OSA Flashcards
Is COPD reversible?
Partially, but not fully reversible
What systemic manifestations is severe COPD associated with?
Cachexia, generalized weakness, osteoporosis, depression, anxiety, coronary artery disease
In which disease is there permanent enlargement of airspaces?
Emphysema
Role of alpha-1-antitrypsin
Inhibits elastase, keeping the balance of breakdown of elastic fibers in check
Name 5 risk factors for COPD
Smoking, exposure to occupational dusts, family history of COPD, alpha-1-antitrypsin deficiency, and older than 45 years
How is DLCO affected in asthma?
Increased
How are DLCO, RV, and TLC affected in COPD, particularly emphysema?
Decreased DLCO because of decrease in capillary bed due to lung parenchyma loss in COPD, and increased RV and TLC due to air trapping causing hyperinflated lung indicative of air trapping, in emphysema
Top causes of chronic cough (more than or equal to 8 weeks)
UACS (upper airway cough syndrome) or post-nasal drip (sinusitis leads to excessive mucus which accumulates in back of throat), asthma, GERD, and chronic bronchitis. Also, role of ace inhibitors and bordatella pertussis.
Expiratory time in COPD
Forced expiration time greater than 6 seconds, normal is 3
COPD classifications according to GOLD criteria
Stage 1 mild, 2-moderate, 3-severe, 4-very severe
Normal FEV1/FVC ratio
greater than or equal to 80%
FVC and FEV1 normals
should be greater than or equal to 80%
5 A’s and R’s in behavior interventions of COPD smoking management
Ask, advise, assess, assist, arrange. Relevance, risks, rewards, roadblocks, repeat.
Bronchodilators used in COPD management
Beta 2 agonists and anticholinergics
Beta 2 agonist short acting and long acting
short acting- albuterol, levalbuterol, pirbuterol. long acting- salmeterol, formoterol, indacaterol
anticholinergics as bronchodilators- name
Short acting- ipratropium. long acting- tiotropium
Inhaled corticosteroids for management of COPD
Fluticasone, budesonide
COPD medications-name
Bronchodilators, corticosteroids, combinations, methylxanthines, phosphodiesterase-4 inhibitors, mucolytic agents (little management), and antibiotics for acute exacerbations
What is methylxanthine and name a couple
Phosphodiesterase inhibitors- theophylline and aminophylline
Side effect of inhaled corticosteroids?
Thrush- tell patients to swish and spit 3 x
What are different ways in which bronchodilators can be administered?
Metered dose inhalers, dry powder inhalers, and nebulizers
How do phosphodiesterase-4 inhibitors work?
Increase intracellular cAMP and decrease inflammation. Promote airway smooth muscle relaxation. Decrease exacerbations if frequent of chronic bronchitis. Ex: Roflumilast PO.
What is pirbuterol?
Short acting Beta 2 agonist used for bronchodilation
What is theophylline?
Methylxanthine, phosphodiesterase inhibitor
What is Roflumilast?
Phosphodiesterase-4 inhibitor
What is budesonide
Inhaled corticosteroid to suppress immune system
What is tiotropium?
Long acting anticholinergic
What is indacaterol?
Long acting beta 2 agonist for bronchodilation
What is ipratropium?
Short acting anticholinergic
Mucolytic agents
Guaifenesin, N-acetylcysteine
Meds for acute exacerbations in COPD
Abx- macrolides, sulfa drugs, tetracyclines, penicillins, cephalosporins, and/or FQs. Chronic azithromycin.
What would help in reducing frequency of acute exacerbations in COPD?
Azithryomycin
Predominant organisms causing acute exacerbations in COPD?
H. influenzae, strep pnuemo, moraxella catarrhalis, although usually viral infection precedes exacerbations
Advanced COPD complications
Pulmonary HTN, cor pulmonale, chronic respiratory failure
Cardinal features of asthma
Reversible airway obstruction, airway inflammation, and airway hyperresponsiveness to a multiplicity of stimuli
In which disease state would you see a lot of eosinophils, mast cells activated, subepithelial fibrosis, and mucous gland and goblet cell hyperplasia and what would this lead to?
Asthma- lots of mucus, leads to mucus plugging and further narrowing/blockage of airways
When is the onset of asthma most common?
in childhood. If in adulthood, often occupation related.
What is the predominant symptom in asthma patients?
