Pulmonary Flashcards
asthma defintion
chronic episodic airway disease with effective treatment but no known cure
what percent of people have asthma
how many office visits are asthmas related
7-10%
1-3%
what is the leading cause of hospitalization among children and teens
asthma
asthma incidence has been increasing for 30 years
two theories why
air pollution
increased sensitivity to allergens due to hygiene hypothesis
what demographic is most likely to have asthmai
inner city population
what is the pathophysiology of asthma
reduction in airway diameter brough about by a contraction of smooth muscle, vascular congestion, edema, and tenacious sputum
three results of airway inflammation
bronchial hyperreactivity and bronchospasm
increased secretion and viscosity
bronchial remodeling
four causes related to asthma that reduce airway diameter
bronchospasm
vascular congestion
edema
thick sputum
two main types of asthma
which is most common
allergic and idiosyncratic
allergic
hallmarks of allergic asthma
personal or family Hx of allergies
early onset
what differentiates allergic from idiosyncratic asthma
idiosyncratic has no Hx, negative allergy skin tests, normal serum IgE
common triggers of allergic ashtma
allergies
psychological
medications
infections
habits
atmospheric
three mediations that cause cause asthma
beta blockers
anaphylaxis to medication
aspirin
three atmospheric triggers of asthma
pollution
cold air
abrupt weather changes
clinical manifestations of asthma
chronic dry cough
wheezing
SOB
sleep disturbances
poor exercise tolerance
chest tightness
T/F “all that wheezes is not asthma, and all asthma does not wheeze”
true
three non-asthmatic causes of wheezing
heart disease
COPD
inhaled foreign body
diagnostic process for asthma
improvement of symptoms with bronchodilators
sensitivity to stimuli
sputum elevated IgE
high blood eosinophil counts
what is the long term complication of asthma
airway remodeling in response to chronic inflammation that can lead to decline in pulmonary function
three goals of asthma treatment
reduce inflammation
dilate terminal airways
improve airway secretions
what medications can be used to reduce inflammation of asthma
glucocorticoids or other anti-inflammatories
why is inhalation therapy common
maximizes airway dose, minimizes systemic dose to decrease side effects
what is the function of beta-2 agonists in asthma treatment
side effects are caused by beta 1 cross reactivity
what are the side efects
bronchodilation
tachycardia, hyperglycemia, HTN
two types of beta 2 agonists and one example of each
short acting (albuterol)
long acting (salmetrol)
what is the effect of glucocorticoids on asthma treatment
typical oral treatment
one example of inhaled glucocorticoids
strong anti inflammatory effect
prednisone for 5-10 days
flunisolide
what is the relationship of leukotrines to asthma treatment
what is one side effect of increased leukotrienes
modulation of inflammation
LTD4 is a powerful bronchoconstrictor
what produces leukotrienes
three types
the action of 5-lipoxygenase on arachadonic acid
LTC4, LTD4, LTE4
types of leukotriene blocking drugs
leukotriene receptor antagonists
5-lipoxygenase inhibitor
what is the strategy for decreasing bronchial secretions in asthma treatment
application of anticholinergic/antimuscarinic agents to improve air way diamter
three types of emergency asthma treatment
epinephrine subcutaneous injection
beta 2 inhalers
glucocorticoids
describe the use of glucocorticoid as an emergency asthma therapy
oral is as effective as paenteral
takes 6-12 hours
reduces hospitalization
define pneumonia
inflammation of the lungs caused by bacteria, viruses, fungus
risk factors for pneumonia
smoking, alcoholism, comorbid disease, immunosuppression
downsides of glucocorticoid treatment of asthma
can cause calcium deficiency, HTN, hyperglycemia
three common symptoms of pneumonia
productive cough
fever/chills
dyspnea
four less common symptoms of pneumonia
pleurisy, chest pain, hemoptysis, anorexia
diagnostic process of pneumonia
symptoms plus
CXR
Labs
point of care tests
sources of organisms that typically cause pneumonia
community acquired (CAP)
hospital acquired (HAP)
what can cause CAP pneumonia
what is the most common
bacteria, virus, fungi
strepococcus pneumoniae (65-70%)
gram positive sources of HAP pneumonia
strep and staph
gram negative sources of HAP
klebsiella, pseudomonas
treatment for CAP
antibiotics, hospitalization for 25%, supportive care
treatment for HAP
ABx for resistant pathogens
supportive care
common antibiotics for CAP
cell wall inhibitors (amoxicillin/ampicillin)
protein inhibitors (macrolides)
fluoroquinolones (nucleic acid inhibitors)
typical cause of lobar pneumonia
strep
what is the prognosis of pneumonia
stabilization in 3-5 days
full recovery in 4-12 weeks dependant on age
what is the current mortality for hospital pneumonia patients
10%
three potential complications of pneumonia
pleural empyema
lung abcess
pleural effusion
three pathophysiology hallmarks of COPD
airflow obstruction
alveolar dialtion and destruction
chronic and acute airway infection
two types of COPD
what is the difference
chronic bronchitis and emphysema
chronic bronchitis is has more obstruction from sputum and inflammation
emphysema has more destruction of alveoli
T/F both chronic bronchitis and emphysema have alveolar loss and obstrution
true
three typical causes of COPD
how does it rank as common cause of death
smoking (99%)
other debris (coal dust/silica)
genetics (cystic fibrosis)
main symptoms of emphysema
chronic bronchitis
SOB with exertion and SOB at rest
chronic productive caugh with mucopurulent sputum
how is COPD related to asthma
smoking damages epithelium, leading to infection, inflammtion and asthma like reactive airways
three goals of COPD treatment
prevent, improve, support
smoking cessation is only effective 15-20% of the time
why?
