Obstructive Pulmonary Diseases Flashcards
3 characteristic components of Asthma
- Obstruction of Airflow
- Bronchial hyperreactivity
- Inflammation of airway
A disease of chronic inflammation leading to airway narrowing and increased mucus production.
Chronic inflammation is associated with bronchospasms that lead to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing.
Often reversible airflow obstruction.
Asthma
3rd leading cause of death in US
COPD
A common, preventable, treatable disease that is not reversible. It is usually progressive and associated with enhanced chronic inflammatory response in the airway and lung to noxious particles or gas.
COPD
A chronic inflammatory condition of the small airways that results in a chronic productive cough
cough must last for 3 months in each of 2 successive years
other causes of cough (bronchiectasis, malignancy etc) must be ruled out
Chronic Bronchitis
Abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles due to chronic inflammation.
Destruction of airspace walls but no overt fibrosis.
Emphysema
Asthma classification and diagnosis
Classified according to
- frequency of symptoms
- PFT (pulmonary function testing)
Asthmatic symptoms appear 2 or less days / week, does not interfere w daily activities.
Nighttime symptoms 2 or fewer times per month.
Mild / Intermittent
Asthmatic symptoms appear more than 2 days / week but not daily. Minor limitation.
Nighttime symptoms 3-4 times / month
Mild persistent
Asthmatic symptoms appear daily. Some limitation in daily activity.
Nighttime symptoms more than 1x / week but not nightly
Daily use of medication
Moderate persistent
Asthmatic symptoms are continuous. Extremely limited physical activities. Nighttime symptoms often every night.
Medication use several times / day
Severe persistent
FEV1 > 80% predicted
PEFR variability < 20%
Mild intermittent
FEV1 > 80% predicted
PEFR variability 20 - 30 %
Mild persistant
FEV1 > 60% , < 80%
PEFR variability > 30%
Moderate persistent
FEV 1 < 60%
PEFR variability >60%
Severe persistent
How is the diagnosis of asthma confirmed?
Demonstrating reversibility of airflow obstruction with use of short-acting bronchodilator.
Reversibility = improve FEV1 by 12% and 200mL
Using PEFR to confirmed asthma diagnosis
Peek Expiratory Flow Rate, to measure diurnal variability
( {highest daily PEFR - lowest daily PEFR} / {highest daily PEFR} )
Diagnosis of asthma if PEFR varies by at least 20%, for 3 days in a week over several weeks
OR
PEFR increases by at least 20% in response to treatment
Treatment for Intermittent asthma
Step 1
SABA (inhaled short acting beta2 agonists) PRN
up to 3 treatments at 20 minute intervals, as needed
Indication of inadequate control of symptoms and need to “step up”
use of SABA >2x / week for symptom relief
not including EIB prevention
Treatment for persistent asthma, step 2
Low-dose ICS (inhaled corticosteroid)
Tx persistant asthma, step 3
Low dose ICS + LABA (long-acting inhaled beta 2 agonist)
OR
Medium-dose ICS
Tx persistant asthma, step 4
Medium dose ICS + LABA
Tx persistant asthma, step 5
High-dose ICS + LABA
AND
allergy treatment (Omalizumab)
Tx persistant asthma, step 6
High-dose ICS + LABA + Oral corticosteroid
AND
allergy treatment (omalizumab)
Necessary components for each step of asthma treatment
Patient education
Environmental control
Management of comorbidities
Special treatment considerations for steps 2-4
Consider subcutaneous allergen immunotherapy for patients with allergic asthma - especially children
When to consider consultation with asthma specialist
Consider at step 3, definitely consult if need to step tup to 4
Abnormal, permanent dilation of the bronchi and destruction of bronchial walls.
Bronchiectasis
What can lead to bronchiectasis?
- Congenital cystic fibrosis ** half of all cases here **
- Recurrent inflammation and infections (TB, fungal, abscess)
- Tumor obstruction
Indication of recurrent pulmonary infections and chronic, purulent, foul-smelling sputum?
Bronchiectasis
transmural inflammation, mucosal edema, cratering, ulceration, and neovascularization in the airways. The result is permanent abnormal dilatation and destruction of the major bronchi and bronchiole walls.
Test of choice for bronchiectasis
High-resolution chest CT - reveals dilated, tortuous airways “SIGNET-RING SIGN}
Treatment for bronchiectasis
10-14 days or longterm antibiotics (augmenting, bacterium, or ciproflox)
Bronchodilators
Chest physiotherapy - airway clearance
consider lung transplant
Rule-out tests for bronchiectasis
- Sweat chloride - rule out cystic fibrosis
2. alpha 1 anti trypsin deficiency (serum)
Signet-ring sign in chest CT classic feature of what?
Bronchiectasis
Pathophysiological / clinical syndrome that includes emphysema and chronic bronchitis
COPD
Condition in which the air spaces are enlarged as a consequence of destruction of alveolar space
Emphysema
Disease characterized by a chronic cough that is productive of phlegm occurring on most days for
3 months of the year for 2 or more consecutive years
without an others-defined acute cause
Chronic bronchitis
Causes of COPD other than smoking
Environmental pollutants Recurrent URI Eosinophilia Bronchial hyper-responsiveness Alpha-1 Antitrypsin deficiency
Clinical features of emphysematous COPD
Progressive SOB
Excessive DRY cough
Weight loss
Advanced stage:
Pursed lip breathing
Grunting expirations
Chest examination of COPD patient
Hyperinflation, increased AP dimensions
Increased resonance w percussion
Decreased breath sounds
Early Inspiratory crackles
Prolonged duration of expiration
First test for diagnosing and monitoring COPD
Spirometry and PFTs
FEV1 <70%, nonreversible with bronchodilator -
*for both chronic bronchitis and emphysema
Definitive test to determine presence of emphysema
Chest CT
