Pulmonary Pathophysiology Flashcards
What is the difference between obstructive and restrictive pulmonary diseases?
Obstructive diseases - flow of air is impeded (during expiration)
Restrictive diseases - volume of air is decreased
What are the four main categories of pulmonary diseases?
- Infectious/inflammatory disorders
- Obstructive
- Restrictive
- Malignancy
What are two types of infectious pulmonary disorders?
- Pneumonia
2. Tuberculosis (TB)
What are two types of obstructive pulmonary diseases?
- COPD
2. Asthma
What are the two types of COPD?
- Chronic bronchitis
2. Emphysema
What are two types of restrictive pulmonary disease?
- Pulmonary fibrosis
2. Cystic fibrosis
What is pneumonia?
Infectious process in the lungs
What are risk factors for pneumonia?
Increasing age, dysphagia, immunosuppression, diabetes, malnutrition, dehydration, hospitalization, immobility, altered consciousness, and smoking history
What is the pathogenesis of pneumonia?
Normal immune response does not eliminate bacteria/virus - fluid buildup (parenchyma) causes mucosal membrane damage and alveolar capillary membrane damage (impedes oxygen diffusion)
What are the two types of pneumonia and what do lobes do they affect?
- Bacteria - limited to 1 or 2 lobes
2. Virus - bilateral (both sides of lungs)
What is aspiration pneumonia?
Impaired airway protection - fluid or food aspirated into the lungs
Which lung is aspiration pneumonia more likely to affect?
Right - main bronchus is more vertical
What are two symptoms associate with aspirated pneumonia?
Seizures and depressed gag reflex
What is the mortality rate for aspirated pneumonia?
5% (low)
What is a major sign/symptom aspiration pneumonia?
Coughing/SOB with eating or shortly after
What is a PT implication for aspiration pneumonia?
Head/neck positioning and posture during swalling
What is PCP?
Pneumocystis carinii pneumonia - new pneumocytes formed affecting participation in gas exchange
What population is most likely to get PCP?
AIDS or immunosuppressed patients
How long does pneumonia last?
1-2 weeks
What is treatment for pneumonia?
Antibiotics, hydration, exercise for pulmonary hygiene, and vaccines for >65 years old, diabetes, chronic lung disease, or immunocompromized patient
How is pneumonia diagnosed?
History of URI, sputum culture, chest x-ray, urine antigen, auscultation (crackles, wheezing, decreased lung sounds)
What disease is the 6th leading cause of death in the US?
Pneumonia
What is TB?
Infectious disease of the lungs - transmitted by inhaled droplets (sneeze, cough, etc) - causes proliferation of epithelial cells in alveoli
Is TB asymptomatic or symptomatic?
Asymptomatic
What are the signs/symptoms of active TB seen on chest x-rays?
Necrotic center, fibrosis of tissue, and spread through bloodstream/lymphatics
What are other signs/symptoms of TB?
Productive cough (>3 weeks), weight loss, fever, and malaise
What are the risk factors for TB?
Age, HIV, homeless, overcrowded living arrangements, malnutrition, prison inmates, ESRD, immunocompromised, and health care workers
What is the diagnosis of TB?
History, chest x-ray, sputum culture, and skin test (TB test)
What is the treatment for TB?
Medications to prevent cell wall biosynthesis (6-9 months) and chest x-rays to monitor people who already have TB
What is the prognosis for TB?
Untreated - 50-80% fatal in 2.5 years
What are PT implications for TB?
2 step PPD test yearly, cover mouth and nose when sneezing, masks, disinfect stethoscope, and hand washing
What are risk factors for obstructive diseases?
Smoking, age, sex, environmental allergens, and heredity
What sex is more likely to develop obstructive diseases?
Men - although this is changing
What are characteristics of COPD?
Airway obstruction, air trapping, gas exchange abnormalities, mucus production, pulmonary HTN, systemic effects
What type of muscle fibers are lost for patients with COPD?
Type I
What are factors of chronic bronchitis?
Productive cough (at least 3 months each year for two consecutive years), decreased expiratory flow (FEV1), and effects to large and small bronchi
What is the pathogenesis of chronic bronchitis?
Inflammation on bronchi with scarring of bronchial lining, increases mucous production (wheezing, productive cough, decreases size of lumen), frequent infections, and airway collapse/trapping (decreases amount of air that reaches alveoli and decreases ventilation)
What are signs/symptoms of chronic bronchitis?
Cough, sputum productions, SOB, activity intolerance, enlarged A-P diameter, use of accessory muscles with activity, wheezing, cyanosis, and cor pulmonale
What is emphysema?
Destruction of the distal airways beyond the terminal bronchiole, destruction of elastic properties of the alveolar wall, and pockets of air formed between alveolar spaces
What structure does emphysema affect?
Alveoli
What are signs and symptoms of emphysema?
Dyspnea progressing to SOB at rest, cor pulmonale, accessory muscle use, cachectic, barrel chest, and atrophy of endurance muscles
What disease presents with a barrel chest and why?
Emphysema - more air left in the lungs after expiration (residual volume)
Which pulmonary disease presents with an enlarged A-P diameter?
COPD - chronic bronchitis and emphysema
What are the three diagnostic tests for obstructive pulmonary diseases?
- Pulmonary function test (PFT)
- Gas flow rates
- Forced vital capacity
What is the function of a PFT?
Test the function of respiratory muscles, health and function of airways, and classify diseases - indicate airflow abnormalities
What is the function of gas flow rates?
