Pulmonary- Obstructive disease Flashcards
1
Q
What is COPD?
A
- Airflow obstruction due to chronic bronchitis or emphysema
- airflow obstruction is generally progressive
- may be accompanied by airway hyper-reactivity
- may be partially reversible in asthma, but NOT in progressive COPD
- Obstruction is worse on expiration
2
Q
What are the common obstructive disorders?
Signs and symptoms?
A
- common disorders:
- asthma
- emphysema
- chronic bronchitis
- Signs/Symptoms
- Dyspnea
- wheezing
3
Q
What is Asthma?
A
- Chronic inflammatory disorder of the airways
- The inflammation causes:
- recurrent episodes of wheezing
- breathlessness
- chest tightness, cough (especially at night an in early morning)
- hyper-responsive to stimuli
- Widespread but variable obstruction that is often reversible
- **A. normal, B. emphysema, C. bronchitis, D. Asthma
4
Q
Asthma is an atopic disorder. What does this mean?
A
- Atopy- a genetic predisposition for the development of an IgE mediated response to common aeroallergens
- This is the strongest identifiable predisposing factor for developing asthma
5
Q
What are some stimuli that provoke asthma?
A
6
Q
What are the risk factors for asthma?
A
- Atopy
- increased serum IgE
- Family history of allergic diseases
- maternal smoking during pregnancy
- viral infections
- especially RSV and rhino as an infant
7
Q
How is Asthma diagnosed?
What are the differences in severity?
What dictates how the asthma is managed?
A
- Diagnosis based on flow-volume curves
- FEV1 and FEV1/FVC ratio decreased
- Management dictated by FEV1
8
Q
What is the pathophysiology of Asthma?
(chart)
A
9
Q
What are the characteristics of COPD?
A
- deterioration in elasticity or recoil which normally maintains the airways in open position
- decreased rigidity of bronchiolar wall
- collapse during exhalation
- Increase in gas flow velocity in the narrowed bronchioli, which lowers the pressure inside the bronchioli and favors collapse
- Increased secretions that cause bronchospasm
- destruction of lung parenchyma, causing enlarged air sacs and developing into emphysema
- **A. normal, B. emphysema, C. bronchitis, D. Asthma
10
Q
What are the risk factors of COPD
A
- Cigarette smoking
- passive smoking- increases airway reactivity
- chronic infections
- occupational factors
- coal mining, textile factories, dentists?
- Genetic
- Alpha-1-antitrypsin deficiency
- only known genetic abnormality that leads to COPD
- Accounts for less than 1% of cases
11
Q
What causes air trapping?
A
- During inspiration the airways are pulled open so air is able to enter
- Upon expiration, due to loss of recoil in the airways, they will collapse and prevent normal expiratory flow
12
Q
How is COPD diagnosed?
A
- Chronic productive cough
- airflow obstruction
- pulmonary function tests
- FEV1/FVC ratio decreased
- significant decrease in FEF 25-75%
13
Q
How do the lung volumes compare between a person with COPD and a person with healthy lungs?
A
- COPD
- Larger total lung capacity (TLC)
- Larger residual volume (RV) because they cannot get as much air out of their lungs
- decreased expiratory reserve volume (ERV)
14
Q
How is COPD staged?
A
- **All stages have FEV1:FEV ratio <70%
- 0: At risk
- normal spirometry but chronic cough or sputum
- 1: Mild COPD
- FEV1 >80%
- 2: Moderate COPD
- 50% 1 <80%
- 3: Severe COPD
- 30% < FEV1 <50%
- 4: Very severe COPD
- FEV1 < 30%
15
Q
What is chronic bronchitis?
A
- Hypersecretion of mucus and chronic productive cough that lasts for at least 3 months of the year and for at least 2 consecutive years
- inspired irritants increase mucus production as well as the size and number of mucus glands
- mucus is thicker than normal
16
Q
What is emphysema?
What are the different classifications of emphysema?
A
- abnormal permanent enlargement of the gas exchange airways with destruction of alveolar walls but no obvious fibrosis
- loss of elastic recoil
- Classifications
- Centriacinar- dilation initially affects the respiratory bronchioles
- Panacinar- dilation initially affects the alveolus and alveolar duct
17
Q
What is the difference between pure chronic bronchitis and pure emphysema?
(pic)
A
18
Q
What do anti-proteases do?
A
- Antiproteases prevent the breakdown of tissue proteins
- alpha1- anti-trypsin deficiency is a genetic disorder where the person doesnt have the anti-proteases so their tissue proteins get broken down faster than normal
19
Q
How does smoking cause emphysema?
A
- Tobacco introduces free radicals into lungs
- the free radicals inactivate the antiproteases
- causing a “functional” alpha-1 antitrypsin deficiency
- This increases neutrophil response and neutrophil elastase
- neutrophil and macrophage elastases cause damage to the tissue
20
Q
What is the pathophysiology of COPD?
(Chart)
A
21
Q
What is absorption atelectasis?
A
- Caused when inhaled volumes are not big enough to open the pores of kohn
- make sure TV is set large enough
- encourage post op deep breathing
22
Q
What is Bronchiectasis?
How is it diagnosed?
A
- Localized irreversible dilation of the bronchus caused by bacterial infections (air polutants too?)
- Destroys airways leading to airway collapse, airflow obstruction, and inability to clear secretions
- pooling mucus
- bacterial superinfection is tough to eradicate
- Diagnosis-
- chronic purulent cough
- clubbing of fingers (not characteristic of COPD)
- hemoptysis
- dyspnea/wheezing
23
Q
What is cystic fibrosis?
A
- Caused by mutation in a single gene on chromosome 7
- with this mutation, they lack a protein that helps move Na and H2O in and out of cells (Cl- is affected too)
- Decreased Cl- transport results in
- results in an abnormally thick mucus outside of epithelial cells
- destruction and scarring of various glands and tissues, causing damage to lungs, pancreas, liver, GI, & reproductive organs
- Primary cause of M&M of pts with CF is chronic pulmonary infection
24
Q
How id CF diagnosed?
A
- diagnosed by sweat Cl higher than 70 mEq/L
