Pulm Flashcards
Pathophys of asthma
Airway inflammation via mast cells, eosinophils, epithelial, cells, macrophages, and activated T lymphocytes
Airflow obstruction via acute bronchoconstriction, airway edema, chronic mucous plug formation, and airway remodeling
Hyperinflation to compensate for the airflow obstruction
Factors that can contribute to asthma or airway hyperreactivity
Environmental allergens Viral respiratory tract infections Exercise, hyperventilation Gastroesophageal reflux disease Chronic sinusitis or rhinitis ASA or NSAID hypersensitivity, sulfite sensitivity Use of BBs Obesity Environmental pollutants, tobacco smoke Occupational exposure Irritants Various high and low molecular weight compounds Emotional factors or stress Perinatal factors
FHx of asthma
May be pertinent for: Asthma Allergy Sinusitis Rhinitis Eczema Nasal polyps
Exacerbation history of asthma
Usual prodromal signs or sx
Rapidity of onset
Associated illnesses
Number in the last year
Need for ED visits, hospitalizations, ICU admissions, intubations
Missed days from work or school or activity limitation
General manifestations of asthma
Wheezing is one of the most common sx
-However not necessary for the dx
Cough may be the only symptom of asthma
Other non-specific sx in infants or young children:
-Hx of recurrent bronchitis, bronchiolitis, or PNA
-Persistent cough with colds
-Recurrent croup or chest rattling
Mild episode PE- asthma
Pts may be breathless after physical activity such as walking Able to lie flat RR is increased Accessory muscles are not used HR <100 Pulsus paradoxus not present Moderate wheezing, often end-expiratory
Moderately severe episode PE- asthma
RR is increased Accessory muscles are used In children, supraclavicular and intercostal retractions, nasal flaring, abdominal breathing HR 100-120 Loud expiratory wheezing Pulsus paradoxus may be present SpO2 91-95% Breathless while talking
Severe episode PE- asthma
Pts are breathless at rest Not interested in eating Sit upright Talk in words rather than sentences Usually agitated RR >30 Accessory muscles Suprasternal retractions HR >120 bpm Loud biphasic wheezing Pulsus paradoxus if often present SpO2 <91%
Imminent respiratory arrest PE- asthma
Children- Drowsy and confused
Status asthmaticus- paradoxical thoracoabdominal movement
Wheezing may be absent, and severe hypoxemia may manifest as bradycardia
Pulsus paradoxus may be absent
As it becomes more severe, profuse diaphoresis
Pts may struggle for air, act confused and agitated and pull off their oxygen
Almost no breath sounds may be heard
Nonpulmonary manifestations of asthma
Signs of atopy or allergic rhinitis: Conjunctival congestion and inflammation Ocular shiners Transverse crease on the nose Pale violaceous nasal mucosa Turbinates may be erythematous or boggy Polyps may be present Skin: Atopic dermatitis Eczema
Nocturnal sx of asthma
Bronchoconstriction
Workup of asthma
Labs are not routinely indicated for the dx of asthma, but they may be used to exclude other diagnoses ABG and SpO2 are valuable for assessing severity of exacerbations and following response to tx CXR EKG for severe sx Allergy skin testing PFTs Bronchoprovocation Peak flow monitoring
Tx of asthma
Avoidance of allergens
Avoid tobacco smoke
Consider immunotherapy if a relationship is clear between sx and exposure to an unavoidable allergen to which the pt is sensitive, sx occur all year or during a major portion of the year, or sx are difficult to control with pharmacologic management
Stepwise therapy
Pathophys of acute bronchitis
The cells of the bronchial lining tissue are irritated and the mucous membrane becomes hyperemic and edematous, diminishing bronchial mucociliary function
Consequently, the air passages become clogged by debris and irritation increases
In response, copious secretion of mucus develops
Etiology of acute bronchitis
MC viruses include influenza A and B, parainfluenza, RSV, and coronavirus
Usually called by infections, such as Mycoplasma, C. pneumoniae, S. pneumoniae, M. catarrhalis, and H. influenza and by viruses
