Wk 1 Obstructive Airway Conditions Flashcards
Narrowed airways cause obstruction that is worse on __
Expiration
What problem do narrowed airways cause for the patient?
Increased work of breathing, emptyting of the lungs is slowed
How do we measure emptying of the lungs?
FEV1
All obstructive disease cause what?
V/Q mismatch
What is a V/Q mismatch?
Air and blood in our lungs are not perfectly matched up, which causes the blood to not get oxygenated well enough, causing hypoxemia
When air gets trapped in the lungs (because of narrowed airways), what does this cause?
Hypoventilation, hypercapnia, hypoxemia
__ and __ are present in ALL obstructive diseases
Dyspnea and wheezing
When does air trapping occur?
When the person is not able to fully exhale, can’t get the air out
What does air trapping lead to?
High CO2
What is hypercapnia?
High CO2
When air is trapped in the alveoli itself, what happens?
The person works harder to breathe and lungs are hyperinflated
When normal exhalation is obstructed, this causes
high CO2 and low O2
How do you know if someone has high CO2?
arterial blood gas or venous blood gas, ETCO2 (exhaled CO2 using capnography),
What is asthma?
Chronic inflammation of the bronchial airways (NOT alveoli)
Chronic inflammation in asthma causes what 3 things?
1) bronchial hyperresponsiveness
2) constriction of the airways
3) variable airflow obstruction that is reversible
Asthma is a chronic disease state with…
acute exacerbations
Asthma usually starts in __.
childhood
Asthma is highly associated with __.
allergies
What are the risk factors for asthma?
Familial links, levels of allergen exposure, urban residency, exposure to pollution, tobacco exposure/smoke, recurrent respiratory viral infections, GERD
What triggers asthma?
Exposure to an antigen
Inflammation during an asthma attack causes what 3 things?
hypersecretion of mucus, airway muscle constriction, swelling bronchial membranes
Inflammation in an asthma attack causes narrowing of the breathing passages which looks like…
wheezing, cough, shortness of breath, tightness in chest
What is the most common trigger for an asthma attack?
Exercise
What are other triggers for asthma attacks?
Second hand smoke, climate conditions, pests, pet dander, pollen
What is the early response for asthma?
Cellular responses are activated immediately and the cascade of release of inflammatory mediators occurs within minutes.
What are details of the early response for asthma? (5)
Vasodilation Increased capillary permeability Mucosal edema Bronchial smooth muscle contraction Mucus secretion
When does the late asthmatic response occur?
4-8 hours after early/immediate response
Why does the late response in asthma occur?
The recruitment of eosinophils, neutrophils, and lymphocytes during the early response causes another release of inflammatory mediators inciting the same process
What is something to teach patients with asthma?
If you have a response earlier in the day, you are at a very high risk to have another response later in the day (keep meds nearby)
What happens if a patient doesn’t prevent asthma attacks?
It can lead to airway damage that is irreversible
What is airway remodeling in an asthma patient?
The result of chronic inflammation due to poorly controlled asthma
What does airway remodeling cause?
chronic asthma
What is the #1 symptom of an asthma attack?
Bronchoconstriction
What symptom is the biggest problem and causes the seriousness of asthma?
Inflammation because it causes the airway remodeling long term
For diagnosing asthma, what do we look at in a patient’s health history?
Allergies, recurrent episodes of wheezing, dyspnea, and exercise intolerance
What is the fold standard for diagnosing asthma?
PFTs
What do pulmonary function tests measure?
Lung function with respect to time, (seconds)
What do we look for on the PFT to diagnose asthma?
decreased expiratory flow rate, and decreased FEV1
What is a decreased FEV1?
How much air can a patient blow out in 1 second
Asthma is often __.
misdiagnosed
What are the classic symptoms of asthma?
Wheezing
Shortness of air
Cough
Chest tightness
What are symptoms in a severe asthma attack?
Use of accessory muscle Distant, decreased or absent lung sounds Diaphoresis Inability to speak more than one or two words without taking a breath Eventually, respiratory failure
What are two characteristics of respiratory failure?
Inaudible breath sounds
Repetitive hacking cough
What is the mainstay treatment for asthma attacks?
