Shortness of Breath Flashcards
What is Dyspnea?
“Abnormally uncomfortable awareness of breathing”
What may or may not Dyspnea be related to?
Exertion
What is the mechanism behind Dyspnea?
- Peripheral afferents (chemoreceptors) sense: Inc. PaCO2, Dec. PaO2, Dec. pH. + Stretch receptors on the lung sense stretch
- Information goes to the Brain respiratory center.
- Then to sensory cortex
- Then to motor cortex
- Then to brain respiratory center
What is the Ddx for Dyspnea on exertion (DOE)?
- Congestive heart failure
- Angina (anginal equivalent)
- Obstructive pulmonary disease
- Pleural Effusion
- Anemia
- Hypothyroid
- Metabolic acidosis
- Anxiety and hyperventilation
Why is COPD so important?
- Fourth-ranked cause of death in U.S.
- Most important lung disease in U.S.
What is the definition of Chronic Obstructive Pulmonary Disease?
“disease state characterized by airflow limitation that is not fully reversible, progressive and associated with an abnormal inflammatory response of the lungs to noxious particle or gases.”
What is Chronic bronchitis?
Chronic productive cough for three months in two successive years.
What is Emphysema?
Pathological term in which there is enlargement of airspaces with destruction of bronchiole walls
What is Asthma?
Inflammatory disease of airways with significantly reversible narrowing
What are the three types of COPD?
- Chronic bronchitis
- Emphysema
- Asthma
What patients with asthma don’t have COPD?
Patients with asthma whose airflow obstruction is completely reversible are not considered to have COPD.
What are patients with unremitting asthma classified as?
COPD
What are patients with chronic bronchitis or emphysema without airflow obstruction classified as?
NOT HAVING COPD
What is different between the airflow limitation in asthma and the airflow limitation in COPD?
Airway limitation in asthma is completely reversible. COPD is completely irreversible.
What is the pathology of asthma?
Sensitizing agent –> asthmatic airway inflammation –> CD4+ T lymphocytes, Eosinophils –> airflow limitation
What is the pathology of COPD?
Noxious agent –> COPD airway inflammation –> CD8+ T lymphocytes, Macrophages, Neutrophils —> Airflow limitation
What are the clinical features of COPD?
- Patients have usually smoked at least 20 cigarettes per day for 20 or more years
- Usually starts with a chronic cough
- Dyspnea may not occur until 10-20 years later
What test is needed to establish a diagnosis of COPD?
Spirometry
What key indicators should you use when considering COPD diagnosis?
- Chronic cough
- Chronic sputum production
- Dyspnea that is progressive, persistent, worse on exercise and with infections, described as heaviness, gasping
- History of exposure to risk factors (tobacco smoke, dust, chemicals, cooking and heating fuels)
What is on the Ddx for COPD?
- Asthma
- CHF
- Bronchiectasis
- Tuberculosis
- Obliterative Bronchiolitis
- Diffuse Panbronchiolitis
What symptoms occur as COPD progresses?
- Chronic clear sputum production
- Weight loss
- Morning headache
- Hypercapnia with hypoxemia
- Cor pulmonale
When does FEV1 start to decrease in COPD?
Around age 35-40
When does FEV1 reach 25% its value at age 25 yrs in COPD patients?
Around age 70
What is FEV1?
Forced expiratory volume in one second
