Obstructive Lung Disease Flashcards
the age 25-44 experience the “common cold” at what rate per year
19%
the age 45-65 experience the “common cold” at what rate per year
16%
T/F a fraction of scheduled surgery patients will have an active URI
true
what accounts for 95% of all URIs
infectious nasopharyngitis
associated viral pathogens in the URI
rhinovirus
coronavirus
influenza
parainfluenza
RSV
noninfectious nasopharygitis can be of what 2 origins
allergic or vasomotor
T/F viral culture and lab tests are sensitve, tho time consuming
false, viral culture and lab tests lack sensitivity
children with URIs have a higher risk of what perioperative adverse events
laryngospasm
coughing
breath holding
transient hypoxemia
a patient has had a URI for _____ and is ____ and improving can be safely managed without postponing surgery
weeks; stable
if surgery is cancelled due to active URI, it should be rescheduled within
6 weeks due to airway hyperreactivity
the COLDS scoring system takes into account what 5 things
current symptoms
onset of symptoms
presence of lung disease
airway device present
type of surgery
anesthetic management of patients with URI includes
adequate hydration, reducing secretions, and limiting airway manipulation
what can be done to reduce upper airway sensitivity
inhaleed or topical local anesthetics on the vocal cords
as far as airway/ventilation management what can be done to reduce risk of laryngospasm
use of LMA over ETT
when there are no contraindications; what can be done for a smoother emergence
deep extubation
adverse respiratory events in patients with URI
bronchospasm
laryngospasm
airway obstruction
postintubation croup
desaturation
atelectasis
intraoperative and postoperative hypoxemia are common and treated with
supplemental O2
what is astham
chronic inflammation of the mucosa of the lower airways
with asthma activation of the inflammatory cascade leads to
infilitration of airway mucosa with eosinophils, neutrophils, mast cells, T cells, B cells, and leukotrienes
the inflammatory cascade involving eosinophils, neutrophils, mast cells, T cells, B cells and leurkotrienes causes what
airway edema; especially in the bronchi
what kind of airway remodeling occurs with asthma
thickening of the basement membrane and smooth muscle mass
the main inflammatory mediatiors implicated in asthma include
histamine
prostaglandin D2
leukotrienes
what can provoke asthma
allergens
ASA, NSAIDs, sulfiting drugs
infections
exercise
emotional stress
T/F excersie induce asthma occurs after the exertion
true
asthma is an episodic disease with _________ _______ and ______ _______
acute exacerbations and asymptomatic periods
symptoms of asthma include
expiratory wheeze,
productive/nonproductive cough
dyspea
chest tightness
eosinophilia
what is status asthmaticus
dangerous, life threathening bronchospasm that persists despite treatment
when the history is obtained from an asthma patients- what is ur focus of assessment
intubation for asthma
ICU admission for asthma
2+ hospitalizations for astham in the past year
and presence of coexisting disease
diagnosis of asthma depends on
clincal history, symotoms, objective measurements of airway obstruction
astham is diagnosed when
pt reports wheezing, chest tightness, or SOB, and demonstrates airflow obstruction on PFT (that is at least partially reversible by bronchodilators
FEV1 normal values
80-120%
lung tests used with asthma
FEV1
FVC
FEV1:FVC
FEF 25-75
Diffusing Capaity (DCLO)
FVC normal values male/female
male - 4.8L
female - 3.7L
normal FEV1/FVC ratio in adults
75-90%
maximum ventilatory ventilation is a test that examines
the maximum amount of air that can inhaled and exhaled within 1 min
for patient comfort it is measured over 15 sec time period
what PFTs are a direct measure of the severity of the expiratory obstruction
FEV1
FEF
midexpiratory phase flow
what is the FEV1 of a symptomatic asthmatic patient
FEV1 <35%
during moderate to severe astham attacks what effects are seen on TLC and FRC
FRC increases but TLC is unchanged
with expriatory obstruction and relief f obstruction after administration of bronchodilator suggests
asthma
t/f abnormal PFTs may persist for several days after an attack despite absence of symptoms
true
since asthma is episodic, diagnosis can be suspected with normal PFTs
mild asthma attack is accompanied by what ABG findings`
normal PaO2 and PaCO2
during an asthma attack tachypnea and hyperventilation is caused by
neural reflexes of the lung not hypoxemia
what ABG findings might you see in sytmptomatic asthma patient
hypocarbia and respiratory alkalosis
as the severity of expiratory obstruction increases, the associated VQ mismatching results in a PaO2 of
less than 60 mmHg
when is the PaCO2 likely to increase in an asthmatic patient
when FEV1<25% of predicted value
what can cotnribute to the hypercarbia during an asthamtic attack
fatigue of skeletal muscles