Low-dose corticosteroids
What is the mainstay treatment for milder asthma symptoms?
Short acting beta-agonist inhaler
Two examples of low-dose corticosteroids used for asthma attacks
PO predniose or hydrocortisone
What medications might a patient be on who has more severe asthmatic symptoms? (4)
Anti-inflammatory medications
INHALED corticosteroids
long acting beta-agonist inhalers
leukotriene antagonists
Why is it important to teach asthma patients about their symptoms?
They often underestimate the severity of an attack or their symptoms
What else can be used to treat an asthma patient?
Immunotherapy such as allergy shots or monoclonal antibody therapy
What is monoclonal antibody therapy?
Cloning of white blood cells
How to measure FEV1?
Peak flow meter
What is asthma classified by?
Degree of control - number of episodes, nocturnal symptoms, PFTs, or peak flow findings
What is it called when an asthma patient has peak symptoms?
Status asthmaticus
What is status asthmaticus?
An unrelenting asthma attack characterized by silent chest, because no air movement
What ABG of VBG CO2 measurement would indicate status asthmaticus?
greater than 70 mmHG
Status asthmaticus is a __ __ __
life threatening emergency
What does status asthmaticus usually require?
IV epinephrine
Mainstays for an acute asthma attack (3)
Bronchodilators, corticosteroids, and oxygen therapy
Asthma medications are classified as either __ or __
Preventers or relievers (rescue meds)
Hypersecretion of mucus and chronic productive cough
Chronic bronchitis
How long must you have symptoms to be diagnosed with chronic bronchitis?
for at least 3 months of the year for two consecutive years
Inflammation of the bronchi and bronchioles
Simple acute bronchitis
What is responsible for 80% of simple acute bronchitis?
Bacteria or viruses
What is different about acute bronchitis versus chronic?
There is no airflow obstruction in acute bronchitis
What is the treatment for acute bronchitis?
Usually supportive care
About 90% of the people who have chronic bronchitis are also…
Smokers
Chronic bronchitis + airflow obstruction =
COPD
What is the prognosis for chronic bronchitis?
Premature morbidity and mortality
What is the hallmark sign of chronic bronchitis?
Persistent productive cough
The expectorate in chronic bronchitis can be __ if superimposed respiratory infection
Purulent
Why are patients with chronic bronchitis more susceptible to respiratory infections?
The increased mucus secretions is a breeding ground for bacteria
As chronic bronchitis progresses, what will symptoms will patients see?
Increased cough, increased congestion, increased shortness of air
How is chronic bronchitis diagnosed?
History of symptoms, physical exam, chest imaging, and pulmonary function tests
What would the FEV1 for someone with chronic bronchitis look like and why?
Decreased because of the airflow obstruction
What is the usual scenario when a patient seeks treatment for chronic bronchitis?
Disease is in a progressive state and the pathological changes that have occurred are irreversible
Who gets chronic bronchitis?
Smokers including vapers!
For the development of chronic bronchitis, inhaled irritants results in what?
Airway inflammation
What is characteristic of airway inflammation in chronic bronchitis?
Neutrophils, macrophages, lymphocytes go into the bronchial walls causing increased mucus production and inflammation
Continual bronchial inflammation leads to what?
Bronchial edema, increased number and size of goblet cells and mucus glands
Term for cells getting bigger in size
Hyperplasia
Hyperplasia of goblet cells in the development of chronic bronchitis causes what?
Thick, tenacious mucus production that the patient can’t expectorate due to impaired ciliary function
What does tenacious mean?
tending to adhere or stick to another surface
In the development of chronic bronchitis, why is there impaired ciliary function?
Bronchial walls are inflamed and thickened due to edema
Impaired ciliary function leads to accumulation of..?
Inflammatory cells
What is the end result of the inflammation in the development of chronic bronchitis?
Thickened smooth muscle secondary to chronic bronchospasm
What is pulmonary fibrosis?
Scarring tissue in the lungs
Chronic bronchospasm causes what?
Pulmonary fibrosis
Initially the process of chronic bronchitis development only affects __ __, but eventually all airways are affected.
larger bronchi
Obstruction occurs particularly during __.
expiration
What is the late clinical manifestation for chronic bronchitis?
