obstructive pulmonary conditions

Question 1

obstructive pulmonary conditions

Answer 1

emphysema
chronic bronchitis
asthma

Question 2

asthma

Answer 2

chronic inflammation of bronchial airways (NOT alveoli)

Question 3

asthma risk factors

Answer 3

-genetic
-level of exposure to allergens
-urban residency
-exposure to pollution
-tobacco exposure/smoker
-recurrent respiratory viral infections & GERD

Question 4

patho of ashtma

Answer 4

1. exposure to trigger/antigen 2. airway inflammation
2. hyper secretion of mucus, airway muscle constriction, swelling bronchioles
3. narrow breathing passage
4. wheezing, cough, SOB, tightness in chest

Question 5

patho of ashtma

Answer 5

1. exposure to trigger/antigen 2. airway inflammation
2. hyper secretion of mucus, airway muscle constriction, swelling bronchioles
3. narrow breathing passage
4. wheezing, cough, SOB, tightness in chest

Question 6

what immune cells are involved in asthma process?

Answer 6

dendritic
T helper
B lymphocytes
mast cells
neutrophils
basophils
eosinophils

Question 7

early asthmatic response

Answer 7

responses activated immediately and release of inflammatory mediators occurs within minutes

-vasodilation
-increased capillary permeability
-mucosal edema
-bronchoconstriction
-mucus secretion

Question 8

late asthmatic response

Answer 8

4-8 hours after early

-eosinophils, neutrophils, lymphocytes gather
-another release of inflammatory mediators again –> causing same process

Question 9

airway remodeling

Answer 9

untreated inflammation

long-term airway damage - IRREVERSIBLE

Question 10

1 sign of asthma attack

Answer 10

bronchoconstriction

Question 11

what is the biggest problem r/t asthma?

Answer 11

inflammation

long-term problem that causes seriousness of disease

Question 12

how is asthma diagnosed? gold standard

Answer 12

pulmonary functions test: measures lung function with respect to time
*decreased FEV-1
*decreased flow rate

Question 13

classic asthma symptoms

Answer 13

wheezing, SOB, cough, chest tightness

Question 14

severe asthma symptoms (attack)

Answer 14

use of accessory muscles, distant breath sounds, diaphoresis, inability to speak, RESPIRATORY FAILURE (inaudible breath sounds, repetitive hacking cough, pCO2 >70)

Question 15

management of asthma

Answer 15

avoid triggers
*peak flow meter (measures FEV1 @ home)
*lose-dose corticosteroids
*SABA (mild)
*anti-inflammatory, inhaled corticosteroids, LABA, leukotriene antagonist (severe)
*immunotherapy

Question 16

treatment for asthma attack

Answer 16

bronchodilators, corticosteroids, oxygen

Question 17

chronic bronchitis

Answer 17

hyper secretion of mucus and chronic productive cough for at least 3 months of the year for 2 years

Question 18

acute bronchitis

Answer 18

inflammation of bronchi and bronchioles
*caused by bacterial or viral infection - NO obstruction
*mild and self-limiting - usually better in 3-4 weeks

Question 19

chronic bronchitis

Answer 19

bronchitis for 3 months of of the year for 2 years

caused by SMOKING and OBSTRUCTION of airway

*may have acute exacerbation

Question 20

what is the prognosis of acute exacerbation?

Answer 20

premature morbidity and mortality

Question 21

chronic bronchitis: S/S

Answer 21

*persistent productive cough (purulent)
*frequent resp infections

as disease progresses…
increased cough, congestion, SOA

Question 22

chronic bronchitis: diagnosis

Answer 22

based on hx of symptoms, exam, chest imaging, PFTs

low FEV1

*typically disease is progressed and irreversible by the time pt seeks treatment

Question 23

patho chronic bronchitis

Answer 23

1. inhaled irritants = airway inflammation
2. infiltration of neutrophils, macrophages, lymphocytes into bronchial wall
3. continual bronchial inflammation –> bronchial edema increase number and size of GOBLET cells and mucus glands
4. causes thick mucus and can’t be cleared bc impaired ciliary fxn

Question 24

late clinical manifestations of chronic bronchitis

Answer 24

pulmonary HTN: increase in pulmonary artery pressure d/t elevated pulmonary venous pressure, increased pulmonary blood flow, pulmonary vascular obstruction or hypoxemia
^may result in right-sided heart failure (cor pulmonale)

S/S: DOE, syncope, fatigue

Question 25

treatment of chronic bronchitis

Answer 25

IRREVERSIBLE

stop smoking: halt progression

TEACH: if stopped before s/s occur, risk for bronchitis decreases considerably

*bronchodilators
*expectorants
*CPT
*steroids (late disease or acute exacerbations)
*O2 therapy

Question 26

emphysema

Answer 26

chronic, irreversible, progressive lung disease characterized by:
-loss of elastic recoil
-abnormal, permanent enlargement of air sacs distal to bronchioles –> destruction of alveolar walls and capillaries
*AIRWAY REMODELING
-lung hyperinflation

Question 27

destruction in emphysema results from

Answer 27

tissue changes NOT mucus production

Question 28

loss of elastic recoil in emphysema - caused by

Answer 28

SMOKING
air pollution
childhood resp infections
genetic emphysema (alpha-antitrypsin

Question 29

clinical manifestations of emphysema

Answer 29

*DOE
*SOA at rest (prolonged expiratory phase + O2 dependent)
*wheezing
*malnourished
*decrease muscle mass
*barrel chest
*pursed lip breathing
*decreased breath sounds !!!!!

Question 30

diagnosis of emphysema

Answer 30

PFT’s: FEV1 decreased

CXR: hyperinfiltration

ABG’s: respiratory acidosis (high CO2, decreased pH)

check alpha1-antitrypsin (AAT)

Question 31

treatment of emphysema

Answer 31

stop smoking
bronchodilators and anti-inflammatories
O2 therapy
breathing retraining
relaxation techniques
ATB for acute infections