Obstructive pulmonary diseases

Question 1

obstructive pathophysiology

Answer 1

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

Question 2

asthma

Answer 2

chronic inflammation of the bronchial airways (NOT alveoli)
chronic inflammation causes brochial HYPERRESPONSIVENESS, constriction of airways and variable airflow obstruction that is reversible

Question 3

Risk factors for asthma

Answer 3

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

Question 4

pathophysiology of asthma

Answer 4

exposure to antigen (trigger) –> airway inflammation –> narrow breathing passages –> wheezing, cough, SOB, tightness in chest

Question 5

what are the two responses of asthma

Answer 5

bronchoconstriction (#1 symptom of asthma attack) and inflammation

Question 6

how is asthma diagnosed

Answer 6

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

Question 7

classic symptoms associated with asthma

Answer 7

wheezing, shortness of air, cough, tight chest

Question 8

severe attack asthma symptoms

Answer 8

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

Question 9

how to manage asthma

Answer 9

avoidance of asthma/irritant
use of peak flow meter
low dose corticosteroids
immunotherapy

Question 10

status asthmaticus

Answer 10

respiratory failure that comes with the worst form of acute severe asthma attack

Question 11

Symptoms of status asthmaticus

Answer 11

SEVERE
SILENT CHEST
pCO2 > 70 mmhg

LIFE THREATENING

Question 12

treatment of status asthmaticus

Answer 12

avoidance of precipitating factors and prophylactic

drug therapy: bronchodilators, corticosteroids, and oxygen therapy

Question 13

what is chronic bronchitis

Answer 13

hypersecretion of mucus and chronic productive cough for at least 3 months for at least 2 consecutive years

Question 14

what is simple (acute) bronchitis

Answer 14

inflammation of the bronchi and bronchioles

• bacterial or viral
• no airflow obstruction

Question 15

how does someone with acute bronchitis present

Answer 15

usually mild and self-limiting, requiring supportive care

usually gets better 3-4 weeks

Question 16

what is chronic bronchitis

Answer 16

bronchitis for 3 months out of the year for at least 2 years 
airflow obstruction (form of COPD)

Question 17

clinical manifestations of chronic bronchitis

Answer 17

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

Question 18

how to diagnose chronic bronchitis

Answer 18

history of symptoms, physical exam, chest imaging, pulmonary function tests

Question 19

who gets chronic bronchitis

Answer 19

smokers

Question 20

pathophysiology of chronic bronchitis

Answer 20

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

Question 21

late clinical manifestations of chronic bronchitis

Answer 21

pulmonary hypertension - advanced disease

Question 22

treatment for chronic bronchitis

Answer 22

irreversible
prevention:
-stoping smoking
-bronchodilators
-expectorants/prophylactic antibiotic therapy
-chest physiotherapy
-steroids late in disease (with acute exacerbations)

Question 23

what is emphysema

Answer 23

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

Question 24

causes of emphysema

Answer 24

SMOKING!!!!!
air pollution
childhood respiratory infections
genetic emphysema

Question 25

CM for emphysema

Answer 25

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

Question 26

how to diagnose emphysema

Answer 26

Pulmonary function tests
FEV1 - DECREASED
Chest X-Ray - hyperinflation
ABG - respiratory acidosis

Question 27

treatment of emphysema

Answer 27

smoking cessation 
bronchodilators and anti inflammatory agents 
O2 supplementation 
breathing retraining 
relaxation techniques 
antibiotics for acute infections