Obstructive lung diseases (rowley) Flashcards
What is the definition of asthma?
- reversible airway obstruction
- airway inflammation
- increased airway responsiveness to a variety of stimuli
What gender more likely to develop asthma in middle age?
Females
What is the role of smooth muscle innervation as it relates to asthma?
PS contraction - narrows airway
SS relaxation- relaxes airway smooth muscle (minor)
What encompasses the Early Asthmatic Response?
minutes-2 hrs
Mast cell and mediators! blocked by B ag and cromlyn
What up with the late asthmatic response?
only in 50%, usually occurs within 6-8 hrs and can last 24 hrs. mediates by remaining inflammatory cells (bronchial hyperreactivity!) NOT related to mast cells! antihistamine won’t do anything
What’s the stimulus that causes bronchial hyperreactivity in asthma?
NONSPECIFIC!! not an allergen! histamine/methacoline used clinically
Airway inflammation leads to airway obstruction via?
smooth muscle activation (bronchospasm)
vascular congestion/bronchial edema
accumulation of airway secretions, mucus casts, cellular debris
What are the PFT changes in asthma between attacks?
normal!!!
WHat are the pft changes during an asthma attack?
obstructive pattern! Decreased FEV1, FVC and FEV/FVC ratio! increased RV and FRC
What do we see grossly in asthmatic lungs?
hyperinflation! airway is narrowed so can’t get air out of lungs so hyperinflate! also because of air trapping
What role does asthma have on lung compliance?
DECREASES!! increased airway resistance causes hyperinflation of lungs, causes flattened diaphragm. work of breathing increases because lungs are stiffer and need more pressure to effect change in lung volume
Does asthma cause alterations in gas exchange?
During attacks, VQ mismatch! So, hypoxemia and increased dead space
What is the presentation of a moderate asthmatic?
Appears in distress! wheezes, tachypnea, tachycardia, diaphoresis, accessory muscle use.
What ABGs of a moderate asthmatic during an attack?
mild- respiratory alkalosis (dec co2) mod- mild hypoxemia, pco2 decreased or normal
What is the presentation of severe asthmatic attack?
chest is QUIET because not moving air!! fatigue/somnolence, cyanotic
What ABGs of severe asthmatic attack?
severe hypoxemia! respiratory acidosis! (increase PCO2, decrease PO2)
How do we classify someone with intermittent asthma?
smptoms less than 2 days a week, awake less than 2x month, use beta agonist less than 2x/week, lung function normal (rule of 2s)
What is the MAIN goal of asthma treatment?
TREAT THE INFLAMMATION!! can’t just give albuterol! treating the bronchospasm won’t fix the inflammation
What is the mainstay treatment for asthma?
corticosteroids b/c of their broad anti-inflam action.
inhaled for chronic- fluticasone/budesonide
oral/iv for exacerbation- prednisone, methylprednisolone
What are three contributors to the pathogenesis of COPD?
role of inflammation, role of oxidative stress, role of amplification
In what COPD do we see increased lung compliance?
emphysema
What is the definition of bronchiectasis?
chronic, irreversible dilation and distortion of bronchi caused by inflammatory destruction of bronchial walls
What are some potential etiologies for bronchiectasis?
infections, immotile cilia syndrome (kartageners), hpogammaglobulinemia (inc freq infections), cystic fibrosis, allergic bronchopulmonary aspergillosis
what is the specific spectrum that presents with allergic bronchopulmonary aspergillosis?
episodic wheezing, febrile episodes, expectoration of mucous plugs, peripheral blood eosinophilia, intermittent pulmonary infiltrations
