Unit 3 - Respiratory Diseases pt 2 - obstructive Flashcards
obstructive diseases
Airway is obstructed during exhalation (hard to get air OUTTTTT)
Flow rates are altered in a predictable manner, resulting in abnormal pulmonary function tests.
(COPD) “Check -valve effect”
leading to bronchiolar obstruction
A. During inspiration, lumen widens enough to allow air entry.
B. During expiration, premature collapse and narrowed lumen prevent egress of air that becomes trapped in alveoli.
hypoxemia, hypercapnia, air retention, diffusion block, shunt effect, cyanosis
COPD blood gasses
- Arterial blood gasses normal values:
- arterial pO2: 80-100 mmHg
- arterial pCO2: 35-45 mmHg
- hemoglobin O2 sat: SaO2 95-100% - respiratory acidosis:
- dec ph of body fluids, normal is 7.35-7.45
- hypoventilation
- excess carbonic acid in the blood
pulmonary functions testing
Airflow Decrease – Reduced FEV1
“Forced ExpiratoryVolume in 1 second”
“The amount of air that can be forcibly exhaled in 1 second following a maximal inspiration”.
Abnormal if < 80% of predicted for age, gender and height.
Very important indicator of obstructive disease!!
2 conditions under the category of COPD
- emphysema
2. chronic bronchitis
COPD cause
80-90% of those diagnosed with COPD are current or former smokers
emphysema
Progressive destruction of: Distal Airways and Alveoli
“Irreversible”
Pulmonary Infections
“End Stage” Lung Disease
Males > Females
3 types of emphysema
Centrilobular
Panlobular
Mixture
Centrilobular Emphysema
- Destruction of Respiratory Bronchioles
- Affects the Central Acinus (“terminal repiratory unit”)
Poor Ventilation causes V/Q Imbalance
Cyanosis
Bradypnea (slow breathing)
Cor Pulmonale
Panlobular Emphysema
- Affects all of the Alveoli of an Acinus
- Increased Pulmonary Dead Space
Diffusion Block
Compensation by Tachypnea (fast breathing)
Spontaneous Pneumothorax-Blebs
Bullae Formation
blebs
represent a build-up of air on the surface of the lung - an air pocket
bulla
characterized by an air-filled, thin-walled space within the lung tissue itself resulting from the dilation and destruction of alveoli
“pink puffer”
description of someone with emphysema
Thin, “cachectic” Accessory muscle use Barrel chest Elevated shoulders Pink/rosy skin tones (“less hypoxia than the blue-bloater”) Digital clubbing “Pursed-lip breathing”
chronic bronchitis
Progressive Disease
May have Hyperactive Airway Component
High incidence in England
Smoking History!!!!
cough and expectoration of at least 3 months duration, occurring for at least 2 consecutive years.
Incidence
25-35% of all men
15% of all women
pathophysiology of chronic bronchitis
chronic inflammation and narrowing of the airways
increased mucous production
recurrent respiratory infections
“blue bloater”
description of someone with chronic bronchitis
dyspnea excess body weight swelling and congestive heart failure excessive sputum hypoxia and hypercapnia sleep apnea poor prognosis
other obstructive pulmonary diseases
Asthma Bronchiectasis Carcinoma of the Lung (may also result in restrictive problems) Cystic Fibrosis bronchial asthma
bronchial asthma
Hyperactive Airway Disease (“Reactive Airway Disease”)
Reversible
Wheezing – Rhonchus
3,300 Deaths/year
25,000,000 individuals in the US with asthma
Greatest increase in recent years has been in black children
common triggers:
House Dust Mites, Cigarette Smoke, Cockroaches, Hyperthyroidism, cold air, emotional distress, allergens, exercise induced asthma
asthma pathophysiology (3)
Smooth muscle spasm
Mucosal edema
Increased bronchial secretions
asthma s/s
Use of Accessory Respiratory Muscles Wheezing Apprehension Tachycardia Perspiration Dyspnea Flushing Diminished Breath Sounds Cough Cyanosis Respiratory Distress
types of bronchial asthma
Intrinsic (Adult Onset)
Extrinsic
Mixed
intrinsic asthma
- Adult onset (no childhood/fam history)
- Not IgE Induced: no allergies
- Exercise induced
Chronic Sinusitis, Nasal Polyps
allergy shots do not work
worse prognosis - There seems to be a connection between GERD and asthma risk in adults.
extrinsic asthma
- Allergen provoked (IgE mediated)
- Exercise, cold temp
- Childhood onset of allergies and asthma, fam history
Positive skin tests
Childhood history of eczema
Presence of “allergic shiner”
Allergy shots work!
“atopic march”
refers to the allergic “march” toward asthma
Eczema → food allergies → allergic rhinitis → asthma
*mostly with extrinsic asthma
mixed asthma
Intrinsic and extrinsic components, same symptoms
Status Asthmaticus
Severe, intractable asthmatic episode
Rapid breathing: PaCO2 falls
hypocapnea
Fatigue and exhaustion
Breathing slows: PaCO2 rises (hypercapnea)
bronchiectasis
- chronic abnormal bronchial airway dilation and inflammation
- airways lose their elasticity, are dilated, and EASILY COLLAPSABLE
- in individuals with other underlying pulmonary disorders such as chronic bronchitis, cystic fibrosis, or tuberculosis.
causes of bronchiectasis
Pertussis (“whooping cough”) – bacterium – “Bordetella pertussis
Measles (viral infection) –”Koplik’s” spots
Bronchopneumonia
Chronic Bronchitis
Cystic Fibrosis (~50%)
Cystic Fibrosis info
Genetic disorder
Recessive Trait (“both parents must be carriers”)
High early mortality
80%-First 2 decades
CF definition
characterized by abnormal production of thick and sticky mucus in the lungs as well as other areas throughout the body
pulmonary consequences of CF
Persistent productive cough
Wheezing
Repeated lung and sinus infections
Steadily declining lung function (“abnormal PFT’s”)
pancreatic effects of CF
thick mucus clogs the tubes that carry digestive enzymes from the pancreas to the small intestine.
Malabsorption of nutrients:
Impaired weight gain/growth
Constipation
Intestinal Blockage
clinical picture CF
Thin, Asthenic
Barrel Chest
Protruding abdomen
Elevated shoulders
Tx of CF
Postural Drainage
Exercise; Breathing Exercises
Pursed-lip Breathing
Antibiotics & O2
