Respiratory Flashcards
What is dyspnea?
Subjective sensation of uncomfortable breathing
What is severe dyspnea?
- Flaring of the nostrils
- Use of accessory muscles of respiration
- Retraction of the intercostal spaces
What is orthopnea?
Dyspnea when lying down
What is paroxysmal nocturnal dyspnea?
Awaking at night and gasping for air; must sit up or stand up
What is a cough?
Protective reflex that helps clear the airways by an explosive expiration
What is a acute cough?
Cough that resolves within 2 to 3 weeks
What is a chronic cough?
Cough lasting longer than 3 weeks
What is abnormal sputum?
Changes in amount, consistency, color, and odour provide information about the progression of disease and the effectiveness of therapy. E.g yellow or green sputum = bacterial infection, pink = blood
What is hemoptysis?
Coughing up blood or bloody secretions
What is eupnea?
A normal breathing pattern
What are abnormal breathing patterns?
Adjustments made by the body to minimise the work of the respiratory muscles
What are Kussmaul respirations (hyperpnea)?
Slightly increased ventilatory rate, very large tidal volume, and no
expiratory pause
What is labored breathing?
Increased work of breathing
What is restricted breathing?
Disorders that stiffen the lungs or chest wall and decrease compliance
What are Cheyne-Stokes respirations?
Alternating periods of deep and shallow breathing; apnea lasting 15 to 60 seconds, followed by ventilations that increase in volume until a peak is reached, after which ventilation decreases again to apnea
What is cyanosis?
- Bluish purple discolouration of the skin and mucous membranes
- Develops when have five grams of desaturated haemoglobin, regardless of concentration
What is peripheral cyanosis?
- Most often caused by poor circulation
- Best observed in the nail beds
What is central cyanosis?
- Caused by decreased arterial oxygenation (low saturation of oxygen [SO2])
- Best observed in buccal mucous membranes and lips
What is clubbing?
- Enlargement of tips of fingers and change in angle of the nail bed
- Amount of soft tissue below nail increases
What is ventilation (V)?
Air reaching alveoli
What is perfusion (Q)?
Blood reaching alveoli
What is the normal V/Q ratio?
0.8-0.9
What does mismatched V/Q cause?
Hypoxemia
What does low V/Q ratio cause?
Impaired gas exchange,
causing low partial oxygen
What does high V/Q ratio cause?
It is caused by pulmonary embolism and result in low partial oxygen
What do pulmonary function tests do?
- Assess the function of the lungs
- Determine fitness
- Detect impairment
What do ventilatory function measure?
Lung volumes and pressures
What do tests for diffusion of alveolar gases measure?
Gases in expired air and in the blood
What is hyercapnia?
- Increased carbon dioxide in the arterial blood
- Occurs from decreased drive to breathe or an
inadequate ability to respond to ventilatory stimulation
What is hypoxemia and hypoxia?
- Hypoxemia (blood) versus hypoxia (tissues)
- Ventilation-perfusion abnormalities: Most common cause
What is a spirometer?
- Measures lung volume & capacity
- Dependent on age, gender, ethnicity & height
- Measure FEV1 & FVC
What is FEV1?
- Forced volume capacity
- Forced expiratory volume in one second
What is FVC?
- Forced vital capacity
- Maximum amount of air that can be expired
What is normal FEV1/FVC?
80%
What FEV1/FVC ratio diagnoses COPD?
70%
What are restrictive defects?
Decrease compliance of the lungs or chest wall
What are obstructive defects?
Block the exchange of air to and from the lungs
How do tests for obstructive defects show?
- FEV1 greatly reduced
- FVC normal or slightly reduced
- FEV1/FVC below 80%
How do tests for restrictive defects show?
- FEV1 slightly reduced
- FVC reduced proportionally
- FEV1/FVC normal
What are risk factors for COPD?
- Tobacco smoke
- Pollution
- Occupational exposure
- Frequent lower respiratory infections
What are risk factors for COPD?
