RESPIRATORY - obstructive lung disorders: asthma & COPD

Question 1

what is the definition of obstructive lung disorder?

Answer 1

airways that are narrowed –> allows alveoli to inflate but can not deflate –> increase overall lung volume + can not bring more air in because of the air trapped already –> impaired gas exchange + acid base imbalance

Question 2

what are the two disorders under obstructive lung dsorders?

Answer 2

• asthma
• COPD (chronic obstructive pulmonary disease)

Question 3

what is asthma?

Answer 3

inflammation disorder to the bronchial mucosa

Question 4

what is the asthma’s pathophysiology?

Answer 4

airway exposed to antigen/irritant
–> degranulation mast cells
–> histamine release
–> bronchoconstriction + vasodilation
–> cytokines + leukotrienes
–> vasodilation, incr. capillary membrane, smooth muscle constriction & mucus secretion
–> obstructs airway
–> air trapped into alveoli
–> air can not escape
–> impaired gas exchange + hypoxemia
–> hyperventilation
–> respiratory acidosis –> respiratory alkalosis
–> respiratory failure

Question 5

what are asthma’s risk factors?

Answer 5

hypersensitivities (type 1) + environmental exposure!!
- genetics
- recurrent respiratory infections
- exercise
- GERD

Question 6

what are the biggest asthma manifestations?

Answer 6

• wheezes
• non productive cough
• use of accessory muscles to breathe

Question 7

what are the other asthma manifestations?

Answer 7

• neuro: altered LOC, dizziness, anxiety
• CV: tachycardia & hypotension
• resp: tachypnea, dyspnea & diminished breath sound
• GI: n/v
• GU: oliguria
• integ/musc: cyanosis & delayed capillary refill

Question 8

what labs and lab diagnostics would we use for asthma?

Answer 8

ABGs & PFTs (pulmonary function tests)

Question 9

what types of drugs do we use for asthma?

Answer 9

• ventilatory support: O2 & mech vent
• opening airways
• reduce allergic reactions

Question 10

what are the asthma’s complications

Answer 10

• status asthmaticus
• acid base imbalance –> respiratory failure –> cardiac arrest –> death

Question 11

what is status asthmaticus?

Answer 11

a continuous state of asthma attack –> can get hypoxic –> respiratory/cardiac arrest

Question 12

what is COPD? does it have a cure?

Answer 12

a progressive disease characterized by airflow limits

Question 13

what are the two major divisions of COPD and what are they? what do they both lead to?

Answer 13

• chronic bronchitis: overproduction of mucus & productive cough
• emphysema: destruction of alveolar walls –> breakdown elasticity of alveoli –> enlarges gas exchange airways

BOTH LEAD TO TRAPPING OF AIR –> chronic hypercapnia + hypoxia

Question 14

what is the the pathophysiology of COPD’s chronic bronchitis?

Answer 14

1. inflammation –> incr. in cells + mucus production –> air able to get into alveoli during inhalation –> air gets trapped bc of mucus during exhalation –> decr. gas exchange –> v/q mismatch

Question 15

what is the the pathophysiology of COPD’s emphysema?

Answer 15

neutrophils release an incr. of elastase & protease –> breaks down alveoli & bronchioles –> they lose elasticity –> air trapped –> v/q mismatch

Question 16

what is the haldane effect? is that part of chronic bronchitis or emphysema?

Answer 16

where oxygenated blood cant carry CO2 well –> if we give more O2 –> it kicks CO2 in the serum –> pt naturally breathes faster –> but w/COPD you can NOT –> pt becomes hypercapnic, hypoxic, & vasoconstriction in lungs

Question 17

what are COPD’s risk factors?

Answer 17

• genetics
• smoking!
• exposure to chemicals/pollution
• repeated respiratory infections

Question 18

what are COPDs manifestations?

Answer 18

• neuro: altered LOC, dizzy & anxiety
• CV: tachycardia & hypotension
• resp: tachypnea, dyspnea, diminished breath sounds
• GI: n/v
• GU: oliguria
• integ/musc: cyanosis, delayed capillary refill, using accessory muscles, weight loss, barrel chest, tripod breathing & clubbing
• repeated respiratory infections

Question 19

what are the biggest differences to know if its more chronic bronchitis or emphysema?

Answer 19

• chronic bronchitis: wheezing & productive cough
• emphysema: non productive cough

Question 20

what labs & diagnostics are we using for COPD?

Answer 20

-ABGs: 60-60 club
- PFTs & Xray

Question 21

what does the 60-60 club mean?

Answer 21

when the pt is hypoxic & hypercapnic
- PO2 = 60 (norm 80-100)
- CO2 = 60 (norm 35-45)

Question 22

what are COPD’s complications?

Answer 22

• infection
• spesis
• hypercapnia!: haldane effect & v/q mismatch
• hypoxemia!
• respiratory acidosis
• acute respiratory failure
• renal failure
• cor pulmonale
• death