Obstructive lung diseases (rowley)

Question 1

What is the definition of asthma?

Answer 1

• reversible airway obstruction
• airway inflammation
• increased airway responsiveness to a variety of stimuli

Question 2

What gender more likely to develop asthma in middle age?

Answer 2

Females

Question 3

What is the role of smooth muscle innervation as it relates to asthma?

Answer 3

PS contraction - narrows airway

SS relaxation- relaxes airway smooth muscle (minor)

Question 4

What encompasses the Early Asthmatic Response?

Answer 4

minutes-2 hrs

Mast cell and mediators! blocked by B ag and cromlyn

Question 5

What up with the late asthmatic response?

Answer 5

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

Question 6

What’s the stimulus that causes bronchial hyperreactivity in asthma?

Answer 6

NONSPECIFIC!! not an allergen! histamine/methacoline used clinically

Question 7

Airway inflammation leads to airway obstruction via?

Answer 7

smooth muscle activation (bronchospasm)
vascular congestion/bronchial edema
accumulation of airway secretions, mucus casts, cellular debris

Question 8

What are the PFT changes in asthma between attacks?

Answer 8

normal!!!

Question 9

WHat are the pft changes during an asthma attack?

Answer 9

obstructive pattern! Decreased FEV1, FVC and FEV/FVC ratio! increased RV and FRC

Question 10

What do we see grossly in asthmatic lungs?

Answer 10

hyperinflation! airway is narrowed so can’t get air out of lungs so hyperinflate! also because of air trapping

Question 11

What role does asthma have on lung compliance?

Answer 11

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

Question 12

Does asthma cause alterations in gas exchange?

Answer 12

During attacks, VQ mismatch! So, hypoxemia and increased dead space

Question 13

What is the presentation of a moderate asthmatic?

Answer 13

Appears in distress! wheezes, tachypnea, tachycardia, diaphoresis, accessory muscle use.

Question 14

What ABGs of a moderate asthmatic during an attack?

Answer 14

mild- respiratory alkalosis (dec co2) mod- mild hypoxemia, pco2 decreased or normal

Question 15

What is the presentation of severe asthmatic attack?

Answer 15

chest is QUIET because not moving air!! fatigue/somnolence, cyanotic

Question 16

What ABGs of severe asthmatic attack?

Answer 16

severe hypoxemia! respiratory acidosis! (increase PCO2, decrease PO2)

Question 17

How do we classify someone with intermittent asthma?

Answer 17

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)

Question 18

What is the MAIN goal of asthma treatment?

Answer 18

TREAT THE INFLAMMATION!! can’t just give albuterol! treating the bronchospasm won’t fix the inflammation

Question 19

What is the mainstay treatment for asthma?

Answer 19

corticosteroids b/c of their broad anti-inflam action.
inhaled for chronic- fluticasone/budesonide
oral/iv for exacerbation- prednisone, methylprednisolone

Question 20

What are three contributors to the pathogenesis of COPD?

Answer 20

role of inflammation, role of oxidative stress, role of amplification

Question 21

In what COPD do we see increased lung compliance?

Answer 21

emphysema

Question 22

What is the definition of bronchiectasis?

Answer 22

chronic, irreversible dilation and distortion of bronchi caused by inflammatory destruction of bronchial walls

Question 23

What are some potential etiologies for bronchiectasis?

Answer 23

infections, immotile cilia syndrome (kartageners), hpogammaglobulinemia (inc freq infections), cystic fibrosis, allergic bronchopulmonary aspergillosis

Question 24

what is the specific spectrum that presents with allergic bronchopulmonary aspergillosis?

Answer 24

episodic wheezing, febrile episodes, expectoration of mucous plugs, peripheral blood eosinophilia, intermittent pulmonary infiltrations