Unit 2_Obstructive and Restrictive Pulmonary Disease Flashcards by Danielle Pieri

What measure different components of lung volume and flow rates?

Individuals breath into a spirometer with relaxed patterns, forced exhalation and forced inhalation.

Pulmonary function tests

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What is resting volume of air inspired and exhaled?

Tidal Volume (TV)

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What is the amount of air maximally inspired at the end of normal inspiration?

Inspiratory Reserve Volume (IRV)

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What is the amount of air maximally expired at the end of normal exhalation?

Expiratory Reserve Volume (ERV)

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What is the amount of air remaining after maximal exhalation?

Residual Volume (RV)

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What is the amount of air that can maximally be inspired?

Total Lung Capacity (TLC)

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What is the amount of air forcefully exhaled after a forced inhale? Intervals (common is 1 second FEV1).

Forced Expiratory Volume (FVC)

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What disease occurs when the airway is obstructed during expiration? Flow rates are altered in a predictable manner, resulting in abnormal pulmonary function tests.

Obstructive Diseases

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What disease occurs when respiratory depth (volume) is restricted? No blockage of air flow.
Causes:
Pulmonary Volume Reduction
Pulmonary Under-inflation

Restrictive Diseases

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What condition can you observe via the following:
1. During inspiration, lumen widens enough to allow air entry.
2. During expiration, premature collapse and narrowed lumen prevent egress of air that becomes trapped in alveoli.

Obstructive conditions:
Check - valve effect leading to bronchiolar obstruction

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What occurs when:
- Lower FEV1
- Abnormal if < 80% of predicted for age, gender and height.

Obstructive Conditions: Reduced air flow

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What occurs when:
- Lower IRV, ERV, and TLC
- Normal lung capacity is 6 liters

Restrictive conditions: Reduced lung volume

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What occurs when:
Ventilation (V) perfusion (Q) ratio should be 1. However, increased alveolar size can cause a shunt or dead space (shunt is when ventilation but not perfusion is spared)

Obstructive conditions: Check – valve effect leads to Air Retention AND Diffusion Block

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What are normal Arterial Blood Gases (ABGs)?

Arterial PaO2 (80-100 mm Hg)
Arterial PaCO2 (35-45 mm Hg)

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What are normal Hemoglobin O2 saturation?

SaO2 (95-100%)

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What obstructive changes to blood gases results from decrease ph of body fluids: Normal = 7.35-7.45?

Develops from:
Hypoventilation
Excess carbonic acid in blood

Hypoxemia
Hypercapnia

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What are chronic obstructive conditions?

Chronic Obstructive Pulmonary Disease (COPD)

Emphysema
Chronic Bronchitis

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What COPD condition is:
Progressive (irreversible) destruction of:
Distal airways
Alveoli

A form of “End stage lung disease”

Risk factors:
Smoking
Male

Three Types:
Centrilobular
Panlobular
Mixture (both types)

Emphysema

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What COPD condition is:
Destruction of Respiratory Bronchioles

Affects the Central Acinus (“terminal respiratory unit”)

Poor Ventilation causes diffusion block but maintained perfusion
Leads to:
- Cyanosis
- Bradypnea
- Cor Pulmonale

Centrilobular Emphysema

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What COPD condition is:
Affects all of the Alveoli of an Acinus

Diffusion Block – Leads to full Pulmonary Dead Space
- Compensation by Tachypnea
- Spontaneous Pneumothorax-Blebs
- Bullae Formation

Panlobar Emphysema

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What represent a build-up of air on the surface of the lung?
Sometimes occurs in otherwise healthy young adults.

Blebs

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What are characterized by an air-filled, thin-walled space within the lung tissue itself resulting from the dilation and destruction of alveoli?
They occupy space and lead to compression of healthy lung tissue. Can be surgically removed – “bullectomy”

Bulla

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What can lead to pneumothorax (“collapsed lung”)?

