activities)
- persistent: more than 2x/wk
mild: more than 2x BUT normal FEV1/FVC
mod: more than 2x AND FEV1 is 60% (predicted is 80%) AND REDUCED 5% FEV1/FVC
severe: more than 2x AND FEV1 PREDICTED is 60% AND REDUCED more than 5% FEV1/FVC
How to tx asthma?
step 1 (intermittent): SABA (rescue inhaler)
step 2 (NOT intermittent): SABA + low dose ICS
step 3: SABA + LD ICS w/ LABA OR MD ICS
step 4: SABA + MD ICS w/ LABA
step 5: SABA + HD ICS w/ LABA +/- IgE tx
step 6: SABA + HD ICS w/ LABA + oral corticosteroids
ALWAYS HAVE AN ACTION PLAN GIVEN TO PT
What is chronic obstructive pulmonary dz?
obstruction to expiration
Cx of COPD?
- SMOKERS
- polluation (occupation)
- hypersensative leading to chronic inflammation that could be from allergies
- alpha 1 anti-tripsin def
What dz is COPD made up of?
emphysema and chronic bronchitis
What is emphysema?
- the alveolar walls are collapsing
- pink puffers
- there is NOT much coughing +/- mucus
- thin
- using accessory muscles
- NO peripheral edema
- chest is quiet (stomach breathing)
What is chronic bronchitis?
- there is scarring in the lungs (fibrosis)
- blue boaters
- there IS coughing d/t MUCUS
- overweight
- cyanosis and comfortable at rest
- chest is NOISY w/ wheezes (d/t mucus)
What is happening in COPD?
smoking and pollution is cxing INFLAMMATION in the lungs -> cxing INCREASE of elactase protein –> cxing breakdown of elastic fibers
*not only smoking and pollution but if we have inflammation going on throughout the lungs, usually we have anti-triptase to help decrease and elastic fiber breakdown but those who are anti-triptase def are at higher risk of COPD
Why is there barrel chesting in COPD?
as the alveolars die d/t to lack of elastic fibers, the equilibrium between the chest and lungs are lost cxing chest to get bigger (tug of war and chest is winning) –> cxing barrel chesting and getting filled w/air
How do you tx COPD?
- STOP smoking
- COPD w/ bronchitis –> Abx
- bronchodilators for QOL
- CS for exacerbations
- gold standard
What is the gold standard for COPD?
mild: FEV1/FVC = less than 0.7 FEV1=80% Tx: SABA & Flu vaccine mod:FEV1/FVC = less than 0.7 FEV1 ~80/ 50% Tx: SABA & Flu vaccine, LABA severe:FEV1/FVC = less than 0.7 FEV ~50/30% Tx: SABA & Flu vaccine, LABA, Glucocorticosteroids very severe:FEV1/FVC = less than 0.7 FEV1~30 OR ~50% w/ chronic resp failure Tx: SABA & flu vaccine, LABA, glucocorticosteroids, O2 +/-surgery
What is bronchiectasis?
- the permanent dilation and destruction of the bronchial walls and SCARRING of the bronchial TUBES
- there is extra mucus build up b/c the cilia is broken and can’t clear it up
What cxs bronchiectasis?
- cystic fiborsis
- whooping cough from a young age
What is the pathophysiology of bronchiectasis?
- CHRONIC inflammation of the walls d/t cystic fibrosis (genetic)
- destruction of the cilia (genetic)
PE of bronchiectasis?
- CHRONIC coughing w/ sputum (smells bad) –> recurrent infxn
- hemoptysis
- wheezing
- weight loss
- persistent basilar crackles
- clubbing
- hypoxemia (mod-severe)
Labs for bronchiectasis?
- PFT: obstructive
- Hi Res CT: dilated and THICK bronchi; tram tracks; SIGNET RINGS
- sputum culture: H. influenza
Tx for bronchiectasis?
- Abx (infxn)
- KEEP THE MUCUS OUT OF THE LUNGS: CHEST PHYSIOTHERAPY (percussion to drain mucus b/c cilia is broken)
- bronchodilators
- hydration
- bronchoscopy
- resection
What is cystic fibrosis?
- it is a HEREDITARY dz
- problem with the CFCTR
What is the pathophys of CF?
the CFTR is not working:
skin: Cl is not reabsorbed into body (CFTR is broken) –> Na follows Cl so Na is not reabsorbed into body
lungs: Cl is not secreted –> Na is not secreted –> H20 is not secreted –> MUCUS IS THICK
PE of CF?
- able to dx w/in 1 yo
- PANCREATITIS (d/t the defective protein)
- INFERTILITY (messes up w/ the sperm ct in men)
- HEMOPTYSIS
- chronic lung dz
- chronic coughing
- DECREASE in exercise
- chronic rhinosinusitis, steatorrhea (fat in feces), abdominal pain, diarrhea d/t mucus build up in body
- clubbing
- hyperressonance to percussion (mucus)
- apical crackles
Labs for CF?
CXR: -cuffing -mucus plugging -PFT: mixed pattern GOLD STANDARD: SWEAT CHLORIDE TEST (must be done 2x no diff days)
Tx for CF?
- bronchodilators
- abx (infxn)
- CS if needed
- CHEST PATHOPHYSIOLOGY (for mucus)
