wheezing and stridor Flashcards
shortness of breath differential
lung cancer, asthma
clinical symptoms of copd
Dyspnea (at rest, with exertion)
Cough - with or without sputum
Wheezing
frequent chest illness/cold/bronchitis
Chronic inflammation of copd
Causes structural changes
Narrows small airways
Decreases lung elastic recoil
chronic bronchitis
chronic productive cough for 3 months in each of 2 successive years
Other causes of cough have been ruled out, may proceed or follow development of air flow limitiation obstruction
emphysema
pathologic term
Structural changes- Abnormal and permanent enlargement of airspaces distal to the terminal bronchioles, destruction of airspace walls without obvious fibrosis
Can be present in pts without air flow limitations
risk factors for copd
Host factors- Alpha 1 antitrypsin deficiency, airway hyperresponsiveness, lung growth impairment (low birth weight, childhood respiratory infections
Exposures- tobacco smoke, occupational dusts and chemicals, indoor airpollution, biomass fuels and ETs
Outdoor air pollution from inhaled particles, SES
Assessment of COPD
Symptoms- less symptoms or more symptoms based on modified medical research council dyspnea scale (mMRC) or COPD assessment test (CAT)
Grade of airflow limitation on post bronchodilator spirometry (low risk or high risk)
Number of exacerbations requiring a medication change (low risk or high risk)
Identification of comorbitidities that contribute to individual disease severeity
0- 4 (worst
Cat- 0 40(worst)
Airflow limitation
Grade 1 to 4 severe
Exacerbations
Acute events characterized by worsening of symptoms beyond normal-day to day variation and necessitating a change in medication (oral steroid and/or antibiotics)
Previous exacerbations predict future exacerbations
As airflow limitation worsens, exacerbation risk increases
Low risk of exacerbation <1 exacerbation/year and post-bronchodilator FEV1 >50% predicted
High risk of exacerbation >2 exacerbation/year and post bronchodilator FEV1<50 % predicted
treatment options for COPD
Self management education and smoking cessation Bronchodilators Inhaled corticosteroids Pulmonary rehabilitation Oxygen Surgery
Drug names for COPD
Short acting B2 adrenergic agonists (SABA)- Albuterol
Short acting anticholinergic Antagonist- Ipratropium bromide
Long acting B2 adrenergic agonists (LABA)- salmeterol, formoterol
Long acting anticholinergic antagonist- tiotropium
Inhaled Corticosteroids- beclomethasone, fluticasone, and budesonide
Combined drugs- fluticasone/salmeterol, Budesonide/formoterol
Theophyllin (Tachycardia, many toxicity) PDE4 inhibitor (roflumilast)
Other
managing acute exacerbations of COPD
Bronchodilators (SABA, short acting anticholinergic antagonists, combination)
Systemic corticosteroids- oral prednisone
Antibiotics- clinical improvement in pts with a moderate to severe exacerbation
Oxygen therapy
anticholinergics in COPD
anticholinergic drugs may be as effective as or even superior to B2 agonists
drugs inhibit vagally mediated airway tone, thereby producing bronchodilation
This effect is small in normal airway but it greater in airways of patients COPD
Which are structurally narrowed and have higher resistance to airflow because airway resistance is inversely related to the fourth power of the radius
Ipratropium bromide
Adverse effects- predictable consequences of muscarinic receptor (Dry mouth, constipation, blurred vision, dyspepsia, cognitive impairment)
Adverse effects and contraindications are of less concern with anticholinergics administered by inhalation
Wheezing
Congestion, rattling, wheezing stridor
Not all wheezes=Asthma, all wheezes=obstruction
continuous mucosal sound (multiple) that can be produced by oscillation of opposing walls of an airway that is narrowed almost to the point of closure
During inspiration or expiration (mostly expiration) from the large extrathoracic upper airway to the intrathoracic small airways