Pulmonary hypertension
What does pulmonary hypertension do?
Increased pressure leads to increased pulmonary blood flow, pulmonary vascular obstruction, or hypoxemia
What are symptoms of pulmonary hypertension?
syncope, dyspnea, and fatigue
What is cor pulmonale?
right sided heart failure
How does cor pulmoale occur?
Pulmonary hypertension increases work of the right ventricle leading to hypertrophy and dilation.
What is the treatment for chronic bronchitis?
Stop smoking!
If a person stops smoking before symptoms occur then…
Eventually the damage reaches the level of someone who has never smoked
What is the medication treatment for chronic bronchitis?
Bronchodilators Expectorants Prophylactic antibiotics Steroids later in the disease Home o2 therapy
In a very severe chronic bronchitis exacerbation, a patient may need __ __
mechanical ventilation
What is emphysema?
Abnormal, permanent enlargement of gas exchange airways, accompanied by destruction of alveolar walls
What causes the destruction of alveolar walls in emphysema?
Inflammatory and destructive changes in lung tissue
What causes airway limitation in emphysema during expiration?
Loss of elastic recoil with collapse of airways
Emphysema is a disease of the __
alveoli
In emphysema is destruction is caused by __ where in chronic bronchitis the destruction is caused by __
inflammation, mucus
What is emphysema characterized by? (2)
1) Loss of elastic recoil
2) Abnormal, permanent enlargement of airspaces distal to terminal bronchioles
In emphysema, abnormal, permanent enlargement of airspaces distal to terminal bronchioles is secondary to…
destruction of alveolar walls and capillary beds
Emphysema: What results because of the destruction of alveolar walls and capillary beds?
Airway remodeling
Emphysema: Airway remodeling results in __ __
Lung hyperinflation, alveoli are permanently popped open
Emphysema: Destruction occurs from __ __, not mucus production.
tissue changes
What is apoptosis?
Cell death
A patient with emphysema will develop blebs which are popped out alveoli that…
cannot produce gas exchange
Emphysema: what causes hyperexpansion of the chest?
Air trapping in the alevoli blebs
What are two other potential causes of emphysema is a patient doesn’t smoke?
Air pollution and chronic childhood respiratory infections
What is primary emphysema?
A genetic form of emphysema present in less than 2% of patients
What causes genetic emphysema?
Deficiency of enzyme alpha-antitrypsin
Emphysema leads to gradual increase in breathlessness with __
exertion
Emphysema eventually leads to breathlessness even __ __
at rest
People with emphysema have a prolonged __ __
expiratory phase
People with emphysema often become __ and suffer from __ __
malnourished, muscle loss
Why do people with emphysema often become malnourished?
Their body’s primary goal is breathing
Three characteristics of emphysema
1) wheezing
2) pursed lip breathing and tripod position
3) barrel chest
What is the hallmark sign of emphysema?
Decreased breath sounds throughout
What is the primary way to diagnose emphysema?
PFTs, decreased FEV1
What other ways can emphysema be diagnosed?
Hyperinflation on chest x ray, respiratory acidosis on ABGs
What is respiratory acidosis?
High CO2
If patient does not have a history of smoking and has emphysema, what will we check?
AAT (alpha-antitrypsin)
What is the mainstay of treatment for emphysema?
Bronchodilators and anti-inflammatory agents
5 other treatment methods for emphysema
1) Smoking cessation
2) oxygen supplementation
3) Breathing retraining
4) Relaxation techniques
5) Antibiotics for acute infections
What might a patient with emphysema look like?
Older, pink skin color, thin, accessory muscle use, barrel chest, severe dyspnea, quiet chest
What might a patient with chronic bronchitis look like?
Overweight and cyanotic, peripheral edema, rhonchi and wheezing
A patient with chronic bronchitis may have an elevated __.
Hemoglobin
Both chronic bronchitis and emphysema patients will show __ and high co2
hypoxemia
Three conditions covered under the umbrella term COPD
Chronic bronchitis, emphysema, Irreversible or refractory asthma
