Obstructive Lung Diseases Flashcards
Obstructive Lung Diseases
Description & Key Characteristics
Respiratory disorder(s) characterized by increased airway resistance & obstruction affecting expiratory airway
Obstruction will lead to:
- DEC forced expiratory flow rates: FEV1, FEV1/FVC, FEF 25-75%, PEFR
- INC air trapping (static lung volumes): TLC, RV, FRC
FLOW rates goes DOWN & volume/capacities go UP
Obstructive Lung Diseases: Etiology
6
- Smoking
Irritates airways - bronchospasm
Inhibits cillia mobility - help clear the lungs (into cough sensitive regions) & keep it free - Air Pollution
- Genetics (alpha-1 antitrypsin)
- Infection
- Aging - more compliant - Do NOT recoil the same
- Allergy
Obstructive Lung Diseases
(4)
- Chronic Bronchitis
- Emphysema
- Asthma
- Bronchiectasis
Chronic Bronchitis
Description
Productive cough on most days for 3 months/year for 2 consecutive years (provided other conditions have not been ruled out)
Chronic Bronchitis: Pathophysiology
(4)
- Hypertrophy (size of cell INC)+ hyperplasia (# of cell INC) of mucous glands & goblet cells (INC mucus)
- DEC # of cilia (secretion retention)
- Chronic inflammatory changes in bronchial walls
- DEC gas exchange (d/t fomation of msshapn & large alveolar sacs)
INC mucous production & retention
Chronic Bronchitis: Etiology
(1)
Long term irritation of tracheobronchial tree
1. Smoking
2. Pollution
Chronic Bronchitis: Clinical Presentation
(6)
Inspection:
- Obese & cynaotic - “blue blotter”
- Mucus colour can be white, yellow, or green (yellow - depending on if there is an infection)
- Possible INC JVP & ankle edema
CB commonly associated with RHF
Palpation:
- Tactile Fremitus: DEC in areas of air trapping * INC in areas of secretions (may see both)
- Possible ankle edema (RHF)
Percussion:
- Hyper-resonant over areas of air trapping & dull over areas of secretion retention
Auscultation:
- DEC BS (air not moving)
- Early inspiratory wet crackles (secretions)
- Possible wheezing (secondary finding) - obstruction of airways
ABGs:
- Large DEC in PaO2, INC PaCO2
- Respiratory acidosis
HYPOXEMIA - Mod/Severe - more than any other condition
CXR:
- Cardiomegaly (enlarged heart)
- White haziness
What obstructive lung diseases experiences more HYPOXEAMIA?
Chronic Bronchitis
Emphysema
Description & Types (2)
Enlargement of the airway distal to the terminal bronchioles, accompanied by destruction of their walls
Types of Emphysema:
Centrilobar (more common)
- Affects respiratory bronchioles
- M>F
- Rare amoung non-smokers (cause is b/c of smoking & 2nd hand smoke)
- Commonly found in patients with chronic bronchitis
Panlobar
- Affects terminal & respiratory bronchioles
- D/t alpha-antitrypsin deficiency
Deficient in inhibiting elastase = break down of elastin & w/ot elastin = floppy (lots of air trapping)
Emphysema: Pathophysiology
(3)
- Bullae may be found in these patients
Dilated airspace in the lung (parenchyma) - Sx to remove it b/c it can rupture & cause a pneuothorax - Develops from an obstruction of the air flow during expiration
- Leads to hyperinflation > destruction of alveloar walls > DEC elastic recoil > INC dead space (area of no gas exchange) > DEC gas exchange (alveloar walls rupture & alveolar capillaries are destroyed)
Emphysema: Etiology
(3)
- Smoking
- Pollution
- Alpha-antitrypsin deficieny (exclusively for PANLOBAR)
Emphysema: Clinical Presentation
(6)
Inspection:
- Thin & wasted - “pink puffer”
- Barrel chest: AP=ML (1:1)
- I:E ratio prolonged (1:3 or longer exhalation)
- Pursed lip breathing (PLB)
- INC accessory mm use (30% diaphragm, 70% accessory mm use - APICAL breathing)
Should address - more energy tacking = less tired
More energy efficient to use diaphragm
- Other signs of respiratory distress - leaning over w/ hands on knees to unload thorax
Palpation:
- Tactile Fremitus: INC (entire area is air trapping)
- Chest wall expansion: DEC - already hyper-inflated (less mvmt occurring bilaterally)
Percussion:
- Hyper-resonant
Ascultation:
- DEC BS
