Obstructive Pulmonary Disorders Flashcards
What are the obstructive pulmonary disorders?
Asthma Bronchiectasis Chronic Bronchitis Cystic Fibrosis Emphysema
Reversible hyper irritability of the tracheobronchial tree, resulting in bronchoconstriction and inflammation
Asthma
Sumter’s triad/Atopic triad for asthma
Asthma
Nasal Polyps
ASA/NSAID allergy
Associated eczema
Which disorders have a pathologic low V:Q ratio?
Asthma, chronic bronchitis, acute pulmonary edema
Which disorders have a pathologic high V:Q ratio?
Emphysema, pulmonary embolism, or foreign body
What is the most common chronic disease in childhood?
Asthma
What are the three components of asthma?
Bronchoconstriction, Inflammation, airway hyper reactivity
Airway narrowing secondary to smooth muscle constriction, bronchial wall edema, and thick mucous secretions; the obstruction leads to a decrease in expiratory air flow, a decrease in airway resistance (increase work of breathing), and V/Q mismatch
Bronchoconstriction in asthma
Occurs secondary to cellular infiltration (T lymphocytes, neutrophils, eosinophils) and their inflammatory cytokines as well as IgE mediated histamine release from mast cells
Inflammation in asthma
Occurs from extrinsic (allergic) or intrinsic (idiosyncratic) exposure in asthma
Airway hyper reactivity
What are the most common extrinsic allergen triggers for airway hyperactivity in asthma?
Pollen, ragweed, dander, dust, mold, aerosols, tobacco, smoke
What are the most common intrinsic nonallergic triggers for airway hyperactivity in asthma?
Infection (esp viral URI/Sinusitis), pharmacologic, occupational, exercise, emotional, cold air
What is the classic triad to look for when gathering a history on a patient with asthma?
Dyspnea, wheezing, cough (esp @ night)
These could be with or without chest tightness, prolonged expiration, and fatigue
What are some clues you could gather from patient history that would help you measure the severity of a patient who has asthma?
Steroid use
Previous intubations/ICU/hospital admissions
What should you look for when assessing physical clinical manifestations in a patient with asthma?
Prolonged expiration with wheezing, hyper resonance, use of accessory muscles
What should you look for when assessing physical clinical manifestations in a patient with SEVERE asthma?
Inability to speak in full sentences
Low peak flow reading
Tripod position
“Silent chest”
What is the strongest predisposing factor to asthma?
Atopy or sumters triad
What are some drugs that can cause asthma?
Beta blockers, angiotensin-converting enzyme (ACE) inhibitors, aspirin, NSAIDs
What is the gold standard to diagnose asthma with reversible obstruction?
PFT
What pulse oximetry reading is indicative of respiratory distress?
Less than 90%
What is the best OBJECTIVE way to assess severity of asthma and patient response to medication in the ED*?
Peak flow meter (PEFR)
How do you tell if a patient with asthma is responding to treatment using a peak flow meter? What is a normal reading?
If PEFR is 15% greater from initial attempt
Normal: 400-600
Bronchoprovocation test that uses a cholinergic drug to cause bronchospasm
Metacholine challenge test (+ is >20% decrease in FEV1)
What results from a bronchodilator test (bronchoprovocation tests) are consistent with asthma?
+ if >12% decrease in FEV1 (>200cc)