Shortness of Breath II (Johns) - W3 Flashcards
Definition of dyspnea
abnormally uncomfortable awareness of breathing
Dyspnea on exertion (DOE) differential diagnosis
Differential Diagnosis
- Congestive heart failure
- Angina (angina equivalent)
- Obstructive pulmonary disease
- Pleural effusion
- Anemia
- Hypothyroid
- Metabolic acidosis
- Anxiety and hyperventilation
4th ranked cause of death in US
most important lung disease in US
“disease has airflow limitation that is NOT FULLY REVERESIBLE”
Chronic obstructive pulmonary disease
Key indicators of COPD
- chronic cough
- long smoking history
- dyspnea - progressive, worse on exercise
- chronic clear sputum production
- weight loss
- morning headache
- cor pulmonale
Physical exam for COPD
- prolonged expiration
- hyperinflation
- hyperresonant to percussion
- decreased breath sounds
- wheezes
- accessory muscles, pursed lips, cyanosis, enlarged liver, asterixis
How do you diagnose COPD?
- chest x-ray
- chest CT
- pulmonary function tests
What do you see on pulmonary function tests with COPD?
- decreased FEV-1
- Decreased FEV-1/FVC ratio
- increased total lung capacity
- absense of bronchodilator response
What could be causing a low FEV1/FVC ratio
- Bronchodilator
- FEV1 increased = asthma
- NO increase = COPD
How should stable COPD be managed?
smoking cessation
What drugs can treat COPD?
- Beta-2 agonist
- Inhaled ipratropium (anticholinergics) - may show increased bronchidlation compared to beta agonists - inhibiting parasympaethic response. Prevent it happening and decrease mucous production.
- Theophylline
- Corticosteroids - may slow decline of FEV-1
- supplemental oxygen
- flu and pneumococcal vaccine
what antioxidant levels are often imbalanced in smokers/
Vitamin E levels low
Vitamin C, E and beta-carotene dietary intake low
What are the 3 types of COPD
asthma
emphysema
bronchitis
Which population is asthma more prevalent in?
Puerto Rican
Multiple race
children
blacks
What is seen and definited by the “definition of asthma”
Wheezing.
Cough.
Chest tightness.
What is the classic triad of symptoms?
Persistent wheeze.
Chronic cough.
Chronic dyspena.
