Obstructive Lung Disease Flashcards
what is obstructive lung disease?
any disease that limits the movement of air out of the lungs
how do obstructive lung diseases broadly impact the lungs?
increase total lung volume
increase RV
obstructive lung disease can also be referred to as what general term?
Chronic Obstructive Pulmonary Disease
(COPD)
T/F: COPD is a specific medical diagnosis
FALSE
it refers to several disorders that can occur independently or in combo with one another
COPD include which disorders?
- Emphysema
- Chronic asthma
- Chronic bronchitis + small airway disease
what are some risk factors for COPD?
- exposure to air pollution
- secondhand smoke
- occupational dusts and chemicals
- heredity
- history of childhood respiratory infections and SES
what are the presenting signs of COPD?
- dyspnea
- sputum production
- chronic cough
- exertional dyspnea
- reduced function
what is one of the most important diagnostic criteria for COPD?
FEV/FVC ratio <0.70 after a bronchodilator has been given
what is emphysema?
a pathologic accumulation of air in the lungs
a disease of exhalation
what would you expect the diaphragm to look like in a patient with emphysema?
flattened
how does emphysema impact lung volume?
increase in residual volume (RV)
increase in total lung capacity
decrease in FEV/FCV ratio
what are the 2 main causes of emphysema?
genetic defect
smoking
what genetic defect results in emphysema?
alpha-1 antitrypsin (A-1AT) deficiency
what is the purpose of A-1AT?
blood protein synthesized in the liver
protects the lungs from degrading actions of powerful enzyme called neutrophil elastase (increases elastin degradation) and other proteases
how does smoking result in emphysema?
cigarette smoking inactivates A-1AT leaving the lung susceptible to damage
smoking also causes hyperinflammatory state which means that neutrophils are busy and a lot of elastase is produced
what is the collective anatomical/physiological effects of deficiency of A-1AT and cigarette smoking on the lungs?
- destruction of individual alveoli
- development of “super” alveoli
- destruction of CT supports for the very smallest airways allowing them to collapse during expiration
A-1AT deficiency can also result in _______
liver disease
what FEV/FCV ratio is “bad news”?
<0,5
what are the clinical manifestations of emphysema?
- SOB at rest (first complaint)
- apprehensive, anxious, addicted to O2
- thin, cachectic
- deformed chest w/prolonged expiration
- absent or non-productive cough
- accompanying cardiac problems (cor pulmonale)
- hypoxemia → can worsen to hypercapnia
- chronic pulmonary metabolic acidosis
- deconditioning
what is the prognosis of emphysema?
usually very poor
how is emphysema usually treated?
- reduce airway edema secondary to inflammation and bronchospasm
- facilitating the elimination of bronchial secretions
- preventing and treating respiratory infection
- increasing exercise tolerance
- avoiding airway irritants and allergens
- relieving anxiety and treating depression
- long-term O2 therapy potentially
what types of medications may be given to a patient with emphysema?
- Beta-2 agonists or anticholinergics
- anti-inflammatory agents
- antibiotics
- mucolytic expectorants
- mast cell membrane stabilizers
- antihistamines
- glucocorticoids
List some PT implications for patients with emphysema
- always use pulse oximeter
- monitor HR, RR, and BP frequently
- exercise program may include HITT or aerobic training
what is hypoxic drive and how does it relate to emphysema?
emphysema → retain CO2 may have a decrease hypoxic drive
hypoxic drive → a form of respiratory drive in which the body uses O2 chemoreceptors instead of CO2 receptors to regulate the respiratory cycle
increasing O2 through a nasal cannula may prevent this mechanism
pulmonary emphysema patients may be nicknamed ______
pink puffers
chronic bronchitis patients may be nicknamed ______
blue bloaters
what is required for the diagnosis of chronic bronchitis?
- productive cough lasting at least 3 months per year for 2 consecutive years
- FEV/FVC < 75%
chronic bronchitis is characterized by what?
- inflammation
- excessive mucous production
- scarring of lining of bronchial tubes
- obstruction of bronchial air flow caused by increased mucous production/reduced mucous clearance
how does chronic bronchitis develop?
- chronic exposure to irritants cause mucus hypersecretion and hypertrophy of mucus producing glands in the largest bronchi
- destruction of ciliary cells lining airway occurs
- smooth muscle hypertrophy and atrophy of epithelial cells
- decrease in radius
- airway collapses may occur leading to reduced alveoli ventilation, hypoxia and acidosis
how would a patient with chronic bronchitis present throughout the day?
recurring productive morning cough
production of phelgm and chronic coughing increases over the course of the day
wheezing
what can cause an exacerbation of chronic bronchitis?
upper and lower respiratory infections
exposure to environmental irritants such as dust, fumes or air pollution
describe what “blue bloater” means
chronic bronchitis patient, has the following:
- decreasing ventilation
- increasing RV and decreasing expiratory flow
- terrible V/Q mismatch
- hypoxemia, hypercapnia, cyanosis, polycthemia
- cor pulmonale secondary pulmonary HTN
list some PT implications for patients with chronic bronchitis
- reduce exposure to irritants
- bronchodilators (B-2 agonsits)
- mucolytics
- no evidence for use of antibiotics, oral corticosteroids, expectorants, or postural drainage
- NSAIDs
what is asthma?
episodic, reversible, obstructive lung disease characterized by bronchospams resulting from an exaggerated inflammatory response of the airway smooth muscle to various stimuli (allergens)
Bronchial hyperactivity
what are the clinical manifestations of asthma?
episodic dyspnea
coughing and wheezing
what are the 2 main types of asthma?
