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Pathopharmacology I > Wk 1 Obstructive Airway Conditions > Flashcards

Wk 1 Obstructive Airway Conditions Flashcards

1
Q

Narrowed airways cause obstruction that is worse on __

A

Expiration

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2
Q

What problem do narrowed airways cause for the patient?

A

Increased work of breathing, emptyting of the lungs is slowed

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3
Q

How do we measure emptying of the lungs?

A

FEV1

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4
Q

All obstructive disease cause what?

A

V/Q mismatch

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5
Q

What is a V/Q mismatch?

A

Air and blood in our lungs are not perfectly matched up, which causes the blood to not get oxygenated well enough, causing hypoxemia

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6
Q

When air gets trapped in the lungs (because of narrowed airways), what does this cause?

A

Hypoventilation, hypercapnia, hypoxemia

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7
Q

__ and __ are present in ALL obstructive diseases

A

Dyspnea and wheezing

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8
Q

When does air trapping occur?

A

When the person is not able to fully exhale, can’t get the air out

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9
Q

What does air trapping lead to?

A

High CO2

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10
Q

What is hypercapnia?

A

High CO2

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11
Q

When air is trapped in the alveoli itself, what happens?

A

The person works harder to breathe and lungs are hyperinflated

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12
Q

When normal exhalation is obstructed, this causes

A

high CO2 and low O2

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13
Q

How do you know if someone has high CO2?

A

arterial blood gas or venous blood gas, ETCO2 (exhaled CO2 using capnography),

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14
Q

What is asthma?

A

Chronic inflammation of the bronchial airways (NOT alveoli)

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15
Q

Chronic inflammation in asthma causes what 3 things?

A

1) bronchial hyperresponsiveness
2) constriction of the airways
3) variable airflow obstruction that is reversible

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16
Q

Asthma is a chronic disease state with…

A

acute exacerbations

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17
Q

Asthma usually starts in __.

A

childhood

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18
Q

Asthma is highly associated with __.

A

allergies

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19
Q

What are the risk factors for asthma?

A

Familial links, levels of allergen exposure, urban residency, exposure to pollution, tobacco exposure/smoke, recurrent respiratory viral infections, GERD

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20
Q

What triggers asthma?

A

Exposure to an antigen

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21
Q

Inflammation during an asthma attack causes what 3 things?

A

hypersecretion of mucus, airway muscle constriction, swelling bronchial membranes

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22
Q

Inflammation in an asthma attack causes narrowing of the breathing passages which looks like…

A

wheezing, cough, shortness of breath, tightness in chest

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23
Q

What is the most common trigger for an asthma attack?

A

Exercise

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24
Q

What are other triggers for asthma attacks?

A

Second hand smoke, climate conditions, pests, pet dander, pollen

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25
Q

What is the early response for asthma?

A

Cellular responses are activated immediately and the cascade of release of inflammatory mediators occurs within minutes.

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26
Q

What are details of the early response for asthma? (5)

A 
Vasodilation
Increased capillary permeability 
Mucosal edema
Bronchial smooth muscle contraction
Mucus secretion
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27
Q

When does the late asthmatic response occur?

A

4-8 hours after early/immediate response

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28
Q

Why does the late response in asthma occur?

A

The recruitment of eosinophils, neutrophils, and lymphocytes during the early response causes another release of inflammatory mediators inciting the same process

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29
Q

What is something to teach patients with asthma?

A

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)

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30
Q

What happens if a patient doesn’t prevent asthma attacks?

A

It can lead to airway damage that is irreversible

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31
Q

What is airway remodeling in an asthma patient?

A

The result of chronic inflammation due to poorly controlled asthma

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32
Q

What does airway remodeling cause?

A

chronic asthma

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33
Q

What is the #1 symptom of an asthma attack?

A

Bronchoconstriction

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34
Q

What symptom is the biggest problem and causes the seriousness of asthma?

A

Inflammation because it causes the airway remodeling long term

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35
Q

For diagnosing asthma, what do we look at in a patient’s health history?

A

Allergies, recurrent episodes of wheezing, dyspnea, and exercise intolerance

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36
Q

What is the fold standard for diagnosing asthma?