Nonproductive cough
Associated conditions with asthma
Nasal polyps (have allergic etiology), rhinitis, and sinusitis
8 year old girl presents describes periods of dyspnea, chest tightness, and coughing. Upon auscultation, you hear wheezes, decreased breath sounds. Hyperinflation of lungs and use of accessory muscles to breathe. She also has a history of getting nasal polyps frequently. Diagnosis?
Asthma
How would you diagnose asthma?
Bronchoprovocation testing with methacholine if normal spirometry and you are suspicious. Allergy skin test or radioallergosorbent test, ABG
If you see a severe asthma patient with normal PaCO2 levels, what do you suspect?
Respiratory failure
What is a radioallergosorbent test?
Tests serum IgE levels
What are the classifications in asthma based on?
frequency of daytime/nighttime symptoms, need for rescue inhaler, limitation in activity, and lung function. Severity is based on worse feature present
Which obstructive diseases are very prone for recurrent bacterial infections?
CF and chronic bronchitis
What is the most common genetic cause of bronchiectasis?
CF
Etiology of CF
Genetic defect of chromosome 7 which produces a defective CFTR gene
What cells are effected by CF
Of epithelial origin- lungs, sinuses, GI system, sweat glands, hepatobiliary system, reproductive tract
In which age of CF would you find clinical features of tachypnea, feeding problems, retractions, and recurrent sinopulmonary infections?
Infant
In which age of CF would you find clinical symptoms of rectal prolapse, jaundice, and meconium ileus?
Neonate
In which age of CF would you find clinical features of diffuse rhonchi/rales, clubbing, cough, and hemoptysis?
Child or adolescent
What is the most common cause of clubbing in children?
CF
16 year old presents with cough, recurrent hemoptysis. You note diffuse rhonch and rales, clubbing of the extremities, and steatorrhea. Hyperresonance to percussion. Mother complains that child is unable to gain weight, no matter how much he eats. Delayed sexual maturity. Diagnosis?
CF
Why would you get a sputum culture in CF?
To monitor if bronchiectasis has developed within the patient- most common organisms affecting are Staph and H. influenzae
Diagnosis of CF
Sweat chloride test, genetic test to look for 2 CF alleles, family history with first degree relative of CF, nasal potential difference, cXR, PFT, sputum culture, fecal fat analysis, semen analysis,
Why do a semen and fecal fat analysis in CF?
Because of pancreatic insufficiency, the small intestine is not digesting the fats. This leads to steatorrhea in which theres excessive discharge of fat in the feces. Semen analysis will show decreased sperm.
What would CXR tell you in CF?
Do this if suspicious of bronchiectasis. May see hyperinflation and ring shadows and cysts.
What is nasal potential difference testing?
Measures how well sodium and chloride flow across the mucous membranes in the nose
False positives for sweat chloride test in CF
AAddisons, hypothyroidism, nephrogenic diabetes insipidus
When is the sweat chloride test positive?
when chloride is greater than 60mmol/L in children
What is death usually due to in CF?
Respiratory failure
Median survival age of CF
36 years
Lung transplantation for CF should not occur if chronic infection with this organism
Burkholderia cenocepacia
How does Ivacaftor work
Is a CFTR modulator in CF patients with G551D mutation. It increases the amount of time the CFTR channel remains open.
4 components of therapy for CF
Mobilization of secretions, nutritional interventions, ATB therapy of chronic bronchiectasis, and control of airway inflammation
Patient presents with chronic cough, purulent, foul smelling sputum, fever, weakness, weight loss. Rale, rhonchi, and wheezes heard on auscultation. CXR shows bronchial wall thickening and airway dilation. What is the diagnosis?
Bronchiectasis- suspect diagnosis if chronic bacterial infection and the production of large quantities of foul-smelling sputum
Are recurrent infections with bronchiectasis common?
Yes
Diagnosis for bronchiectasis
Definitive test by HRCT- dilated airways that are thickened due to mucopurulent plugs (tree in bud pattern). CXR shows bronchial wall thickening, ring shadows with cysts. CBC, sputum culture and smear to check if bacterial cause, PFT, bronchoscopy
What condition can bronchiectasis lead to?
Pulmonary HTN
Who does bronchiolitis most commonly affect?
Infants and kids
Most common cause of bronchiolitis?
RSV- especially in witner months, and rhinovirus
3 main types of bronchiolitis in adults
Proliferative, constrictive, or follicular
Clinical features of bronchiolitis in children
Tachypnea, retractions, wheezing on expiration, grunting, nasal flaring cyanosis
Clinical features of bronchiolits in adults
Sneaky onset of cough and dyspnea
How is bronchiolitis diagnosed?
Clinically