Both blebs and bulla

What COPD condition presents as:
- Thin, “cachectic”
(ka-kec-tick)
- Tachypnea
- Accessory muscle use
- Barrel chest (hyper inflation)
- Severe dyspnea
- Elevated shoulders
- Pink/rosy skin tones (“less hypoxia than the blue-bloater”)
- Digital clubbing

The “Pink Puffer”

What is a progressive disease: - Characterized by inflamed bronchial tubes and increased sputum production - Damages cilia and results in recurrent respiratory infection - Diagnostic requirement: cough and sputum of at least 3 months duration, occurring for at least 2 consecutive years. Incidence: - 25-35% of all men - 15% of all women

Chronic Bronchitis

What presents as: - Chronic, productive cough - Purulent sputum - Cyanosis - Peripheral edema - Wheezing - Pulmonary hypertension - Cor pulmonale - Peripheral edema

The "Blue Bloater"

What are additional obstructive diseases?

Asthma Bronchiectasis Carcinoma of the Lung (may also result in restrictive problems) Cystic Fibrosis

What obstructive disease is: Reversible Hyperactive Airway Disease - Also known as “Reactive Airway Disease” Characteristic Breath Sound: Wheezing - Example video Common causes (triggers) - Cigarette Smoke - Cockroaches - Hyperthyroidism - Exercise Induced Asthma (EIA) - Emotional Distress - Cold Air - Allergens (dust mites, pollen spores, Pollen) - Idiopathic

Bronchial Asthma

What obstructive disease is: Reversible Hyperactive Airway Disease - Also known as “Reactive Airway Disease” Triggers lead to smooth muscle spasms in the bronchial tubes, mucosal edema, and increased secretions.

Bronchial Asthma

What are the following signs and symptoms of? Use of Accessory Respiratory Muscles Wheezing Apprehension Tachycardia Perspiration Dyspnea Flushing Diminished Breath Sounds Cough Cyanosis Respiratory Distress

Bronchial Asthma

What type of Bronchial Asthma includes: - No Childhood or Familial history - Not IgE Induced-No Allergens - Exercise or Cold Temperature Induced - Develops Chronic Sinusitis, Nasal Polyps - There is a correlation with Gastroesophageal Reflux Disease (GERD) - Prognosis is poor

Intrinsic (adult onset)

What type of Bronchial Asthma includes: - IgE Mediated - Allergen Provoked - Exercise or Cold Temperature Induced

Extrinsic

What type of Bronchial Asthma includes a combination of Intrinsic and Extrinsic components?

Mixed

What type of bronchial asthma is: Childhood history of eczema is a precursor for developing asthma (The Atopic March) Eczema --> food allergies --> allergic rhinitis --> asthma Persons develop an “allergic shiner” (dark circles under the eyes) Pathology: 1. The allergen triggers IgE response 2. IgE attaches to mast cells and triggers degranulation 3. Release of histamine and other inflammatory mediators leads to mucus production, itchiness, redness, and swelling Allergy shots can help treat extrinsic asthma

Extrinsic

What is a severe and intractable asthma response? Pathology: 1. Rapid and intractable bronchospasm 2. Paired with mucosal plugs Symptoms: 1. Immediate dyspnea resulting in hyperventilation and drop in PaCO2 (hypocapnea) 2. Increased breathing work leads to hypoventilation and increase in PaCO2 leading to hypercapnea and acidosis with extreme fatigue

Status Asthmaticus

What is the following treatment for: Recognize that there is no relieve from acute beta-agnosists (ex. albuterol inhalers) or subcutaneous epinephrine (EPI) Immediate medical attention (911 or code) is necessary Requires O2, high doses of epinephrine and corticosteroids

Status Asthmaticus

What involves chronic abnormal bronchial airway dilation and inflammation? Bronchioles lose their elasticity, are dilated, and easily collapse. Commonly co-occurs with bronchopneumonia, chronic bronchitis, cystic fibrosis, or tuberculosis. Can develop from: - Pertussis (“whooping cough”) – bacterium – Bordetella pertussis - Measles (viral infection) –”Koplik’s” spots A. Longitudinal section of bronchial wall: chronic infection/ coughing cause damage to bronchial walls. B. Collection of purulent material in dilated bronchioles leading to persistent infection.

