Obstructive Lung Disease Flashcards
Function of the following structures: trachea, carina, R/L main stem, lobar bronchi, segmental bronchi, subsegmental bronchi
They’re the tubes of the respiratory system
They carry gas
Function of the following structures: terminal bronchioles, respiratory bronchioles, alveolar ducts, alveolar sacs
Exchange units of the lungs
Exchagen O2 for CO2
Structure:
300 million clusters in the adult lung
SA of a tennis court
Elastic
Alveolar sacs
Describe Chronic Obstructive Pulmonary Disease (COPD)
FLOW of air is IMPEDED; trouble getting air OUT
Describe Restrictive Lung Disease (RLD)
VOLUME of air REDUCED, trouble getting air IN
Disease: affects both the MECHANICAL function and gas EXCHANGE of the respiratory system
COPD
Disease: LONG expiratory time; I:E of 1:4+
COPD
Disease Risk Factors:
Smoking
Air Pollution
Familly Hx
Occupational Dusts
COPD
Disease Physical Symptoms:
Dyspnea on Exertion
Fatigue
Chronic Cough
Wheezing/Rhonchi
Expectoration of Mucus
COPD
Disease loss of normal elastic recoil and bronchial tubes collapse
COPD
Describe the PFT changes with COPD
Decreased ERV
Increased RV and FRC
With COPD both the _____________ and __________ of the respiratory system is affected
efficiency, function
COPD Pathophysiology: ______1_____ bronchial lumen; ___2___ mucus production, _____3_____ of the mucosal lining (thickening) due to repeated ______4______. ____5____ (constriction) of bronchial smooth muscle. Respiratory muscles must work ____6____. Enlarged ____7____ is already inflated (___8___ chested). Must overcome _____9_____ to airflow obstruction. Alveolar ventilation is _____10______.
- Decreased
- Increased
- Inflammation
- Infection
- Spasm
- Harder
- Thorax
- Barrel
- Resistance
- Decreased
List the signs and symptoms of COPD (4)
- Hypoxemia (for most)
- Polycythemia (increased RBC and visocisty = increased resistance)
- Cor Pulmonale (R sided heart failure)
- Respiratory Failure (frequent cause of death for COPD)
List the Tx for COPD (3)
- Remove irritant/afflicting agent
- Inhaled medications (albuterol, anti-cholinergics, corticosteroids, antibiotics)
- Exercise training
List the disease grouped under COPD
- Emphysema
- Chronic Bronchitis
- Asthma
- Cystic Fibrosis
** Conditions can be separate or co-exist
Disease:
Alveolar/Parenchymal Disease
Lung function altered [elastic recoil, collapse of airways w/exhalation and chronic airflow obstruction]
Abnormal PFTx & CXR
Emphysema
Disease: Enlargement of air spaces distal to terminal bronchioles, loss of elastic fibers, and destruction of alveolar septal walls
Alveolar/Parenchymal Disease
Type of Emphysema: destruction of more proximal or central alveoli
Centriacinar
Type of Emphysema: destruction of more distal alveoli
Panacinar or Panlobular
Term: Stretched out alveoli that are at risk for blowing out
Panlobular
Centrilobular emphysema affects _____1_____ _____2_____ sparing distal avleoli, worse in the __3__ __4__, particularly the _____5_____. Most common in ___6___. Closely associated with ____7____.
