Obstructive Lung Disease Flashcards
Obstructive Pulmonary Diseases
Diseases of airways, which produce obstruction of expiratory flow
Airflow obstruction can be related to:
Retained secretions
Inflammation of mucosal lining of airway walls
Bronchial constriction
Weakening of support structure
Signs of lung hyperinflation
Elevation of shoulder girdle
Horizontal ribs
Barrel-shaped thorax
Low, flattened diaphragms
Symptoms
Dyspnea on exertion (DOE), especially during functional activities
May have increased anxiety level
Secretion production and cough
COPD – Physical findings
Cough/sputum/hemoptysis Dyspnea – exertion Decrease breath sounds – more adventitious sounds Inc RR Wt loss Inc AP diameter of chest wall Cyanosis Clubbing Elevated shldr girdle posture Indications on chest xray
Changes with disease
Structural changes to the lung; musculoskeletal changes, psychological component
Lung changes first
Loss of recoil
Rib cage changes shape
As the disease progresses you get a forced expiration instead of passive
Inspiration is affected
Muscle compositions changes
Stage 1 COPD:
mild – FEV1 > 80% predicted, with or without chronic symptoms
Stage 2 COPD:
mod – 50% < FEV1 < 80%, SOB with exertion
Stage 3 COPD:
severe – 30% < FEV1 < 80%, SOB, dec exercise capacity
Stage 4 COPD:
very severe - FEV1 < 30%, dec QOL, life threatening
Chronic respiratory failure:
FEV1 < 50%
Gold standard for diagnosing COPD
spirometry
Lung volumes with COPD:
Larger than normal total lung capacity (TLC)
Larger residual volumes (RV)
Adult Obstructive Lung Conditions
COPD Emphysema Chronic Bronchitis Combination Bronchiectasis
Adult COPD
easily fatigued frequent respiratory infections use of accessory muscles to breath orthopneic cor pulmonale thin in appearance wheezing pursued lip breathing barrel chest dyspnea
Emphysema:
Condition of lung characterized by destruction of alveolar walls and enlargement of airspaces distal to terminal bronchioles
Chronic Bronchitis
Presence of chronic productive cough for 3 months in each of 2 successive years
Pink Puffers
emphysema no bronchitic component barrel chest dyspnea early hunched over hyperventilation adequate oxygenation weight loss
Blue Bloaters
chronic bronchitis bronchitic component cough, mucus no barrel chest dyspnea late no air hunger ventilation-OK cyanosis cor pulmonale obese
BODE index:
body mass, obstruction, dyspnea, exercise, score of 7 to 10 is associated with high mortality rate of 80% in 52 months
Combination COPD – PT Treatment
Secretion clearance Controlled breathing at rest and with activity Ambulation with rolling walker Education in use of recovery from SOB positions Endurance exercise training Strength training & wt training Thoracic stretching Postural reeducation
Bronchiectasis
Chronic congenital or acquired disease characterized by abnormal dilatation of the bronchi and excessive sputum production
Bronchiectasis - Symptoms
Cough with sputum production (small to large) quantities of mucopurulent secretions
Secretion layers—white frothy, mucoid inner, purulent bottom, composed of thick yellow-green plugs
Sputum greatest in morning
Recurrent, chronic, or recurring lung infections
Hemoptysis
CF:
Genetically inherited
Thickening of secretions of all exocrine glands, leading to obstruction (eg. Pancreatic, pulmonary, GI)
CF may present as an obstructive, restrictive or mixed disease
Clinical signs of CF:
meconium ileus, frequent respiratory infections, especially staphylococcus aureus and pseudomonas aeruginosa and inability to gain weight
Symptoms of CF:
fatigue chronic cough recurrent URI thick, sticky muscus chronic hypoxia clubbing, barrel chest decreased absorption of vitamins and enzymes abdominal distention
Asthma
Trachea & bronchi – inc reaction to stimuli
Reversible – “episodic”
Narrowing of airways
due to inflammation, constriction, secretions
Always some degree of inflammation
Asthma - PT Tx
Need to have medication regime established first Secretion clearance Controlled breathing Exercise & strength Thoracic stretching Postural reeducation
Silhouette sign:
present when normal line of demarcation between two structures is partially or completely obliterated
What is CT primarily used for?
Primarily for dx of tumors vs. calcifications or nodules
Can be ordered if normal CXR but abnormal PFTs
Pulmonary Function Test (PFT)
Tests of lung volume and capacity
Total lung capacity (TLC) = vital capacity + residual volume
Hyperventilation
PaCO2 <40 mm Hg
Hypoventilation
PaCO2 >40 mm Hg
Ventilatory failure
PaCO2 >50 mm Hg
Alkolotic PaCO2:
less than 35 mmHg
Acidic PaCO2:
greater than 45 mmHG
Alkolotic HCO3
greater than 26
Acidic HCO3:
less than 22
Pneumothorax:
entry of air in pleural space
Lung volumes with pneumothorax:
lung volume decreases
VQ mismatching increases
gas exchange impaired
Lung volumes with hemothorax:
increase VQ mismatching
decrease lung compliance
atelectasis
Normal FEV1
3.0 L
Normal FVC:
4.0 L
Normal FEV1/FVC:
75%
Restrictive FEV1
2.5 L
Restrictive FVC:
3.0 L
Restrictive FEV1/FVC:
83%
Obstructive FEV1
1.0 L
Obstructive FVC:
4.0 L
Obstructive FEV1/FVC:
25%
Sympathomimetic:
stimulate adrenergic receptors
bronchodilation
Adrenergic agnonists
stimulate adrenergic receptors
bronchodilation
Sympatholytic:
inhibit adrengeric receptors
bronchoconstrict
Adrenergic antagonists
inhibit adrengeric receptors
bronchoconstrict
Parasympathomimetic
stimulate cholinergic receptors
bronchoconstrict
Muscarinic agonists
stimulate cholinergic receptors
bronchoconstrict
Parasymatholytics
inhibit cholinergic receptors
bronchodilation
Muscarinic antagonists
inhibit cholinergic receptors
bronchodilation