- Tobacco smoke
- Pollution
- Occupational exposure
- Frequent lower respiratory infections
What is the main preventative strategy for COPD?
- Tobacco cessation with nicotine replacement
What is the pathophysiology of COPD?
- Starts as small airway disease
- Takes 30 years to progress
- Irritant causes inflammation of airway epithelium, which infiltrates inflammatory cells & releases cytokines
- Causes continuous bronchial irritation & inflammation = chronic bronchitis
- Causes increased protease activity with breakdown of elastin in lung connective tissue = emphysema
- Accumulation of changes cause airways obstruction, air trapping, & loss of surface area for gas exchange
How to diagnose COPD?
Spirometry FEV1 less than 80%, FEV1/FVC less than 70%
Treatment for COPD?
COPD is not curable, but treatment can slow the progress of the disease, control symptoms and improve quality of life for people with the illness
How does COPD affect expiration?
- Airway obstruction is worse with expiration
- More force or more time is required to expire a given volume of air; emptying the lungs is slowed.
What are the clinical manifestations of COPD?
- Increased work of breathing
- Ventilation-perfusion mismatching
- Decreased forced expiratory volume in one second (FEV1)
What is emphysema?
- Decrease of elastic recall
- Destruction of alveolar walls produce dilated air spaces and less surface area for gas exchange
- Unsupported airways tend to collapse on expiration
- Obstruction of small
bronchioles - Air trapping (dec. elasticity)
- Exertional dyspnoea
- Weight loss
- Accessory muscle breathing
What is air trapping?
When bronchial walls collapse during expiration causing air to become trapped
How does emphysema affect the lungs?
- Destruction of the alveoli due to elastin breakdown due to imbalance between proteases & anti-protease, oxidative stress & apoptosis of the lung’s structural cells
- Cause large spaces within lung parenchyma (bullae) & air spaces to pleura (blebs)
What are the clinical manifestations of emphysema?
- Dyspnea on exertion
- Later progresses to marked dyspnea, even at
rest - Little coughing and very little sputum
- Thin
- Tachypnea with prolonged expiration; use of accessory muscles for ventilation; pursed lips
- Barrel chest
- Tripod position
What is chronic bronchitis?
- Recurrent or chronic productive cough for a minimum of 3 months for 2 consecutive years
- Chronic inflammation, episodic dyspnoea
- Hypertrophy of secretory bronchial glands cause mucus plugging
- Cilia are destroyed
- Bronchoconstriction
- Increased airflow resistance
- Increased work of breathing
- Hypoventilation & CO2 retention causes hypoxemia & hypercapnia
- Accessory muscle breathing
What is the pathophysiology of chronic bronchitis?
- Inflammation of epithelium
- Enlarged submucosal gland
- Hyperinflation of alveoli
- Mucous accumulation & plugging
What are the clinical manifestations of chronic bronchitis?
- Decreased exercise tolerance
- Wheezing and shortness of breath
- Productive cough becomes copious
- Polycythemia
- Decreased FEV1
What does Alpha 1-antitrypsin deficiency do?
- Alpha 1-antitrypsin inhibits proteases which protects tissues from neutrophil elastase
- Deficiency cause neutrophil elastase to breakdown elastin, lower elasticity of lungs and causes complications such as emphysema
- Neutrophil elastase is secreted by neutrophils during inflammation, it destroys bacteria and host tissue
- Cigarette smoke can lead to oxidation of a residue of
Alpha 1-antitrypsin essential for binding elastase - 1 in 2500 people
What is mild COPD?
- FEV1 60-80%
- Breathless with moderate exertion
- Recurrent chest infections
- Little to no impact on ADL’s
What is moderate COPD?
- FEV1 40-59%
- Increased dyspnea
- SOB walking on level ground
- Increased limit on ADL’s
- Cough & sputum production
What is severe COPD?
