Respiratory Flashcards
What is spirometry?
assesses lung function by measuring expiration volume after max inhale
differentiates between obstructive and restrictive lung disease
Includes FEV1, FVC, and % (normal 0.7)
What is FEV1? Normal values?
Forced expiratory volume in 1’s
Volume exhaled in 1st second after deep inspiration and forced expiration
80% or greater than predicted is normal
What is FVC? Normal values?
Forced Vital Capacity
Total volume of air that patient can forcibly exhale in one breath
- *80% or greater** than predicted is normal
- *Low = airway restriction**
How are the results of spirometry expressed?
FEV1 / FVC
in %, best of three readings
Normal is >0.7
What does it mean to have an obstructive spirometry pattern?
FEV1/FVC below 0.7 = obstruction
What does it mean to have a restrictive spirometry pattern?
Normal FEV1/FVC > 0.7
but FVC is low = restriction
Name a few obstructive diseases?
COPD, asthma, emphysema, bronchiectasis, bronchiolitis,
cystic fibrosis
Name a few restrictive diseases?
Pulmonary
Pulm fibrosis, Pulm oedema, TB !
Non pulm
kyphoscoliosis, neuromuscular disease, connective tissue disease, obesity, pregnancy
What is reversibility?
Bronchodilator responsiveness - see if lung function gets better with meds
If
reversible - + asthma likely diagnosis
not reversible - fixed obstructive patho
partially reversible - coexist
How might you assess reversibility?
Spirometry → Administer bronchodilator → repeat
Test with 400 microgram salbutamol
Compare and contrast asthma & COPD?
Asthma
variable airflow obstruction
reversible
COPD
fixed airflow obstruction
may be mixture
What is COPD?
Chronic Obstructive Pulmonary disease
persistent airflow limitation, not fully reversible
progressive, assoc chronic bronchitis & empysema
What is chronic bronchitis?
Cough with sputum for 3 months
2 or more years
- *Hypertrophy & hyperplasia of bronchi** = bronchoconstriction, - airflow,
- *narrowing of airways**
What is emphysema?
Histological!
Enlarged airspaces distal to terminal bronchioles, with destruction of alveolar walls
loss of elastic recoil = - expiratory airflow
loss of alveoli = loss of SA for exchange
= airway collapse during expiration
Risk factors for COPD?
Cigarette smoke
Occupational exposure to pollutants, dust, chemicals, smoke
alpha-1 antitrypsin deficiency
recurrent lung infections
How might cigarette smoke cause COPD?
Mucus gland hypertrophy in large airways
= increase in WBC (N, M & L) & release of inflam mediators →
structural changes in lung = emphysema
Presentation of COPD (4)?
Productive cough
with white or clear sputum
Breathlessness - even at rest
prolonged expiration, poor chest expansion
lungs hyperinflated = barrel chest
Pursed lips on expire = prevent alveolar & airway collapse
Extra-pulmonary manifestations of COPD?
Pulmonary hypertension
= fluid retention, peripheral oedema
= (severe) RV hypertrophy, cyanosed
Weight loss, reduced muscle mass, general weakness, osteoporosis, depression
Function of alpha-1 antitrypsin in normal person?
secreted by liver, acts in parenchyma
Inhibits elastase
= protease that breaks down elastin
Elastin = important for
structural integrity of alveoli
How might alpha-1 antitrypsin deficiency caused COPD present?
Early onset, family history!
auto recess
smoking still +++ risk tho
a-1 a = hepatic secreted elastase inhibitor, deficiency = breakdown of alveoli = emphysema
Investigations for COPD (4)?
Lung function test
FEV < 80
FEV1/FVC < 0.7 = obstruct
CXR / CT
normal / hyper inflated lungs = low flattened diaphragm, long narrow heart shadow
reduced peripheral lung markings
bullae = airspace >1cm, complete destruct of lungs
FBC = chronic hypoxia
alpha-1 antitrypsin levels / genotypes
esp in premature disease & lifelong non smokers
What is peak flow?
= test of peak flow rate during forced expiration following max inspiration
Varies with:
diurnal (high afternoon low early)
age, gender, height
How might you differentiate between asthma & COPD (in investigations)?
Repeat peak flow to exclude asthma
Classification of stages of COPD?
Stage 1 - FEV1 <80%
Stage 2 - FEV1 50-79
Stage 3 - FEV1 30-49
Stage 4 - FEV1 <30%