Obstructive Lung Diseases Flashcards
Obstructive Lung Disease
Obstructive sleep apnea
Asthma
COPD
Miscellaneous
Obstructive Sleep Apnea
Not technically an obstructive lung disease
Mechanical breathing obstruction occurs during sleep when pharyngeal muscles relax → chronic hypoxemia ↑CO2 ↓FRC
Obesity = most significant precipitating factor
Risk factor ↑morbidity
STOPBANG
○ Snoring ○ Tired ○ Observed apnea ○ Pressure HTN ○ BMI >35kg/m2 ○ Age >50yo ○ Neck circumference >40cm ○ Gender M
OSA S/S
Habitual snoring, fragmented sleep, daytime somnolence Comorbidities r/t obesity & hypoxemia - Systemic & pulmonary HTN - Ischemic heart disease - Congestive heart failure
OSA Diagnosis
Polysomnography - records # abnormal respiratory events STOPBANG Apnea-hypopnea index AHI Normal <5 Mild 5-15 Moderate 15-30 Severe >30
FEV1
Forced expiratory volume in 1 second
TLC 5L
Normal FEV1 = 4L
80-120%
FVC
Forced vital capacity
Volume air forcefully exhaled after deep inhalation
Females 3.7L
Males 4.8L
FEV1:FVC Ratio
Normal 75-80%
FEV 25-75%
Air flow measurement at midpoint forced exhalation
Maximum Voluntary Ventilation
MVV
Maximum amount air inhaled & exhaled in 1 minute
Females 80-120L/min
Males 140-180L/min
DLCO
Diffusion capacity
Patient inhales helium & carbon monoxide
Measures volume CO transferred across the alveoli into the blood per minute per unit alveolar partial pressure
Single breath 0.3% CO + 10% helium held for 20 seconds
Normal value 17-25mL/min/mmHg
Acute Upper Respiratory Infection
Common cold
Infectious (viral or bacterial) nasopharyngitis 95%
S/S:
- Non-productive cough
- Sneezing
- Rhinorrhea
- Bacterial include fever, purulent nasal discharge, productive cough, & malaise
Acute Upper Respiratory Infection
Anesthetic Management
Hydration
↓secretions
Limit airway manipulation
LMA vs. ETT
Asthma
REVERSIBLE airway obstruction - Bronchial hyperreactivity - Bronchoconstriction - Lower airways chronic inflammation Genetic & environmental
Asthma Pathophysiology
Inflammatory pathway activation → airway mucosa infiltration w/ eosinophils, neutrophils, mast cells, T/B cells, & inflammatory mediators
→ EDEMA
Asthma S/S
Wheezing, productive/non-productive cough, dyspnea, chest tightness, SOB, airflow obstruction
FEV1 <35% ↑FRC
TLC = WNL
DLCO unchanged
CXR hyperinflation d/t air trapping
R ventricle strain T wave inversion V1-4 & II, III, aVF
Asthma Treatment
Corticosteroids Long-acting bronchodilators Leukotriene modifiers Anti-IgE Methylxanthines Mast cell stabilizer
Status Asthmaticus
Life-threatening emergency Bronchospasm does not respond to treatment β2 agonists IV corticosteroids Supplemental O2 IV magnesium sulfate