Obstructive Lung Disease CIS II Flashcards
asthma components
1 recurrent obstruction - resolves with Tx
2 airway hyperresponsiveness
3 airway inflammation
asthma population
8% adults
boys and women
15 million outpatient visits and 2 million hospitalizations
mild asthma
edema and hyperemia of mucosa and infiltration of mucosa with mast cells, eosinos, lymphocytes
moderate asthma
chemokines eotaxin, RANTES, macro inflammatory protein I, IL8
lead to inflammation and smooth m constriction
severe asthma
hypertrophy and hyperplasia of airway glands and smooth m lead to severe airway thickening
airway obstruction in asthma
constriction of airway smooth m
thickened airway epithelium
liquids in airway
ACh
M3 - smooth m constriction in asthma
histamine
minor role in asthma
-mast cells
leukotrienes and lipoxins
lipoxygenation of arachidonic acid release from target cell membrane phospholipids during cell activation
nitric oxide
produced by airway epithelial cells and by inflammatory cells found asthmatic lung
-high levels found during asthma attacks
asthma Hx
dyspnea, cough, wheezing, anxiety
exercise induced, aspirin ingestion, allergens
cough, hoarseness, inability to sleep
rapid change in temp or humidity may lead to an attack
pulsus paradoxus
10mmHg systolic difference during inspiration
in asthmatics
ABG in asthma
mild hypocapnea
normalized - indicated resp failure
asthma PFT
obstructive
CBC asthma
eosinophilia
IgE elevation
CXR asthma
hyperinflation
EKG asthma
RBBB, P pulmonale, ST-T changes
P pulmonale
right atrial enlargement
omalizumab
monoclonal Ab for IgE
alternate Tx for hypersensitivity asthma
60yo M, cough, productive purulent sputum, dyspnea, hemoptysis, pleuritic chest pain, wheezing and rales, dilated airways
bronchiectasis
atelectasis
collapse of lung
ARDS
acute resp distress syndrome
-white out of lung on CXR
churg strauss syndrome
elevated eosinos
bronchiectasis
abnormal permanent dilation of bronchi and bronchioles
due to repeated cycles of airway infection and inflammation
abnormal cilia, mucous clearance, rainage, and host defenses
mycobacterium avium intracellulare
right middle lobe and lingula of lung
-may lead to bronchiectasis
etiology of bronchiectasis
1/2 CF
1/3 infection
- pertussis, TB, MAI
- CF, primary ciliary dyskinesia, alpha1 antitrypsin
- esophageal dysfunction and aspiration, COPD, aspergillosis, tumor, foreign body
- sjogrens, rheumatoid arthritis, HIV, IgG deficiency
chronic cough, purulent sputum, hemoptysis, pleuritic chest pain, weight loss, fatigue, wheezing and crackles
bronchiectasis
Dx of bronchiectasis
high res CT
-bronchi visible in peripheral 1cm of lung
-internal bronchial diameter greater than diameter of accompanying bronchial artery
CF bronchiectasis
upper lobe predominance
aspiration bronchiectasis
lower lobes
aspergillosis bronchiectasis
central bronchiectasis
bronchiectasis PFT
obstruction
electron microscopy
Dx of primary ciliary dyskinesia
Tx of bronchiectasis
Tx of underlying conditions
antimicrobials
anti-inflammatory
surgery for localized
end stage - transplant
63yo F worsening dyspnea, Hx COPD, no fevers/chills, moderate resp distress, trouble speaking, RR 28, pulse ox 84%
-diminished breath sounds, end expiratory wheezes
ABG pH 7.3, hypoxemia, PCO2 65
no improvement on beta2 agonist and O2 Tx
resp acidosis
CXR hyperinflation and flat diaphragm
to prevent acute increase in PCO2
venturi mask
can tightly control the O2 administration
too much O2 can actually decrease resp drive
venturi mask
dial to control FiO2 patient received
can slowly titrate O2 level up with more control than normal mask
41yo carpenter, asthma, cough, wheezing, sx during work hours, FEV1 decrease with exposure to western red cedar, albuterol inhaler
occupational asthma
best way to manage
-avoid further exposure to wood dust - wear specialized respirator at work - but probably won’t
so add inhaled corticosteroids**
35yo M dyspnea, worsening over last 8 months, SOB when not moving, 5py tobacco, quit smoking 3yr ago, no sputum fevers chills, BP 105/70, P 120, RR 28, intercostal retraction, diminished breath sounds
PFT - TLC and RV elevated, VEF1/FVC decreased
obstructive - severe bc 30% of predicted
most likely Dx - alpha1 antitrypsin deficiency
65yo F productive cough, 2 spoons/day, cough 3 months, chronic cough during different seasons
most appropriate diagnosis
-chronic bronchitis
chronic bronchitis
3 months productive cough for 2 consecutive years**
20yo F wheezing and SOB past 3 months, worse with exercise, seasonal allergies, roommate has pet cat
best assess possible etiology
-serum IgE levels
mycoplasma
chronic non-productive cough
cold agluttinins
reid index
thickness epithelium to blood vessel
thickened = chronic bronchitis
35yo dairy farmer, chronic cough few years, mild wheezing, decreased FEV1 and FVC, CXR normal, eosinophilia, serum thermoactinomyces vulgaris in blood work
most likely diagnosis
-farmers lung
wegeners granulomatis
sinusitis, lung sx, hematuria
sarcoidosis
hilar adenopathy, non-caseating granulomas, serum ACE level elevated
acute farmers lung
resolves 12 hours to days
-fever chills, non-productive cough, chest tight, dyspnea, HA, malaise
acute resp failure with large inhalation
moldy hay or contaminated compost
subacute farmers lung
chronic cough, dyspnea, anorexia, weight loss
insidious onset and may occur over weeks to months
chronic farmers lung
prolonged and continuous exposure
irreversible lung damage possible
severe dyspnea at rest with exertion
