Unit 3 - Respiratory Diseases pt 2 - obstructive

Question 1

obstructive diseases

Answer 1

Airway is obstructed during exhalation (hard to get air OUTTTTT)
Flow rates are altered in a predictable manner, resulting in abnormal pulmonary function tests.

Question 2

(COPD) “Check -valve effect”

Answer 2

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

Question 3

COPD blood gasses

Answer 3

1. Arterial blood gasses normal values:
   - arterial pO2: 80-100 mmHg
   - arterial pCO2: 35-45 mmHg
   - hemoglobin O2 sat: SaO2 95-100%
2. respiratory acidosis:
   - dec ph of body fluids, normal is 7.35-7.45
   - hypoventilation
   - excess carbonic acid in the blood

Question 4

pulmonary functions testing

Answer 4

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!!

Question 5

2 conditions under the category of COPD

Answer 5

1. emphysema

2. chronic bronchitis

Question 6

COPD cause

Answer 6

80-90% of those diagnosed with COPD are current or former smokers

Question 7

emphysema

Answer 7

Progressive destruction of: Distal Airways and Alveoli

“Irreversible”
Pulmonary Infections
“End Stage” Lung Disease
Males > Females

Question 8

3 types of emphysema

Answer 8

Centrilobular
Panlobular
Mixture

Question 9

Centrilobular Emphysema

Answer 9

• Destruction of Respiratory Bronchioles
• Affects the Central Acinus (“terminal repiratory unit”)
  Poor Ventilation causes V/Q Imbalance
  Cyanosis
  Bradypnea (slow breathing)
  Cor Pulmonale

Question 10

Panlobular Emphysema

Answer 10

• Affects all of the Alveoli of an Acinus
• Increased Pulmonary Dead Space
  Diffusion Block
  Compensation by Tachypnea (fast breathing)

Spontaneous Pneumothorax-Blebs
Bullae Formation

Question 11

blebs

Answer 11

represent a build-up of air on the surface of the lung - an air pocket

Question 12

bulla

Answer 12

characterized by an air-filled, thin-walled space within the lung tissue itself resulting from the dilation and destruction of alveoli

Question 13

“pink puffer”

Answer 13

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”

Question 14

chronic bronchitis

Answer 14

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

Question 15

pathophysiology of chronic bronchitis

Answer 15

chronic inflammation and narrowing of the airways
increased mucous production
recurrent respiratory infections

Question 16

“blue bloater”

Answer 16

description of someone with chronic bronchitis

dyspnea
excess body weight
swelling and congestive heart failure
excessive sputum
hypoxia and hypercapnia
sleep apnea
poor prognosis

Question 17

other obstructive pulmonary diseases

Answer 17

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

Question 18

bronchial asthma

Answer 18

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

Question 19

asthma pathophysiology (3)

Answer 19

Smooth muscle spasm
Mucosal edema
Increased bronchial secretions

Question 20

asthma s/s

Answer 20

Use of Accessory Respiratory Muscles
Wheezing 	
Apprehension
Tachycardia
Perspiration
Dyspnea
Flushing
Diminished Breath Sounds 
Cough
Cyanosis
Respiratory Distress

Question 21

types of bronchial asthma

Answer 21

Intrinsic (Adult Onset)
Extrinsic
Mixed

Question 22

intrinsic asthma

Answer 22

• 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.

Question 23

extrinsic asthma

Answer 23

• 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!

Question 24

“atopic march”

Answer 24

refers to the allergic “march” toward asthma

Eczema → food allergies → allergic rhinitis → asthma

*mostly with extrinsic asthma

Question 25

mixed asthma

Answer 25

Intrinsic and extrinsic components, same symptoms

Question 26

Status Asthmaticus

Answer 26

Severe, intractable asthmatic episode

Rapid breathing: PaCO2 falls
hypocapnea
Fatigue and exhaustion
Breathing slows: PaCO2 rises (hypercapnea)

Question 27

bronchiectasis

Answer 27

• 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.

Question 28

causes of bronchiectasis

Answer 28

Pertussis (“whooping cough”) – bacterium – “Bordetella pertussis
Measles (viral infection) –”Koplik’s” spots
Bronchopneumonia
Chronic Bronchitis
Cystic Fibrosis (~50%)

Question 29

Cystic Fibrosis info

Answer 29

Genetic disorder
Recessive Trait (“both parents must be carriers”)
High early mortality
80%-First 2 decades

Question 30

CF definition

Answer 30

characterized by abnormal production of thick and sticky mucus in the lungs as well as other areas throughout the body

Question 31

pulmonary consequences of CF

Answer 31

Persistent productive cough
Wheezing
Repeated lung and sinus infections
Steadily declining lung function (“abnormal PFT’s”)

Question 32

pancreatic effects of CF

Answer 32

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

Question 33

clinical picture CF

Answer 33

Thin, Asthenic
Barrel Chest
Protruding abdomen
Elevated shoulders

Question 34

Tx of CF

Answer 34

Postural Drainage
Exercise; Breathing Exercises
Pursed-lip Breathing
Antibiotics & O2