Pulmonary 1 Diseases Flashcards
COPD - Definition / Etiology & Risk Factors
Reduced expiratory flow and slow forced emptying of the lungs. This limitation in airflow is only minimally reversible with bronchodilators. 2 forms: Chronic Bronchitis and Emphysema.
General COPD Etiology/Risk factors:
- Tobacco smoke (up to 90% of COPD deaths linked)
- Others: air pollution, second-hand smoke, hx of childhood URI, occupational exposure, alpha-1-antitrypsin deficiency (familial emphysema)
Currently over 1/5 of adults in US dx with COPD - 3rd leading cause of death in America
COPD Sign and Symptoms
Barrel Chest Purse-lip breathing Cyanosis *Dyspnea *Chronic productive cough *Wheezing Weight loss Peripheral Edema Nail clubbing
COPD Diagnostic Work-up
*Pulmonary Function Test - increased total lung capacity
CBC - Concurrent infx
*CXR - show hyperinflation
Alpha-1-Antitrysin level - familial link?
*Pulse oximetry - exacerbated states to see oxy state
Arterial blood gases - if hospitalized
Chest CT
Emphysema
“Pink Puffer”
Permanent enlargement of alveolar ducts and air spaces due to loss of recoil and scarring in the distal airways. Going to get progressively worse over time. From SOB to much worse. Smokers and >50yo at risk
AAT deficiency in familial traits - getting emphysema is almost inevitable.
These people tend to naturally reduce their activity level. Limited movement makes effects less.
Sxs: working very hard to breathe, dyspnea from mild exertion to cyanosis at rest.
Exercise intolerance
cough is rare; scant clear mucus
PE for Emphysema
Barrel chest from hyper inflated lungs
Cachectic (muscle and fat wasting)
Appear uncomfortable
Purse-lipped breathing
Prominent use of accessory muscles
Hyper resonance on percussion
decreased breath sounds with exacerbations may be expiratory crackles, wheezing
PMI - point of maximal impulse may be deviated towards sternum
No peripheral edema
Hoover’s sign: lower ribs pull together with deep inhale
May see yellowing on fingernails
Chronic Bronchitis
“Blue Bloater”
Mucus hyper-secretion secondary to hypertrophy of the glandular elements of the bronchial mucosa producing a cough most days of the month, 3 months of a year for 2 successive years without another explanation.
Smoking, pollutants, dust, microbes, commonly occurs 30s-40s
Sxs: cyanosis, polycythemia and fluid retention.
Chronic productive cough, mucopurulent sputum, dyspnea is mild.
PE for Chronic Bronchitis
Larger body habitus, cyanotic
Increased RR and HR
Hyperinflation
Hyper resonance on percussion
Rhonchi, wheezes, decreased breath sounds, prolonged expiration
Early inspiratory cradles
Advanced disease: cyanosis, elevated jugular venous pulse, peripheral edema
DDX for COPD
Bronchiectasis, central airway stenosis, congenital problem, mass outside of lung pressing on bronchus, heart failure, CF, constrictive bronchiolitis, bronchopulmonary mycosis
Asthma
Reversible obstructive lung disorder with an increased reactivity of airways to various stimuli causing attacks or wide spread broncho-constriction and dyspnea. Features overlap COPD but is different with degree of reversibility.
3 Major features:
- Airway obstruction - air moving though the tightened airways causes vibration and a whistling sound known as wheezing. Episodic and reversible.
- Inflammation - red and swollen bronchial tubes
- Airway irritability - airways extremely sensitive and tend to overreact to triggers such as pollen, animal dander, dust or fumes.
Incidence: increasing prevalence and fatality in past 20 years, common in childhood. M:F 2:1 in childhood, M=F in adults >30. Family hx of allergy, asthma, atopy increase risk of developing.
