Obstructive Lung Disease (Thomas) Flashcards
diseases of ___ airways include obstructive apnea, aspiration of foreign body, and airway tumors.
large; in large airways, which are relatively insensitive to small changes in diameter or pressure, greater changes are required to alter airflow (which is turbulant/non-laminar)
diseases of _____ airways include asthma and COPD.
small; in small airways, little changes in diameter produce substantial changes in flow (which is laminar)
why is it easier to hear exhalation wheezes from a patient than inhalation wheezes?
because airway diameter gets smaller during exhalation (increased intrathoracic pressure to overcome atmospheric pressure squishes the airway)
if there is an extrathoracic obstruction of the airway, then the airway diameter gets smaller during inhalation and relaxes during exhalation (this is a finer detail of slide #15 he said we won’t be responsible for knowing)
what happens to airways in someone with emphysema or COPD during exhalation compared to those of a normal lung?
they get even smaller. this is due to loss of supportive tissue around the alveoli, that promotes collapse under pressure during exhalation. As disease progresses, this extends to inhalation as well, and eventually wheezing can be heard throughout the entire respiratory cycle.
A 43 yo presented with about 2 years of weight gain, decreased exercise tolerance. About 6 months of cough, non-productive. Mild orthopnea. He had been treated for asthma with inhaled steroids, oral steroids, albuterol and had even been hospitalized. After seeing multiple physicians, someone did a careful physical exam, obtained spirometry and heard stridor in the trachea. What was diagnosis?
Large airway obstruction; this type of obstruction is asymptomatic until the very end.
All of the following are conditions associated with the pathophysiology of asthma EXCEPT:
A. goblet cell metaplasia
B. thickening of the airway basement membrane and smooth muscle
C. airway epithelial damage
D. eventual lung parenchyma disease
E. recruitment of abnormal inflammmatory cells
D. Asthma is predominantly an airway disease and generally does not lead to lung parenchyma disease. This is how it differs from diseases like COPD.
Asthma is an _____ disease of the small distal airways most commonly associated with ___ cell mediated, eosionophilic airway remodeling and obstruction.
inflammatory; CD4 helper cell
KEY POINT Refer to the picture of airway remodeling on slide 18
Which of the following is NOT a usual physical exam finding in asthma?
A. Diminished air entry and breath sounds
B. Wheezing
C. Prolonged inhalation
D. Hyperinflation of lungs
E. Accessory muscle use during respiration
C. It is a prolonged exhalation, due to diminished diameter of intrathoracic airways under pressure.
what type of drugs are used as controller medications in the treatment of asthma? what type is used for rescue?
controllers:
- corticosteroids: prednisone, fluticasone, mometasone
- leukotriene inhibitors
- long acting beta agonists: salmeterol, formoterol)
rescue drugs:
beta 2 agonists: albuterol
what is the best treatment for someone with moderate persistent asthma, who has daily symptoms, nighttime symptoms at least once per week, and a reduced FEV between 60-80%?
high or moderate dose inhaled corticosteroids, long-acting bronchodilator, and sometimes leukotriene inhibitors.
For patients with mild persistent asthma, which is a person who still has >80% FEV, infrequent night symptoms and non-daily symptoms, it’s a low dose of inhaled corticosteroids and leukotrienes may not be added.
this disease is characterized by irreversible fibrosis of the airways, loss of elastic recoil due to lung tissue destruction, and reversible inflammation with mucus plugging and smooth muscle contraction
COPD
