Obstructive Pulmonary Disease Flashcards
polycythemia
increase in the number of red blood cells
COPD
- chronic obstructive pulmonary disease
- obstruct airflow, not a specific diagnosis
- emphysema, chronic obstructive bronchitis, chronic asthma
risk factors of COPD
- exposure to air pollution
- secondhand smoke
- dust/chemicals
- heredity
- hx of childhood respiratory infections and socioeconomic status
signs of COPD
dyspnea
sputum production
chronic cough
reduced function
spirometry
- lung volumes
- basic and frequent performed test of pulmonary function
- diagnostic & prognostic
when is COPD diagnosed
when the FEV1/FVC ratio is <0.70 after a bronchodilator has been given
emphysema
- pathologic accumulation of air in the lungs
- disease of exhalation
- air trapping in the lungs
- forced expiration causes smaller airways to collapse during expiration
what does emphysema cause
increase in residual volume, total lung capacity and a decrease in the FVC1/FVC ratio
alpha-1 antityrpsin
- enzyme found in the blood
- protects lungs from inflammatory damage
- protects the body from a powerful enzyme called neutrophil elastase
- coats cells and provides protection against neutrophil elastase
what does a deficiency of alpha 1-antitrypsin lead to
- chronic, uninhibited tissue breakdown
- lungs become not as elastic
how does smoking affect the A-1AT
- changes it so that it can NOT bind to elastase allowing elastase to go crazy
cigarette smoke creates a chronic inflammatory state which then leads to what..
elevated neutrophil count –> elevated elastase release = tissue damage
A-1AT deficiency and cigarette smoking
- destruction of individual alveoli
- development of super alveoli
- destruction of connective tissue supports for the very smallest airways allowing them to collapse during expiration
clinical manifestation of emphysema
- SOB
- apprehensive
- anxious
- addicted to O2
- thin, cachectic
- deformed chest with prolonged expiration
- absent or non-productive cough
- pulse Ox could be normal
- cardiac problems
- mild COPD –> mild hypoxemia
- deconditioning
prognosis of emphysema
poor
PT implications for emphysema
- reduce airway edema
- eliminate bronchial secretions
- increase exercise tolerance
- prevent/treat respiratory infxn
- avoid irritants
- relieve anxiety
- pulse Ox
- monitor HR and BP
- hypoxic drive
what is hypoxic drive
- people who retain CO2 (emphysema pt)
- using oxygen to drive respiration instead of CO2
- people with emphysema rely more on blood O2 to drive respiration, if blood concentrations of O2 go up, chemoreceptors start to think they don’t have to breath as much, which then leads to slowed breathing
what do you need to monitor when a pt has hypoxic drive
respiration rate
metered-dose inhaler
- emphysema
- used to deliver drugs to the lungs
- evaluate the ability of the child/adult to correctly use the MDI
- a spacer can remove coordination of hand movement and respiration
chronic bronchitis
- productive cough lasting at least 3 months per year for 2 consecutive years
- FEV1/FEV <75%
chronic bronchitis characteristics
- inflammation
- excessive mucous
- scarring of bronchial lining
- obstructed air flow caused by increased mucous
- decreased radius
causes of chronic bronchitis
- chronic exposure to irritants; mucus hypersecretion
- destruction of ciliary cells lining airways occurs
- smooth muscle hypertrophy, atrpohy of epithelial cells
- reduced radius
symptoms of chronic bronchitis
- recurring morning cough that brings up mucus
- increased production of phlegm
- symptoms worsen over the day
- wheezing, SOB
- cyanotic
- hypoxia
chronic bronchitis pt’s tend to have what also?
- polycythemic
- cor pulmonale
- SOB
- prolonged expiration
- persistent coughing with expectoration
- recurrent infection
PT implications for chronic bronchitis
reduce irritants
bronchodilators
mucolytics
NSAIDs
asthma
episodic, reversible, obstructive lung disease characterized by bronchospasms resulting from an exaggerated inflammatory response of the airway smooth muscles to various stimuli
asthma is clinically manifested by
episodic dyspnea
coughing
wheezing
extrinsic asthma
- allergic reaction to specific triggers
- release histamines
intrinsic asthma
- no known allergic cause
- adult
- secondary to chronic or recurrent infxns of the bronchi, sinuses or tonsils
pathogensis of ashtma
- inflammatory response consisting of cellular infiltration, epithelial disruption, mucosal edema and mucous plugging airways
- inflammatory mediators produces bronchial smooth muscle spasm, vascular congestion, increased vascular permeability, edema formation, production of thick, tenacious mucus and impaired mucociliary function
bronchial provocation test
- static pulmonary function test
- evaluates airway sensitivity
- methacholine causes smooth muscle contraction which reduces pulmonary airflow
- positive test: 20% decrease in FEV1
clinical course of asthma
- attack by dyspnea with wheezing
- upper airway obstruction occurs
- difficulty with expiration
- air trapping in distal alveoli
- hypercapnia
- repeated attacks
- age can determine severity, younger the worse it is
treatment for ashtma
- avoid triggers
- bronchodilators and anti-inflammatory agents
- low dose corticosteroids
exercise induced bronchospasm
- airway hyperactivity
- acute, reversible, usually self-terminating airway obstruction
- develops 5-10 mins after vigorous intensity exercise
- lasts 30-60mins
- warm up is important
symptoms of exercise induced bronchospasm
- coughing
- chest tight
- wheezing / SOB
- tachypnea
- symptoms linked to exercise intensity
- take inhaler 20-30 mins before exercise