Common trigger for asthma attacks
URI - cold and flu, bronchitis or sinus infx
Inhalent allergens - pollens, mold, dander, dust mites
Medications - aspirin, NSAIDS
Food and food additives - sulfite sensitivity
Exercise
Irritants
Weather
Strong emotions
GERD
Asthma S/Sxs
No signs between attacks Cough, at night or with exercise with sputum production Episodic wheezing, SOB Chest tightness, pain or pressure Decreased exercise tolerance
PE Asthma
With asthma attack: Respiratory distress, increased RR, increased HR, sweating, use of accessory muscles, anxiousness, can’t speak
Pulsus paradoxus- slow HR pulse on inspiration
Chest hyperinflation
Labs, imaging, other tests
Pulmonary function tests: spirometry, measurements before or after bronchodilator treatment
CBC: eosinophils >4% or normal
Total serum IgE levels >100 IU
Allergy skin testing
24 hour gastric pH monitoring
Asthma Classifications
Allergic/Extrinsic - allergy to external factors: pollen, mold, etc.
Non-allergic/Intrinsic - from infection of upper or lower airways.
Naturopathic Treatments of Asthma
Magnesium for smooth muscle relaxation N-acetyl cysteine for thinning mucus Attack tools like acute homeopathic Essential oil steam inhalation Inhaler to have on hand
Bronchiectasis
Bronchial permanent dilation. Thickening of walls or out-pouchings. Mucus secretions and recurrent infx that reactivate the cycle. Mucus traps organisms that set up shop. Progressive scarring and deformity of airways.
Common in >50yo woman
Etiology: Congenital bronchial obstruction, immunodeficiency, abnormal secretion clearance, infections, associated conditions.
S/Sxs of Bronchiectasis
Chronic daily productive cough thick viscous sputum hemoptysis dyspnea wheezing pleuritic chest pain chronic fatigue hyposmia, urinary incontinence
PE of Bronchiectasis
Findings are non-specific and may be attributed to other conditions. Fever, weight loss, crackles, clubbing, wheezes, ronchii, nasal polyps.
CHF
Imaging/Labs of Bronchiectasis
HRCT - high resolution CT of the chest showing characteristic features of dilated airways CBC Spirometry Sputum cultures CXR
Case 2: 68 yo female with dyspnea, fatigue, and a chronic productive cough.
DDX: Chronic bronchitis, Bronchiectasis, COPD, CHF
How long has it been going on? Has it changed over time? Quantity and quality of sputum. Occupation? Time of day its worse. Worse with activity/exercise? Do you smoke? Lifestyle factors? Blood in sputum?
PE: Vitals, Lung auscultation, percussion, heart auscultation, peripheral edema, check nail beds for clubbing, cyanosis, cap refill, yellowing. PMI to check for deviation. HEENT, lower structures: lymph, nose, sinuses, mouth. Chest expansion. Thyroid. Conjunctival pallor, hand for anemia. Maybe abdominal exam for thoroughness.
Work-up: pulse oximeter, sputum culture, chest film, CBC
Cystic Fibrosis
Chronic progressive disorder from a gene defect that causes the body to produce abnormally thick mucus, primarily affecting respiratory and digestive systems. Mutation in the CTFR protein leading to thick mucus.
M=F
Sxs: may exhibit sxs at birth or later. mild to life threatening.
CF: multi-system findings
Lungs: persistent, productive cough with sputum
Pancreas: insufficient digestive enzyme production
Bowels: obstruction
Liver: cirrhosis
Skin: salty taste
CF: PE
Nose: Nasal Polyps
Pulmonary: Tachypnea, wheezes, crackles, cough, cyanosis
GI: Hepatosplenomegaly, abdominal distention
Others: dry skin, scoliosis, swelling of salivary glands
CF: Dx / Labs
Genetic, parents are screened. Child isn’t developing at expected. Salty skin, recurrent infections.
Sweat chloride test. Chest film, Pulmonary function test.
Stool test to see if there is excess fat - steatorrhea
Detection of CF in a fetus is possible through genetic testing.
Prognosis: improving, remains a life-limiting disease, median age is 37.4 years.
Bronchiolitis Obliterans
Very rare inflammation of the distal bronchioles caused by a virus or substances like fumes. sudden onset of cough or wheezing. Can look like asthma. Usually because of something inhaled, depending on extent can be damaging or reversible.