- Respiratory
- Bronchioles
- Upper
- Lobes
- Apices
- Men
- Smoking
Panlobular emphysema affects airspaces _____1_____ to the respiratory bronchiole. ___2___ ____3____ most affected. Generally due to a ___4___ deficiency (alpha1 antitrypsin)
- Distal
- Lower
- Lobes
- Protein
List the components of the lung affected by EMPHYSEMA (3)
- Respiratory Bronchioles
- Alveolar Ducts
- Alveolar Sacs
Disease Clinical Features
Dry non-productive cough
“Skin and Bones”
All energy used to breath
Absent/Decreased breath sounds w/auscultation
Increased expiratory phase
Emphysema
Disease: Pink Puffer
Emphysema
Disease: Chronic productive cough for 3 mo/yr OR for > 2 consecutive years
Chronic bronchitis
Disease:
Proliferation of submucosal glands and globet cells
Insidious onset
Smokers cough, morning cough, continual cough
Recurrent pneumonia
Chronic Bronchitis
List the response to irritants in chronic bronchitis (4)
- Contraction of bronchial smooth mm
- Denuded cilia
- Increased secretions
- Swelling of mucosa
Disease Clinical Features:
Chronic productive cough
Overweight
Cyanotic Lip/Nailbeds
Rhonchi/Weezes on auscultation
Expiratory Phase Increased
Abnormal PFT and CXR
Chronic Bronchitis
Describe why you shouldn’t give O2 to those with Chronic Bronchitis
In chronic bronchitis, the CO2 trigger to breath is gone [sensors burned out], Thus the drive to breath is based on a hypoxic drive mechanism [O2]. If they are given O2, their drive to breath will decrease b/c they demand is met by the supplemental O2
If they are SOB just slow them down and work on retraining their breathing
LOW FLOW O2 may be acceptable
List the components of the lung affected by chronic bronchitis (3)
- Lobar bronchi
- Segmental bronchi
- Subsegmental bronchi
Disease: Blue Bloater
Chronic Bronchitis
Disease:
Reversible
Bronchospasm [wheezing, obstruction, coughing]
Younger patients
Asthma
Disease:
Inflammatory disease causing SOA and DOE, wheezing, coughing
Bronchospasm/inflammation caused by hypersensitivity to extrinsic/intrinsic stimuli
Structural changes (thickening) of airways
Asthma
Asthma results in _1_ _____2_____ which _____3_____ RV, thus ___4___ CO2 and ____5____ O2. There is a reduction of __6__ and __7__ ___8___. All of which are _____9_____.
- Air
- Trapping
- Increasing
- Increasing
- Decreasing
- FEV1
- Peak
- Flow
- Reversible
List the Tx for Asthma (2)
- Trigger awareness
- Inhaled agents (bronchodilators, anti-inflammatory, prophylactic)
Disease:
Caused by increased air flow and drying of airways
Can experience w/o hx of dx asthma
Prevent w/proper warm-up and pharm
Up to 30% of olympic athletes
Exercise Induced Bronchospasm
Disease:
Developing pulmonary disease results in increasing hypoexmia (constricts pulmonary system)
Vasoconstriction causes pulmonary hypertension (R heart working harder due to peripheral edema)
R ventricular hypertrophy secondary to these abnormalities of lung structure/function
Cor Pulmonale
Disease:
Inherited chronic disease that affects the lung and digestive system
Defective gene and protein that cause the body to produce unusually thick sticking mucus
Clogs lungs causing lung infection
Clogs pancreas and stop natural enzymes from breaking down/absorbing food
Cystic Fibrosis
Disease Symptoms:
Persistent Coughing
Frequent Lung Infection
Wheezing and SOB
Salty-Tasting Skin
Poor Growth/Weight Gain
Greasy/Bulky Stools w/Difficult Bowel Movements
Cystic Fibrosis
Cystic Fibrosis is caused by a dysregulation of the ___1___ protein which leads to the ____2____ of the airways to clear ___3___. Lung function progresses from ____4____ to the addition of a _____5_____ component.
- CFTR (cystic fibrosis transmembrane conductance regulator)
- Failure
- Mucus
- Obstruction
- Restrictive
List the Tx of Cystic Fibrosis (5)
- Inhaled agents (bronchodilators, mucolytics, antibiotics)
- Exercise
- Nutrition
- Lung Transplant
- Drug Therapies
Once a ___1___ always a ____2____. __3__ and __4__ for all. Hypoxia for _____5_____, hypercarbia for __6__. Dry cough for _____7_____, productive cough for __8__.
- COPDer
- COPDer
- SOA
- DOE
- Emphysema
- CB (chronic bronchitis)
- Emphysema
- CB
Describe different breathing techniques for COPD
Pursed lip: creates backpressure, helps pt. get over the hump, no LT benefit
Tripod Position [elbows on table]: allow accessory mm to more efficiently lift the chest wall
Disease: Decreased flow rates, hypercapnia, hyperinflation
COPD