A

PFTs

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37
Q

What do pulmonary function tests measure?

A

Lung function with respect to time, (seconds)

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38
Q

What do we look for on the PFT to diagnose asthma?

A

decreased expiratory flow rate, and decreased FEV1

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39
Q

What is a decreased FEV1?

A

How much air can a patient blow out in 1 second

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40
Q

Asthma is often __.

A

misdiagnosed

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41
Q

What are the classic symptoms of asthma?

A

Wheezing
Shortness of air
Cough
Chest tightness

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42
Q

What are symptoms in a severe asthma attack?

A 
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
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43
Q

What are two characteristics of respiratory failure?

A

Inaudible breath sounds

Repetitive hacking cough

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44
Q

What is the mainstay treatment for asthma attacks?

A

Low-dose corticosteroids

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45
Q

What is the mainstay treatment for milder asthma symptoms?

A

Short acting beta-agonist inhaler

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46
Q

Two examples of low-dose corticosteroids used for asthma attacks

A

PO predniose or hydrocortisone

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47
Q

What medications might a patient be on who has more severe asthmatic symptoms? (4)

A

Anti-inflammatory medications
INHALED corticosteroids
long acting beta-agonist inhalers
leukotriene antagonists

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48
Q

Why is it important to teach asthma patients about their symptoms?

A

They often underestimate the severity of an attack or their symptoms

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49
Q

What else can be used to treat an asthma patient?

A

Immunotherapy such as allergy shots or monoclonal antibody therapy

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50
Q

What is monoclonal antibody therapy?

A

Cloning of white blood cells

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51
Q

How to measure FEV1?

A

Peak flow meter

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52
Q

What is asthma classified by?

A

Degree of control - number of episodes, nocturnal symptoms, PFTs, or peak flow findings

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53
Q

What is it called when an asthma patient has peak symptoms?

A

Status asthmaticus

54
Q

What is status asthmaticus?

A

An unrelenting asthma attack characterized by silent chest, because no air movement

55
Q

What ABG of VBG CO2 measurement would indicate status asthmaticus?

A

greater than 70 mmHG

56
Q

Status asthmaticus is a __ __ __

A

life threatening emergency

57
Q

What does status asthmaticus usually require?

A

IV epinephrine

58
Q

Mainstays for an acute asthma attack (3)

A

Bronchodilators, corticosteroids, and oxygen therapy

59
Q

Asthma medications are classified as either __ or __

A

Preventers or relievers (rescue meds)

60
Q

Hypersecretion of mucus and chronic productive cough

A

Chronic bronchitis

61
Q

How long must you have symptoms to be diagnosed with chronic bronchitis?

A

for at least 3 months of the year for two consecutive years

62
Q

Inflammation of the bronchi and bronchioles

A

Simple acute bronchitis

63
Q

What is responsible for 80% of simple acute bronchitis?

A

Bacteria or viruses

64
Q

What is different about acute bronchitis versus chronic?

A

There is no airflow obstruction in acute bronchitis

65
Q

What is the treatment for acute bronchitis?

A

Usually supportive care

66
Q

About 90% of the people who have chronic bronchitis are also…

A

Smokers

67
Q

Chronic bronchitis + airflow obstruction =

A

COPD

68
Q

What is the prognosis for chronic bronchitis?

A

Premature morbidity and mortality

69
Q

What is the hallmark sign of chronic bronchitis?

A

Persistent productive cough

70
Q

The expectorate in chronic bronchitis can be __ if superimposed respiratory infection

A

Purulent

71
Q

Why are patients with chronic bronchitis more susceptible to respiratory infections?

A

The increased mucus secretions is a breeding ground for bacteria

72
Q

As chronic bronchitis progresses, what will symptoms will patients see?

A

Increased cough, increased congestion, increased shortness of air

73
Q

How is chronic bronchitis diagnosed?

A

History of symptoms, physical exam, chest imaging, and pulmonary function tests

74
Q

What would the FEV1 for someone with chronic bronchitis look like and why?

A

Decreased because of the airflow obstruction

75
Q

What is the usual scenario when a patient seeks treatment for chronic bronchitis?