Bronchiectasis

What is characterized by abnormal production of thick and sticky mucus in the lungs as well as other areas throughout the body? Cause: Recessive genetic mutation (both parents are carriers) Pulmonary symptoms: - Persistent productive cough - Wheezing - Repeated lung and sinus infections - Steadily declining lung function (abnormal PFT – FEV1) Pancreatic pathology - thick mucus clogs the tubes that carry digestive enzymes from the pancreas to the small intestine. GI symptoms: Without these digestive enzymes, nutrient absorption is impaired leading to: - Malabsorption - Impaired weight gain/growth - Constipation - Intestinal Blockage

Cystic Fibrosis

What disease presents as: - Thin - Barrel Chest - Protruding abdomen - Elevated shoulders Life expectancy: 50-80 years old Previously it was 30 (1993)

Cystic Fibrosis

What is the following treatment for: - Postural drainage - Exercise – including breathing exercises - Pursed-lip breathing - Beta agonists, antibiotics, O2 - Lung transplant

Cystic Fibrosis

What is a breathing technique for all persons with obstructive lung conditions to improve air flow? Slow and forced exhale will create positive end expiratory pressure (PEEP) Person purses lips and provides resistance with a slow exhale out via mouth (1:2) inhale to exhale. Example: 2 second inhale, 4 second exhale Only perform 3-5 breaths because it is fatiguing

Pursed Lip Breathing

What are chronic restrictive pulmonary diseases?

Pneumoconiosis Pickwickian Syndrome Thoracic skeletal disorders Neuromuscular disorders

What are other chronic restrictive pulmonary diseases?

Pneumonia Sarcoidosis Lung Cancer (can also be obstructive)

What is chronic fibrosis and scarring of the lung parenchyma? Primarily caused by inhaling lung irritants: - Silicosis - silica dust inhalation (“stone cutter”) - Anthracosis – coal dust (“black lung”, “coal miners lung”) - Asbestosis

Pneumoconiosis

What is obesity hypoventilation syndrome? Excess body weight leads to hypoventilation with resulting hypoxemia and hypercapnea. Persons are high risk for sleep apnea.

Pickwickian Syndrome

What is Thoracic Deformities Restricting Ventilation, and possibly leading to atelectasis of poorly ventilated alveoli? Examples: Kyphosis Scoliosis Pectus excavatum

Thoracic Skeletal Disorders

What disorders can restricting ventilation by causing muscle weakness? Examples: Guillain-Barre Multiple Sclerosis Spinal cord injury – Quadriplegia Muscular dystrophies

Neuromuscular Disorders

What is systemic (or local to an organ) deposit of gamma globulins from lymphocytes triggers macrophages to develop granulomas (abnormal response)? Granulomas will lead to fibrosis and scarring. Etiology is unknown. - Commonly diagnosed in middle age (40-50) - Women are more commonly diagnosed - Americans who are black are 3x as likely to develop sarcoidosis

Sarcoidosis

What symptoms are the following associated with: - Dependent on organ systems involved - Pulmonary – shortness of breath, fatigue - Musculoskeletal – arthritis - Skin lesions - Nervous system – neuropathies - Cardiac – heart failure Treatment is commonly corticosteroids Advanced disease may require transplant

Sarcoidosis

What is the leading cause of cancer death in the United States? 85-90% of all cases are in persons who smoke (largest risk factor) Common categories of lung carcinomas: - Non-small cell lung cancer (majority of cases - 80%)+ 1. Squamous cell (epidermal) – slow (squamous cells lining airways) 2. Adenocarcinoma – surrounds bronchi and bronchioles in upper airway 3. Large cell (anaplastic) – rapid growth and fast metastasis Small cell lung cancer 1. Small cell (oat cell) – fastest growing Treatments: 1. Chemotherapies 2. Surgical resection

Lung cancer

What type of lung cancer is the majority of cases - 80%+? 1. Squamous cell (epidermal) – slow (squamous cells lining airways) 2. Adenocarcinoma – surrounds bronchi and bronchioles in upper airway 3. Large cell (anaplastic) – rapid growth and fast metastasis

Non-small cell lung cancer

What type of lung cancer is Small cell (oat cell) – fastest growing?

Small cell lung cancer

What is the common signs of: Dyspnea Cough Sputum production Commonly metastasizes to the adrenal glands, brain, bone, liver Typically, the diagnosis follows because of symptoms in metastatic areas

Lung cancer

What is growth on the apex of the lung that compresses the brachial plexus and sympathetic nervous system? (Horner’s – PAM)

Pancoast tumor

What is face, neck, and arm edema? Worse with supine positioning.

Superior Vena Cava Syndrome