- FEV1 less than 40%
- Dyspnea with mild exertion
- ADL’s severely limited
- Chronic cough
- Regular sputum production
What are some COPD management ideas that are non-pharmaceutical?
- Pulmonary function tests, ABG’s, chest x-ray, exercise test, dsypnea scales
- Nutrition interventions since respiratory distress increases calorie needs
- Oxygen therapy
What are some ideas pulmonary rehabilitation for COPD?
- Education
- Aim to improve lung function & other symptoms
- Smoking cessation
- Optimising drug treatment
- Physiotherapy
- Recognising worsening symptoms
What are medications for COPD?
- Bronchodilators (short or long acting)
1) Beta-agonists and anticholinergics,
2) SABA (e.g salbutamol/Ventolin), LABA (eg. Salmeterol), LAAC (eg. tiotropium) - Inhaled corticosteroids (ICS)
- Oral corticosteroids (long term use has side effects)
What are COPD exacerbations?
- When pt with COPD experiences sustained (24-48hrs) increase in cough, sputum production, and/or dyspnea
- Most common causes bacterial or viral infections, annual flu vac, pneumococcal vac
- Common reason for hospitalisation, and requirement for mechanical ventilation
How to manage COPD?
- Drugs- bronchodilators (short and long-acting), Corticosteroids, Antibiotics for infections
- Pressured Metered Dose Inhalers, Nebulisers, Ventilators
- Oxygen Therapy or oxygen concentrator
- Self-Management
What are complications of COPD?
- Cor pulmonale
- Right heart failure
What is cor pulmonale?
- Secondary to Pulmonary Arterial Hypertension (PAH)
- Right ventricular enlargement
- Pulmonary hypertension, creating chronic pressure
overload in the right ventricle
What are clinical manifestations of cor pulmonale?
- Heart appears normal at rest
- With exercise: Decreased cardiac output, chest pain
Treatment of cor pulmonale?
- Decrease workload of the right ventricle by lowering
pulmonary artery pressure - Same as for treating PAH
- Reversal of the underlying lung disease
What is the pathophysiology of cor pulmonale?
1) COPD causes chronic hypoxemia & acidosis
2) Pulmonary artery vasoconstriction
3) Increased pulmonary artery pressure
4) Irreversible until this point
5) Fibrosis & hypertrophy of smooth muscle layer of pulmonary arteries
6) Chronic pulmonary hypertension
7) Cor pulmonale
8) Right heart failure
What is asthma?
- Chronic inflammatory disorder of the airways
- Characterised by reversible airflow obstruction causing cough, wheeze, chest tightness & SOB
- Causes reversible bronchial hyper-responsiveness, constriction of the airways and variable airflow obstruction
What are risk factors for asthma?
- Cause of asthma not understood
- Genetic predisposition with environmental exposure to inhaled substances e.g. smoke, allergen, chemicals
What is the pathophysiology of asthma?
- Reversible airway obstruction
- Dyspnea
- Wheeze
- Early response -bronchoconstriction
- Last phase up to 6 hours later is inflammation and bronchoconstriction
- IgE causes masts cells to degranulate, releasing inflammatory markers
What is the pathophysiology of an exacerbation of asthma?
During exacerbation:
- Bronchial hyperactivity
- Smooth muscle cells in the bronchi constrict
- Airways inflamed and swollen
- Mucus plugs
How to prevent asthma?
- Reduce exposure to allergens
- Lower air pollution
- Smoking cessation
- Immunisation
- Lower occupational exposure
What are pharmacotherapy management of asthma?
- Mild - SABA inhalers
- Persistent - anti-inflammatory medications & ICS
- Not adequately controlled on ICS - Leukotriene antagonists
- Severe - LABA
- Oral NSAID
What are non-pharmacological treatments of asthma?
- Oxygen therapy
- Monitoring of gas exchange & airway
obstruction in response to therapy - Education
- Skin Prick Testing for allergies