Measure gas flow in various parts of the lungs and to test function of the lung, magnitude of impairment, and location of impairment
What is the function of a spirometer?
Measures volume - IRV, ERV, RV, TV, etc
What are signs and symptoms for pneumonia?
URI, productive cough, dyspnea, tachypnea, tachycardia, fever, fatigue, myalgias, and cyanosis
What is the function of forced vital capacity (FVC) test?
Measures the maximum volume of gas a patient can exhale forcefully and quickly
What is forced expiratory volume in one second (FEV1)?
Amount of air exhaled during 1st second of a FVC test
How are PFT’s interpreted?
Actual value divided by predicted value - <80% to be abnormal
What are the PFT values for COPD?
> or equal to 80% - mild
50-79% - moderate
30-49% - severe
What has to be confirmed in order to diagnose COPD?
FEV1/FVC < or equal to .70 after a bronchodilator has been given
What is the diagnosis for COPD?
Chest x-ray, arterial blood gas, sputum cultures, PFT’s, history (smoking and environmental exposure)
What is the treatment for COPD?
Smoking cessation, steroids, bronchodilators, mucolytics, antibiotics, oxygen, exercise, breathing retraining, posture retraining, lung volume reduction surgery, and lung transplant
What is a reversible obstructive lung disease?
Asthma
What is the most common chronic disease?
Asthma
What is asthma?
Chronic inflammatory disorder that leads to airway hyper-responsiveness, airway edema, mucous, and bronchoconstriction
What sex is more likely to develop asthma?
Men - after puberty incidence is the same for men and women
What population is more likely to develop asthma?
Children before age 5
What are risk factors for asthma?
Premature birth, urban settings, cold climates, low SES, African Americans, overcrowded living areas, and obesity
What are some protective factors to developing asthma?
Older siblings, early exposure to pets, large families, and attending daycare
What are the three types of etiologies regarding asthma?
- Extrinsic asthma - triggers from external environment
- Intrinsic asthma - no known triggers
- Occupational asthma - allergen in the workplace
When is the onset generally for intrinsic asthma?
Adults >40 years old
Whom is occupational asthma more common amongst?
Housecleaners, homemakers, textile workers, bakers, farmers, and animal handlers
What is the pathogenesis of asthma?
Narrowing of airway, mucus plugging, air trapping, V/Q mismatch, and increased workload of breathing
What is important about airway inflammation with asthma?
Airway inflammation is always present
How do asthma patients present?
Sensation of airway narrowing, tickle in airways, nonproductive cough, wheezing, tachypnea, tachycardia, fatigue, nostril flaring, accessory muscle use, cyanosis, and restlessness
What is the diagnosis for asthma?
Pulse ox, PFT with medications, arterial blood gas, x-rays, and history
What is prevention for asthma?
Education, medication compliance, and aerobic fitness
What is the main treatment for asthma?
- Identify the trigger - symptoms abate after treatment
2. Inhalers, oral meds, and injections
What are the two types of treatment management for asthma?
- Controllers - take on a daily basis
2. Relievers - taken as needed
What is exercise induced bronchospasm (EIB)?
When exercise is a trigger for asthma: 5-15 minutes after exercise begins and can last 15-60 after exercise ends
What is the diagnosis of EIB?
10-15% or greater drop in FEV1 when 80% of max HR is reached for at least four minutes
What is significant of restrictive lung diseases?
Decreased total lung capacity, decreased exercise intolerance, increased work of breathing, accessory muscle use, weight loss, and hypoxemia
What is pulmonary fibrosis?
Chronic inflammation leads to lung fibrosis - lung is no longer elastic so you can’t get a lot of volume in
What are risk factors for pulmonary fibrosis?
Idiopathic, TB, ARDS, asbestos, lupus, chemotherapy, and radiation
What is the pathogenesis of pulmonary fibrosis?
Irreversible proliferation of fibroblasts –> decreased lung compliance and alveolar and capillary injury
What is the treatment for pulmonary fibrosis?
Corticosteroids, maximize use of diaphragm, maintain airway opening, maintain oxygenation, and cough training
What is the prognosis for pulmonary fibrosis?
Chronic, progressive disease with <4 years
What is cystic fibrosis?
Autosomal recessive disorder with an abnormality in the CFTR protein on chromosome 7 - disorder of sodium and chloride channels
What race is most likely to get CF?
Caucasians
What is the average lifespan of a person with CF?
37.4 years
What is the pathogenesis of CF?
Obstruction by mucus (thick mucus from dehydration), frequent infections, hyperinflation, bronchiolitis/bronchiectasis
How does a patient with CF present?
“Salty” sweat, productive cough, wheezing, frequent infections, weight loss, exercise intolerance, increased WOB, and decreased FEV1
What are some problems associated with CF?
Problems with GI system, liver, pancreas, genitourinary (sterility and infertility), musculoskeletal (rheumatoid arthritis and osteopenia), and lungs (hypoxia and barrel chest)
What is the diagnosis of CF?
Prenatal screening, sweat test, pancreatic elastase, and PFT’s
What is the treatment for CF?
Bronchodilators, mucolytics, corticosteroids, oxygen, and antibiotics
What are PT implications for CF?
Secretion management - chest PT, postural drainage, exercise, positioning, theravest, autogenic drainage, and adjunct airway clearance (PEP and flutter)
Are FEV1 and FVC reduced or increased in people with lung disorders?
Reduced
