Obstructive pulmonary diseases Flashcards
obstructive pathophysiology
THINK AIR TRAPPING
person is not able to fully EXHALE –> air cannot get out = HIGH CO2
air is TRAPPED in the alveoli –> person works harder to breathe, lungs are HYPERINFLATED
therefore normal exhalation is obstructed
chronic HIGH CO2 AND LOW O2
asthma
chronic inflammation of the bronchial airways (NOT alveoli)
chronic inflammation causes brochial HYPERRESPONSIVENESS, constriction of airways and variable airflow obstruction that is reversible
Risk factors for asthma
usually starts in childhood –> associated with ALLERGIES
- familial link
- levels of allergen exposure
- urban residency
- exposure to indoor and outdoor air pollution
- tobacco exposure/smoke
- recurrent respiratory tract viral infections and GERD
pathophysiology of asthma
exposure to antigen (trigger) –> airway inflammation –> narrow breathing passages –> wheezing, cough, SOB, tightness in chest
what are the two responses of asthma
bronchoconstriction (#1 symptom of asthma attack) and inflammation
how is asthma diagnosed
History: allergies, recurrent episodes of wheezing, dyspnea, and course/exercise intolerance
pulmonary function tests: measures lung function with respect to time
FEV1: force expiratory volume in 1 sec
classic symptoms associated with asthma
wheezing, shortness of air, cough, tight chest
severe attack asthma symptoms
use of accessory muscles
distant breath sounds
diaphoresis
inability to speak one or two words before taking breath
respiratory failure: inaudible breath sounds and repetitive hacking cough
how to manage asthma
avoidance of asthma/irritant
use of peak flow meter
low dose corticosteroids
immunotherapy
status asthmaticus
respiratory failure that comes with the worst form of acute severe asthma attack
Symptoms of status asthmaticus
SEVERE
SILENT CHEST
pCO2 > 70 mmhg
LIFE THREATENING
treatment of status asthmaticus
avoidance of precipitating factors and prophylactic
drug therapy: bronchodilators, corticosteroids, and oxygen therapy
what is chronic bronchitis
hypersecretion of mucus and chronic productive cough for at least 3 months for at least 2 consecutive years
what is simple (acute) bronchitis
inflammation of the bronchi and bronchioles
- bacterial or viral
- no airflow obstruction
how does someone with acute bronchitis present
usually mild and self-limiting, requiring supportive care
usually gets better 3-4 weeks
what is chronic bronchitis
bronchitis for 3 months out of the year for at least 2 years airflow obstruction (form of COPD)
clinical manifestations of chronic bronchitis
persistent productive cough !!!
purulent if super imposed respiratory infection
as disease progresses increase cough, increase congestion, increase shortness of air
may have acute exacerbation of chronic bronchitis
how to diagnose chronic bronchitis
history of symptoms, physical exam, chest imaging, pulmonary function tests
who gets chronic bronchitis
smokers
pathophysiology of chronic bronchitis
inhaled irritants result in airway inflammation –> infiltration occurs with neutrophils, macrophages, lymphocytes into bronchial walls
continual bronchial inflammation –> bronchial edema, increase number and size and goblet cell and mucus glands
thick, tenacious mucus produced and cannot be cleared because of impaired ciliary function
late clinical manifestations of chronic bronchitis
pulmonary hypertension - advanced disease
treatment for chronic bronchitis
irreversible
prevention:
-stoping smoking
-bronchodilators
-expectorants/prophylactic antibiotic therapy
-chest physiotherapy
-steroids late in disease (with acute exacerbations)
what is emphysema
abnormal permanent enlargement of gas exchange airways, accompanied by DESTRUCTION of alveolar walls
loss of elastic recoil
lung hyperinflation
destruction results from tissue changes and not mucus production
causes of emphysema
SMOKING!!!!!
air pollution
childhood respiratory infections
genetic emphysema
CM for emphysema
gradual increase in breathlessness -particularly with exertion eventually shortness of air at rest -prolonged expiratory phase -may become oxygen dependent wheezing malnourished decreased muscle mass barrel chest pursed lip breathing decreased breath sounds
how to diagnose emphysema
Pulmonary function tests
FEV1 - DECREASED
Chest X-Ray - hyperinflation
ABG - respiratory acidosis
treatment of emphysema
smoking cessation bronchodilators and anti inflammatory agents O2 supplementation breathing retraining relaxation techniques antibiotics for acute infections
