Respiratory Disorders Flashcards
Respiratory Disorders
- major categories (3)
- cardinal symptoms (2)
Obstructive (e.g. asthma)
Restrictive (e.g. sarcoidosis)
Vascular abnormalities
Dyspnea
Cough
Asthma
- define
- prevalence
Condn in which a person’s airways become inflamed, narrow, swell, and produce excess mucus - difficult to breathe
One of the most common chronic diseases globally
Asthma
- peak incidence
- severity
~3 years old
Varies greatly, but not significantly within a given pt
Asthma
- risk factors vs triggers
- major risk factor
RF: may cause development of disease
T: may exacerbate the disease
Atopy
As Asthma
-pathophysiology
—assoc w/ __
—leading to (6)
Specific chronic inflammation of the mucosa of the lower airways leading to:
Infiltration (inflamm cells) Fibrosis (remodeling) Edema Mucus hypersecretion Smooth muscle hypertrophy/hyperplasia Airway hyper-responsiveness** -> bronchoconstriction (inflamm cascade)
Asthma
-pathophysiology
—foci
—fatal asthma
Down deep in lungs - at level of alveoli (gas exchange site)
Mucus plug is common finding
Asthma
-clinical features
Characteristic symptoms: wheezing, dyspnea, coughing
Prodromal may proceed
May be (-)abnormal when under control
Asthma
-diagnosis
Usually apparent from symptoms
Must be confirmed by objective measurements of lung function
-spirometry
Asthma
-treatment
—bronchodilators
—controllers
Bronchodilators
- rapid relief
- usually beta-2 agonist (albuterol) PRN via inhaler
Controllers
- inhibit underlying inflamm process
- usually low-dose inhaled corticosteroid BID
Asthma
-OD implications (3)
Glaucoma meds interaction
-bottom line, avoid tx glaucoma with Timolol for asthmatics on albuterol
Steroids
Activate emergency response system
Chronic Obstructive Pulmonary Disease (COPD)
- define
- prevalence
Group of lung diseases characterized by persistent respiratory symptoms and airflow limitations that’s not fully reversible
> 10 million
3rd leading cause of death USA
Chronic Obstructive Pulmonary Disease (COPD)
-subcategories and definitions (3)
Emphysema
- anatomically defined
- desctruction of alveoli/loss of septae with air space enlargment
Chronic bronchitis
- clinically defined
- chronic cough and phlegm
Small airway disease
-small bronchioles are narrowed and reduced in number
Chronic Obstructive Pulmonary Disease (COPD) -pathophysiology —when airway limitations occur —triggers —chronic inflammation leads to (3)
In setting of noxious environmental exposures in those genetically susceptible
Ciagrette smoke»_space;> occupational exposures
ECM destruction
Cell death
Ineffective repair
Chronic Obstructive Pulmonary Disease (COPD)
-signs/symptoms
Cough, sputum production, exertional dyspnea
May eventually develop resting hypoxemia -> need supplemental O2
Chronic Obstructive Pulmonary Disease (COPD)
-diagnosis (3)
Pulmonary function tests
Arterial blood gases/oximetry - may demonstrate hypoxemia
Radiographic studies - classify type of COPD
Chronic Obstructive Pulmonary Disease (COPD)
-hypoxia vs hypoxemia
Hypoxia: An absence of enough oxygen in the tissues to sustain bodily functions
Hypoxemia: A low level of oxygen in the blood
Chronic Obstructive Pulmonary Disease (COPD)
-treatment
—goals
—only 3 that have proven to increase survival rate
Symptomatic relief and reduce further risk
Smoking cessation, supplemental O2, lung volume reduction surgery
Chronic Obstructive Pulmonary Disease (COPD)
-OD implications (4)
Dry eye from supplemental O2
Medications (same as asthma)
Susceptible to infections/prone to airborne pathogens
Thinning of RNFL in pts with hypoxia/chronic inflammation
Sleep Apnea
- define
- apnea vs hypopnea
- types (2)
Cessation or reduction in airflow for at least 10 sec during sleep
A: cessatoin
H: reduction
Types
- obstructive (OSAHS)
- central (CSA) - less common
Obstructive Sleep Apnea - pathophysiology —in general —vs asthma/COPD —anatomy —waking
Neuromuscular output to pharyngeal dilator muscles decreases during sleep
Mechanical problem in upper airway (asthma/COPD = lower)
Pharynx collapse (apnea) or near collapse (hypopnea)
Ventilatory reflexes activated, cause arousal
Obstructive Sleep Apnea
- main risk factors (2)
- prevalence
Obesity (4x) Male gender (2-4x) - esp due to fat distribution near neck/airway
Peak 3-8 in children
2-15% mid-age, >20% elderly
Esp high for HTN, DM
Undiagnosed in majority of adults
Obstructive Sleep Apnea
- symptoms (2)
- physical findings (2)
Snoring
Excessive daytime sleepiness
Central obesity
Oropharynx - small orifice with crowding by enlarged tongue, low soft palate, bulky uvula, large tonsils, etc.
Obstructive Sleep Apnea
-diagnosis
Gold standard = polysomnogram
Obstructive Sleep Apnea
-management (4)
Lifestyle/behavioral changes
CPAP - continuous positve airway pressure
Oral appliances
Upper airway surgery
Obstructive Sleep Apnea
-OD implications (4)
Virtually any ischemic ocular disorder may be exacerbated
- diabetic ret
- glaucoma
- NAION
Floppy eyelid
CSCR
Dry eye