what can be done to help the odds
nicotine is highly addictive
multi-faceted programs (education, support groups, meds)
two ways to improve COPD symptoms
stop smoking and control infections
improve airways with asthma medicaiton (bronchodilators, glucocorticoids, reduction in airway mucus
suportive strategy for COPD
airway support
supplemental oxygen
what is the prognosis of lung cancer 1 and 5 year
1 year, 40%
5 year, 15%
four types of lung cancer
most commin in bold
squamous 30%
small cell 15%
large cell 10%
adenocarcinoma 35%
what happens histologically with smoking
the loss of respiratory cilia
from a clinical perspective, what are the two types of lung cancer
small cell and non small cell
why is there a clincial distinciton between small cell lung cancer and others
because it is very aggressive and usually not able to be excised
what is the prognosis of small cells lung cancer with and without treatment
with 10-16 months
without 6-17 weeks
what is the main cause of lung cancer
smoking (13x higher) or exposure to smoke (1.5-2x)
what is the effect of smoking cessation on CVD
decreased risk to normal within 3-5 years
what is the effect of smoking cessation on lung cancer risk and prognosis
risk of lung cancer declines but more slowly than CVD
even with cancer the prognosis is better for those who quit
symptoms of lung cancer
weight loss (50-90%)
cough (60%)
hemoptysis (10-30%)
some have cest pain (20-40%)
what percent of patients with lung cancer are symptomatic on diagnosis
75-90%
diagnostic process of lung cancer
direct visualization with biopsy
diagnostic imaging
three imaging studies for lung cancer and their utlitiy
CXR
CT (for CT biopsy)
PET (useful in looking for distant mets)
what is the screening test for lung cancer
what are the pros and cons
yearly low dose CT for 3 yeras in patients 55 or older with a 30 yr pack history
pro: provides a modest increase in survival
cons: costly, high false positive
what often causes chest pain assocaited with lung cancer
mets to bone
where do lung mets spread
liver, spine, and brain
treatment for small cell lung cancer
combination chem with radiation
treatment of non-small cells carcinoma
surgery and chemo
what causes tuberculosis
describe the pathogens
infection by mycobaterium tuberculosis
slow growing acid fast aerobe
T/F tuberculosis only effects the lungs
false, late stages can effect every organ
T/F what percent of all humans have been infected with TB
30-40 percent
what is the main method of TB spread
where else can it come from
airborne in aerosol mucus
infected cow milk
what is required to pass TB onto someone else
what is the efficiency of transition
fair close prolonged contact
23%
what is the key pathologic feature of TB
why does it form
caseous granuloma
because the immune system cannot eliminate TB
what percent of patients will develop latent TB
what about progressive TB
90-95%
5-10%
symptoms and infectiousness of latent TB
usually none with a positive skin test
no expired TB
symptoms and infectiousness of an active (progressive) TB infection
systemic symptoms (fever, weight loss, cough, hemoptysis, fatigue)
TB bacilli in expired air
prognosis of active TB
100% cure rate with compliance and non-drug resistance
withotut treatment 35% will die in 1 year, another 35% in five years
miliary TB is most common in what patients
is this more or less lethal than other
infants, elderly, immunocompromisd adults
very lethal
what will induce a conversion of latent to active TB
immunosuppresion through HIV infection, glucocorticoids, chemo, poverty
diagnostic process for TB
HP
sputum culture with acid fast stain
skin test
lab test
chest xray
treatment for sensitive TB
first line drugs based on sensitivity for 2-3 months
two to three drugs for additonal 4-7 months
resistant TB treatment
up to 20 months of 2nd or 3rd line agents
isoniazid and rifampin
first line TB drugs
why is follow up in TB treatment so important
monitor compliance, clinical response, and drug toxicity
what percent of TB are resistant to first line drugs
how does mortality from multi-resistant TB compare to untreated active TB
10-15% of all strains
they are similar
