Obstructive Lung Disease CIS I Flashcards
40yo M, dyspnea, cough, wheezing last 2-3 yrs, father cirrhosis, 20py tobacco, decreased breath sounds, hyperinflation, clubbing of digits, flattened diaphragms, FEV1 36% predicted, no improvement bronchodilator
obstructive
- emphysema
- imbalance of neutrophil elastase
sweat testing confirms diagnosis
cystic fibrosis
purified protein derivative skin testing
tuberculosis
sputum cytology
confirmation of cancer
acid fast sputum stain
tuberculosis
alpha 1 antitrypsin deficiency
risk factor for COPD
protects lungs against neutrophil elastase
patient susceptible to smoking
-age 30s or 40s COPD
often fam Hx of cirrhosis
19yo M, acute resp distress, productive cough, sinusitis, meconium ileus at birth, wheezing, rhonchi, clubbing of fingers
hyperinflated lung fields
cystic fibrosis
cystic fibrosis
malabsorption of fat soluble vits
-ADEK
sterile males
non-caseating granulomas
sarcoidosis
cystic fibrosis genetic
autosomal recessive
half siblings will be gene carriers
1/4 have disease
cystic fibrosis prognosis
lung disease to death 90% patients
survival 37 years median
lung manifestations in CF
cough, SOB, poor exercise tolerance, fatigue, sleep decline, daily productive cough
infection in CF
pseudomonas aeruginosa and staph aureus (MRSA)
malabsorption of vitamins
bulky foul smelling stools and flatulence
in CF
sweat glands in CF
elevation of Na and Cl
pancreas in CF
1/3 - diabetes by age 30
MSK in CF
decreased bone density
decreased absorption of Vit D
Dx of CF
screening immunoreactive trypsinogen
-marker of pancreatic injury
if positive - to genetic mutation analysis
Dx confirmation - sweat testing
-pilocarpine iontophoresis
PFT in CF
obstructive
CXR in CF
hyperinflation
bronchiectasis
dornase alfa
recombinant rhDNase
breaks down DNA in mucus
thins mucus in lungs
ibuprofen in CF
high dose continually
-slower decline in lung function
55yo M, COPD, SOB, dyspnea, decrease exercise tolerance, 40py tobacco, inhaled steroids, salmeterol, tiotropium, hyperinflated lungs, flattened diaphragm
bleb - emphysema - nonfunctional area of lung
decreased FEV1/FVC
increased FEV1/FVC
restrictive lung diseases
COPD
progressive, irreversible
onset 20-30 yr after smoking
4th leading cause of mortality in US
leading cause COPD
smokers decrease 40ml/yr per year in FEV1
pregnancy - impaired lung size
mechanics in COPD
lose elastic recoil in lungs
-dependent on elastic fibers in parenchyma and surface tension in alveolar air-liquid interface
especially in small airways - less than 2mm
increased airway resistance
COPD history
SOB over months to years
Hx of acute bronchitis
history of chronic cough
sputum production
wheezing, rhonchi
distant heart sounds
barrel chest
accessory muscle use
mild COPD
FEV1/FVC < 70
AND FEV1 > 80% expected
moderate COPD
FEV1/FVC < 70
AND 50-80% FEV1
severe COPD
FEV1/FVC < 70
AND 30-50% FEV1
very severe COPD
FEV1/FVC < 70
AND < 30% FEV1
or FEV1 < 50% of predicted plus chronic resp failure
CXR COPD
hyperinflation
flat diaphragm
increased retrosternal space
bullae
normal in mild to moderate COPD
emphysema
enlargement of air spaces distal to terminal broncvhioles with destruction of alveolar walls
centriacinar
resp bronchioles distal to terminal bronchiole
-occurs with smoking
emphysema
panacinar
alveolar ducts, alveoli, coalescence and bullae formation
emphysema
alpha1 antitrypsin deficiency**
occurs with smoking
most severe COPD
combo of centriacinar and panacinar emphysema
chronic bronchitis
enlarged mucous glands
-cough and increased mucous production
45yo F Hx asthma, daily cough, increased dyspnea, wakes up 2 or 3 nights / week
medium dose inhaled steroids and albuterol PRN
RR 16, P 80, b/l expiratory wheezing
mild persistent asthma
change Tx - add long acting beta2 agonist inhaler
intermittent asthma
less than 2 days /week or 2 nights / month
mild persistent asthma
more than 2 days/week
but < 1 /day
or > 2 nights / month
moderate persistent asthma
daily or 1 / night
severe persistent asthma
Sx continual during day or frequent at night
Tx intermittent asthma
beta2 agonist PRN
Tx mild persistent asthma
beta2 agonist PRN
inhale corticosteroid
alternate - mast-cell stabilizer, leukotriene-receptor antagonist, theophylline
Tx of moderate persistant asthma
beta2 agonist PRN
low to medium dose inhaled corticosteroid
long-acting beta2 agonist
alternate - increased medium dose corticosteroids OR low-medium dosed corticosteroid and either leukotriene-receptor antagonist or theophylline
Tx severe persistant asthma
beta2 agonist PRN
high dose inhaled corticosteroid and long acting beta2 agonist
2mg/kg/day prednisone - not exceed 60mg/day
