Obstructive Lung Disorders Flashcards
Atelectasis will cause
a V/Q mismatch
What is the presentation of atelectasis?
Typically asymptomatic, but may have SOB, cough, fever, or elevated WBC
In obstructive lung disease the problem is with getting air
out of the lung
What are the PFT findings in obstructive lung diseases?
Decreased FEV1 (< 0.8)
FEV1/FVC = lowered with obstructive patterns
In restrictive lung disease the problem is with getting air
in
Chronic obstructive pulmonary disease (COPD) includes
Emphysema and Chronic Bronchitis
Will expiration be prolonged in obstructive lung disease?
Yes, very prolonged expiratory phase
What causes the obstruction in chronic bronchitis?
Obstructive airflow secondary to thick mucus, not as structural of a process as emphysema
What is the presentation of chronic bronchitis?
Dyspnea (worse with exertion)
Decreased FEV1/FVC
Flare will lead to decreased alveolar lumen
What complications are associated with chronic bronchitis?
Pneumonia distal to obstruction
Hypoxemia
Hypercapnia
VQ mismatch
What is bronchiectasis most commonly due to?
Cystic Fibrosis
Aspiration
Immunodeficiencies
Connective tissue disorder
What is the common presentation of bronchiectasis?
Productive cough
Foul smelling sputum, purulent
Hemoptysis
What are the components of the atopic triad?
Atopic Dermatitis (Eczema)
Allergic Rhinitis (hay fever)
Asthma
During asthma exacerbation, the patient will have increased lung volumes leading to what complications?
Muscular fatigue
Respiratory failure
Pulses paradoxus from intrathoracic pressure
What are the complications of asthma?
Repetitive cellular damage leading to fibrosis
What gene is impacted in cystic fibrosis?
CFTR protein on chromosome 7
CFTR is a chloride transportation protein of the exocrine glands so alteration in this protein will cause what effects?
- Change in water concentration/movement
- Thickening of the secretions (dehydration)
What lung conditions do you likely hear crackles (rales) on exam?
Bronchiectasis
Bronchitis
Pneumonia
Fibrosis
CHF
What lung conditions do you likely hear wheeze on exam?
Asthma
COPD
And other causes of airway obstruction
When rhonchi are heard on exam what does that suggest?
Suggest secretions in the large airways
What is the etiology behind extrinsic (allergic) asthma?
Allergic response to environmental or animal allergens
What is the etiology behind intrinsic (non-allergic) asthma?
Occupational/pollution
Cold/humidity
Stress
Medications (ASA or NSAIDs)
Exercise
Is it possible for a patient to have both extrinsic and intrinsic etiology of asthma?
Yes
What are the risk factors associated with asthma?
Atopy
Environmental/occupational exposures
Childhood asthma or symptoms
Family history
What are the signs of asthma?
Expiratory wheezes
Diminished breath sounds
Accessory muscle use
Tripoding (severe exacerbation)
What is part of the work-up/diagnosis for asthma?
Clinical findings and HISTORY
PFT’s
Bronchoprovocation testing (methacholine, mannitol, exercise or dry air)
What medication class do all asthma patients receive?
SABA as needed (albuterol)
What is the management for step 1 asthma?
All ages: SABA as needed
< 4 years old: sick plan with few days of ICS due to association with URI’s
What is the management for step 2, mild persistent asthma?
All ages: Continue SABA as needed
Children (up to 11): daily low dose ICS or Montelukast
> 12 years: Daily low dose ICS, or daily combination inhaler (can also alternatively use Montelukast)
What is the management for step 3, moderate persistent asthma?
All ages: continue SABA as needed
< 4: Daily combo inhaler (low dose ICS with LABA), daily montelukast, or medium dose ICS
> 4: Daily combination inhaler PLUS as needed Symbicort, or daily medium dose ICS, or low dose ICS plus Montelukast
What is the management for step 4, severe asthma?
Daily combination inhaler (medium dose ICS with LABA) or daily medium dose ICS with Montelukast
What is the management for step 5, severe persistent asthma?
Daily high dose ICS with LABA
OR
Daily high dose ICS with Montelukast
Consider Omalizumab (Xolair)
What are mechanisms of prevention in asthma?