EKG findings of severe asthma patietns
hyperinflation and hilar vascular congestion due to mucous plugging and pulmonary HTN
what can EKG reveal during an asthma attack
R heart strain or ventricular irritability
differiental diagnosis of asthma includes
viral tracheobronchitis
sarcoidosis
rhematoid arthritis with brnchotis
extrinsic/intrinsic AW compression
vocal cord dysfunction
tracheal stenosis
chronic bronchitis, COPD, and foriegn body aspiration
treatment for asthma aims to
control symptoms and reduce exacerbation
1st line treatment for mild asthmatic patients
short acting inhaled B2 agonist
recommended in those with <2 exacerbations a month
what can be added to asthmatic therapy to reduce exacerbations adn decrease risk of hospitalization
inhaled corticosteroid
if asthma symptoms remain uncontrolled what is added to therapy
daily B2 agonist
other therapy options for asthma
inhaled muscarinic atagonists, leukotriene modifiers, and mast cell stabilizers
when are systemic corticosteroids used for asthmatic therapy
severe asthma uncontrolled with inhaled medications
what therapy can be used in asthma treatment to decrease long term use of medications and improve quality of life
SQ immunotherapy
what is bronchial thermoplasty and why is it used in asthma therpay
bronchscopy delivers radiofrequency ablation of smooth muscles to all lung fields except the right middle lobe
loss of airway smooth muscle is thought to reduce bronchoconstriction
with bronchial thermplasty what lobe of the lung is not targeted
right middle lobe
how many sessions of bronchial thermoplasty is recommended
3 sessions
risk for airway fire
with bronchial thermoplasty when the FEV1 improves how much of normal - do patients have minimal or no symoptoms
about 50%
acute severe asthma (status asthmaticus)
bronchocspasm that doesnt resolve despite usual therapy
considered life threatening
treatment for acute severe asthma
high dose, short acting B2 agonist and systemic corticosteroids
inhaled b2 agonist can be used in treatment of acute severe asthma every
15-20 min for several doses without hemodynamic effects
although pts may experience unpleasant sensations due to adrenegic stim
2 most commonly administered corticosteroids for acute severe asthma
methyprednisone
hydrocortisone
with acute severe asthma, when is supplemental O2 given
to maintain saturations > 90%
other drug therapies for acute severe asthma
magneisum, oral leukotriene inhibitors
when is tracheal intubation warranted for acute severe asthma
PaCO > 50 mmhg
MV parameters in acute severe asthma
high gas flows permit short inspiriation timesand longer expiration
expiration time must be prolonged to avoid air trapping “auto-peep”
permissive hypercarbia
what is the likelihood of bronchospasm in asthmatics undergoing GA
0.2-4.2%
risk of bronchoscopasm is correlated with the type of surgery - what surgeries increase the risk
upper abdominal and oncologic surgery
GA mechanisms that increase airway resistance
depression of cough reflex
impairment of mucocilliary funciton, reduction of palatopharyngeal muscle tone
depression of diaphragmatic function
increaed fluid in the airway walll
other factors increasing airway resistance in asthamtic patietns undergoing GA
airway stim (intubation)
PNS activation and or release of neurotransmiters (Substance P and neurokinins)
preop assessment of asthmatic patient includes
notes of symptom control
frequency of exacerbations
need for hospitalization or intubation
previous anesthesia tolerance
what physcial assessment might you note of your asthmatic patient preop
use of accessory muscles
wheezing/creptitis
t/f eosinophil count mirrors the degree of inflammation
true
what PFTs might you want before heading back to surgery with an asthma patient
FEV1 before and after bronchodilator
what PFT findings prdict the risk of periop respiratory complications
FEV1 or FVC < 70% predicted
FEV1:FVC ratio < 65% predicted
what can improve reversible components of asthma
chest physiotherapy, antibiotics, and bronchodilators
how long do you continue preop anti-inflammatories and bronchodilators
until induction
q
if patients are on systemic corticosteroids for asthma within the past 6 months, what is indicated
stress dose hydrocortisone or methylprednisone
ideally patietns should be free of ______ and have a PEFR of > _____ % of predicted or their personal best before surgery
free of wheezing
PEFR > 80%
COPD is a disease of
chronic airflow obstruction
symptoms of COPD include
emphysema - lung parynchema destruction, chronic bronchitis, productive cough and small airway disease
COPD prevalence and rank in leading cause of death
10%
3rd leading cause of death
risk factors for COPD
cigarette smoke, occupational exposure to dust and chemicals, absetos, gold mining, biomass fuel, air pollution. genetic factors, age, female, poor lung development during gestation, low birth weight