Intrinsic (nonallergic/non-immune cause)
Extrinsic (allergens)
what is extrinsic asthma?
results from an allergic reaction to specific triggers
mast cells, sensitized by IgE antibodies, degranulate and release bronchoactive mediators after exposure to a specific antigen
what is intrinsic asthma?
how no known allergic cause or trigger
adult onset
most often secondary to chronic or recurrent infections of the bronchi, sinuses, or tonsils and adenoids
what are some other recognized types of asthma?
- adult-onset
- exercise-induced (can be outgrown)
- aspirin sensitive
- Aspergillus-hypersensitive
- Occupational asthma
describe the pathogenesis of asthma
there is an inflammatory response consisting of:
- cellular infiltration
- epithelial disruption
- mucuosal edema
- mucous plugging of airways
what is the product of inflammatory mediators in asthma?
- bronchial smooth muscle spasm
- vascular congestion
- increased vascular permeability
- edema formation
- production of thick, tenacious mucus
- impaired mucociliary function
T/F: there is difficulty with breathing air in during asthma
FALSE
difficulty with expiration
results in air trapping in distal alveoli and hyperinflation
T/F: asthma results in an increase in blood pH?
FALSE
a decrease (acidosis) due to more retention of CO2 (hypercapnia)
what should you ensure your asthmatic patient always has?
their rescue inhaler
what is an exercise-induced bronchospasm in an asthmatic patient?
acute, reversible, usually self-terminating airway obstruction that develops 5-15 minutes after vigorous exercise
usually the episode subsides spontaneously in 30-60 minutes
be sure to warm up
T/F: Cystic fibrosis can be considered an obstructive lung disease
TRUE
almost all persons w/cystic fibrosis develop obstructive lung disease assocaited with chronic infection that leads to progressive loss of pulmonary function
what is a cystic fibrosis?
genetic disease that causes a disorder of ion transport (sodium and chloride) in the lungs and in exocrine glands of the liver, pancreas, digestive, and male reproductive organs
characterized by secretion of a thick mucous which is very difficult to move
how does cystic fibrosis impact ion exchange?
CFTR proteins are incorrectly manufactured which results in Cl- not being transported to epithelial surfaces and remains trapped in cells
Cl- is necessary for water to move, without the movement of water, mucus becomes thick and hard to expel
what is the result of thickened mucus production in cystic fibrosis (for more than just the lung)?
- reduced movement of cilia in the bronchiole tubes
- obstructs the tubular network in the pancreas which reduces release of digestive enzymes and insulin
- obstruction of the terminal ileum by thick meconium in new borns
- results in biliary fibrosis and portal hypertension
give a more detailed description of how mucous in cystic fibrosis impacts the lungs
increase in mucous results in bronchial obstruction which predisposes the lungs to infection and causes patchy atelectasis
disease can progress to bronchitis, followed by bronchiectasis, pneumonia, fibrosis and formation of large cystic dilations
what is patchy atelectasis?
a complete or partial collapse of the entire lung or area (lobe) of the lung
how has the prognosis for cystic fibrosis changed in the last 60 years?
1938 → 6 months to live, couldn’t distinguish CF from celiac disease
Now → median survival is 36.8 years
what is the most common cause of death from cystic fibrosis?
pulmonary failure
how is cystic fibrosis diagnosed?
- genetic screening
- sweat test
- pancreatic elastase (marker for pancreatic insufficiency)
- pulmonary function tests
- FEV1
- VC
- assessed for DM
how are digestive problems from CF managed?
- digestive enzymes, vitamin supplementation
- enemas and mucolytic agents to treat intestinal blockages
- Diets rich in proteins and calories
- PT interventions
how does CF impact the musculoskeletal system?
- Osteoporosis risk increases
- muscular dysfunction
- thoracic cage deformation → reduced capacity for posture and thoracic cage movement and altered spinal movement results in reduced total lung capacity
- poorer postural control
- reduced ventilation capacity
how is CF treated?
- Pharmacologically
- bronchodilator
- hypertonic saline solutions
- pancreatic enzymes
- high dose NSAIDs
- prophylactic antibiotics
- Treatment
- TherEx
- airway clearance techniques
- lung transplants