- May have dry crackles (not a primary finding)
ABGs:
- DEC PO2 (moderate hypoxemia)
- Normal or INC PaCO2 (**40-60 mmHg = MOD hypoxemia)
CXR:
- INC black area (hyperinflated + DEC lung tissue
- Flattened diaphragm - missing dome shape
- Flattened ribs (no angles) - barrel shape (chest wall has adapted)
- Narrow mediastinum (thin elongated heart)
Asthma
Defintion & Etiolgy
Chronic inflammatoru condition of the airways characterized by hyper-responsiveness of the airways (trachea & bronchi) to various stimulus which results in narrowing of the airways
REACTIVE AIRWAY DISORDER
Etiology: unknown
Asthma: Pathophysiology (acute attack)
(3)
- DEC threshold of airway smooth mm reactivity
- Leads to bronchospasm, bronchial wall edema & inflammation & INC secretion w/in the lumen of the airways
- Narrow airways increase airway resistance (both in & out)
Factors that can trigger an asthma attack…
Intrinsic (6) + Extrinsic (6)
Intrinsic Asthma (idiopathic)
1. Drugs - ie aspirin
2. Exercise-induced asthma (EIA) - especially in KIDS
3. Inhaled irritants - ie smoking, pollution, chemicals
4. Respiratory infections - ie common cold
5. Stress (emotions) - can trigger physical changes (cortisol)
6. Weather - ie humidity, cold air
Extrinsic Asthma (allergic)
- Animals
- dust
- Feathers
- Mood
- Mold
- Pollen
** Everything you would associate with allergies
Asthma: Clinical Presentation
(7)
PFT pre & post bronchodilators shows significant improvements
Inspection:
- INC accessory respiratory mm use
- Other signs of respiratory distress - tripod
Palpation:
- Tactile Femitus: DEC (air trapping)
- Chest wall excursions: DEC (d/t air trapping)
Percussion:
- Hyper-resonant
Auscultation:
- DEC BS
- wheezing - hallmark sign of asthma
- Possible crackles
ABG’s
- DEC PaO2
- INC PaCO2 in severe cases (does not last long - managed by the patient)
- DEC pH = repiratory acidosis
Bronchiectasis
Definition
Irreversible, abnormal dilatiton of medium-sized bronchi & bronchioles resulting in airflow obstructions & secretion retention
Commonly associated with chronic inflammation & infection within these airways
Considered an extreme form of bronchitis
Bronchiectasis: Etiology
(4)
- Post-infection (most common: necrotizing bacteria pneumonia)
- Congential disorders - ie cycstic fibrosis, ciliary defect, ariway defects
- Bronchial obstructions - ie aspiration (foregin substance), cancer
- Other - connective tissue diseases, systemic disorders, immunodeficiencies, idiopathic
Less common because of better ways to treat infections
More common in people w/ infections in airways OR frequent infection (chronic bronchitis) may be more suspectible
Manifests more as an OBSTRUCTIVE diesase but could be both
Bronchiectasis: Pathophysiology
(4)
- Destruction of bronchial wall causing permanent dilation of airwards
- Ciliated walls replaced by non-ciliated, mucus-secreting cells (= INC rention & INC secretion)
- Pooling of infected secretions leading to recurrent infections
- May cause atelectasis distal to obstruction (restrictive disease finding)
Wall is destroyed = more dilation BUT is filling with mucus
Bronchiectasis: Cycle of Inflammation
(4 parts)
Cycle of inflammation & injury
Secretion retention >
INC inflammation >
INC airway damage >
INC airway dilation
& repeat
Bronchiectasis: Clinical Presentation
(5)
Inspection:
- Thin & fatigued
- Clubbing - hypoxaemia
- INC accessory respiratory mm use
- Other signs of respiratory distress
- Severe cough - secretions they are trying to mobilize
- INC INC mucus (FOUL-smelling, ourulent, may contain blood)
Palpation:
- Tactile Femitus: DEC
- Chest wall excursion: DEC (d/t air trapping)
Percussion:
- Hyper-resonant
Ascultation:
- DEC BS
- Wheezing
- Possible course crackles
CXR:
- Dilated airways (seen in varicose or cystic type)
- Dark lung fields in areas of trapping
- Flattened diaphragm
- May or may not see areas of consolidation or atelectasis
- High resolution CT is more commonly used to help diagnose bronchiectasis
Do NOT use x-ray to diagnosis bronchiectasis