Avoid triggers
Allergens (allergy medications, immunotherapy, air filters, or washing face/hands)
Medication Management
Asthma Action Plan
What are signs of bronchioctasis?
Crackles
Wheezing
Digital clubbing
What are symptoms of bronchiocstasis?
Chronic Cough
- Productive
- Malodorous thick, mucopurulent mucus
- Hemoptysis
Fatigue
SOB
Fever/chills
Pleuritic Chest Pain
What is a symptom that is a common “buzz word” on exam questions associated with bronchiectasis?
Persistent or recurrent cough with mucopurulent sputum
What should be included in the work-up of bronchiectasis?
Labs - CBC, Immunoglobulins, Sweat Chloride, Sputum smear, Alpha-1 tripsin, Rh factor
CXR
CT (gold standard)
PFTs (for prognostics)
Bronchoscopy
What is the treatment for bronchiectasis?
Treat and control underlying disease/infection
Bronchodilators (Duonebs or SBA and combo’s)
Chest physiotherapy (Chest PT)
Surgery (sever cases)
What antibiotic should be used for psuedomonas coverage in bronchiectasis?
Fluoroquinolone: Levofloxacin (oral)
Pipercillin/Tazobactam (Zoyn) (IV)
What are some oral antibiotics that can be used to treat bronchiectasis?
Fluoroquinolones
Amoxacillin or Augmentin
Macrolides
What is the most common cause of acute bronchiolitis in pediatric patients?
RSV
What are the types of bronchiolitis?
Acute (most common)
Bronchiolitis Obliterans
Proliferative
Follicular Bronchiolitis
What are the symptoms of bronchiolitis?
Upper respiratory symptoms
Fever
Wheezing
Tachypnea
Shallow respirations
Poor appetite
What should be included in the work-up of bronchiolitis?
Clinical context and medical history
CXR
Viral panel
PFT’s
Biopsy (not for acute)
When is endotracheal intubation indicated in severe bronchiolitis?
Only in respiratory failure
What is the treatment for mild-moderate bronchiolitis?
Supportive therapy and parent eduction
What is the treatment for severe bronchiolitis?
Admission with supportive care
Respiratory support (nasal suctioning and LFNC)
Bronchodilator
+/- Glucocorticoids
CPAP for risk of respiratory failure
Intubation for respiratory failure
Is COPD more common in women or men?
Women, there are also more death in women
What patients are most likely to be diagnosed with COPD?
Current or former smokers
History of asthma
What are the risk factors associated with COPD?
Smoking!
Air pollutants
Genetic factors
Respiratory infections
Atopy and Asthma
What is atopy?
Genetic predisposition to develop atopic triad or atopic triad symptoms (rhinitis, eczema, asthma)
What are the signs/symptoms of COPD?
Cough
Persistent, progressive dyspnea
CO2 retention
Weight loss (emphysema)
Tachycardia
Hypertension
Wheeze/crackles
Prolonged expiratory phase
Barrel chest
What CXR findings can be associated with COPD?
Hyperinflated lungs
Flat diaphragm
What is the treatment for Group A COPD?
SABA or LABA
What is the treatment for Group B COPD?
LABA
Consider SABA and LABA
What is the treatment for Group C COPD?
Add LAMA
What is the treatment for Group D COPD?
Most started on LAMA
Combination LAMA/LABA
LABA/ICS
What organs are impacted in COPD due to containing mucus membranes?
Lungs
Pancreas
Liver
Intestines
Reproductive tract
What are the respiratory signs/symptoms of CF?
Persistent, productive cough
Wheeze
Dyspnea
Hemoptysis
Apical crackles
Bronchiectasis
Barrel chest
Respiratory distress/failure
Digital clubbing
What is the screening test for CF?
Newborn screen
What is the gold standard test for CF?
Sweat chloride test
What is the most definitive test in diagnosing CF?
Genetic testing (numerous different mutations)
What is an indicative chloride concentration on sweat testing for diagnosing CF?
> /= 60 mmol/L
What is the diet recommendation for a patient on Trikafta?
Require a diet high in fats to maximize absorption
