Shortness of Breath - Johns Flashcards
Define asthma.
inflammatory disease of airways with significantly reversible narrowing
What is dyspnea?
“abnormally uncomfortable awareness of breathing”
Can be related to exertion or not related to exertion
Define chronic bronchitis.
chronic productive cough for three months in two successive years
Define emphysema.
pathological term in which there is enlargement of airspaces with destruction of bronchiole walls
Define COPD.
“disease state characterized by airflow limitation that is not fully reversible. Progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases.”
What is the DDx for dyspnea on exertion?
Congestive heart failure Angina (anginal equivalent) Obstructive pulmonary disease Pleural Effusion Anemia Hypothyroid Metabolic acidosis Anxiety and hyperventilation
How common is COPD?
Fourth-ranked cause of death in U.S.
Most important lung disease in U.S.
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
Progesses to:
-Chronic clear sputum production
-Weight loss
-Morning headache
-Hypercapnia with hypoxemia
-Cor pulmonale
What are the physical exam findings in COPD?
Prolonged expiration Hyperinflation – Increased A-P diameter Hyperresonent to percussion Depressed diaphragm Decreased breath sounds Wheezes – airflow obstruction End-stage – accessory muscles, pursed lips, cyanosis, enlarged liver, asterixis
What are the diagnostic tests used to diagnose COPD?
Chest x-ray
Chest CT
Pulmonary function tests
Decreased FEV-1
Decreased FEV-1/FVC
Increased total lung capacity
Absence of bronchodialator responseWhat is the DDx for COPD?
- COPD
- Asthma
- CHF
- Bronchiectasis
- Tuberculosis
- Obliterative bronchitis
- Diffuse panbronchiolitis
What is the most important component of COPD management?
Smoking cessation!!!
Slows decline in FEV-1
5-year decline in smokers – 267 ml
sustained quitters – 72 ml
What is the triad of symptoms for asthma?
Persistent wheeze – 35 %
Chronic cough – 24 %
Chronic dyspnea – 29%
What are the physical exam findings in asthma?
Widespread, high-pitched wheezes
Wheezes are poor predictor of severity of outflow obstruction however
Signs in severe outflow obstruction
accessory muscles
pulses paradoxus (greater than 10mmHG fall
in systolic pressure during inspiration)
How do you evaluate Peak Expiratory Flow Rates (PFT’s)?
Patient measures at home
“Red” – less than 50% of personal best
“Yellow” – 50 to 80%
“Green” – Over 80%
Spirometry – FEV-1 and FVC
Degrees of obstruction (predicted FEV-1)
>80% - borderline
60-80% - mild obstruction
40-60% - moderate