A

Disease is in a progressive state and the pathological changes that have occurred are irreversible

76
Q

Who gets chronic bronchitis?

A

Smokers including vapers!

77
Q

For the development of chronic bronchitis, inhaled irritants results in what?

A

Airway inflammation

78
Q

What is characteristic of airway inflammation in chronic bronchitis?

A

Neutrophils, macrophages, lymphocytes go into the bronchial walls causing increased mucus production and inflammation

79
Q

Continual bronchial inflammation leads to what?

A

Bronchial edema, increased number and size of goblet cells and mucus glands

80
Q

Term for cells getting bigger in size

A

Hyperplasia

81
Q

Hyperplasia of goblet cells in the development of chronic bronchitis causes what?

A

Thick, tenacious mucus production that the patient can’t expectorate due to impaired ciliary function

82
Q

What does tenacious mean?

A

tending to adhere or stick to another surface

83
Q

In the development of chronic bronchitis, why is there impaired ciliary function?

A

Bronchial walls are inflamed and thickened due to edema

84
Q

Impaired ciliary function leads to accumulation of..?

A

Inflammatory cells

85
Q

What is the end result of the inflammation in the development of chronic bronchitis?

A

Thickened smooth muscle secondary to chronic bronchospasm

86
Q

What is pulmonary fibrosis?

A

Scarring tissue in the lungs

87
Q

Chronic bronchospasm causes what?

A

Pulmonary fibrosis

88
Q

Initially the process of chronic bronchitis development only affects __ __, but eventually all airways are affected.

A

larger bronchi

89
Q

Obstruction occurs particularly during __.

A

expiration

90
Q

What is the late clinical manifestation for chronic bronchitis?

A

Pulmonary hypertension

91
Q

What does pulmonary hypertension do?

A

Increased pressure leads to increased pulmonary blood flow, pulmonary vascular obstruction, or hypoxemia

92
Q

What are symptoms of pulmonary hypertension?

A

syncope, dyspnea, and fatigue

93
Q

What is cor pulmonale?

A

right sided heart failure

94
Q

How does cor pulmoale occur?

A

Pulmonary hypertension increases work of the right ventricle leading to hypertrophy and dilation.

95
Q

What is the treatment for chronic bronchitis?

A

Stop smoking!

96
Q

If a person stops smoking before symptoms occur then…

A

Eventually the damage reaches the level of someone who has never smoked

97
Q

What is the medication treatment for chronic bronchitis?

A 
Bronchodilators
Expectorants
Prophylactic antibiotics 
Steroids later in the disease
Home o2 therapy
98
Q

In a very severe chronic bronchitis exacerbation, a patient may need __ __

A

mechanical ventilation

99
Q

What is emphysema?

A

Abnormal, permanent enlargement of gas exchange airways, accompanied by destruction of alveolar walls

100
Q

What causes the destruction of alveolar walls in emphysema?

A

Inflammatory and destructive changes in lung tissue

101
Q

What causes airway limitation in emphysema during expiration?

A

Loss of elastic recoil with collapse of airways

102
Q

Emphysema is a disease of the __

A

alveoli

103
Q

In emphysema is destruction is caused by __ where in chronic bronchitis the destruction is caused by __

A

inflammation, mucus

104
Q

What is emphysema characterized by? (2)

A

1) Loss of elastic recoil

2) Abnormal, permanent enlargement of airspaces distal to terminal bronchioles

105
Q

In emphysema, abnormal, permanent enlargement of airspaces distal to terminal bronchioles is secondary to…

A

destruction of alveolar walls and capillary beds

106
Q

Emphysema: What results because of the destruction of alveolar walls and capillary beds?

A

Airway remodeling

107
Q

Emphysema: Airway remodeling results in __ __

A

Lung hyperinflation, alveoli are permanently popped open

108
Q

Emphysema: Destruction occurs from __ __, not mucus production.

A

tissue changes

109
Q

What is apoptosis?

A

Cell death

110
Q

A patient with emphysema will develop blebs which are popped out alveoli that…

A

cannot produce gas exchange

111
Q

Emphysema: what causes hyperexpansion of the chest?

A

Air trapping in the alevoli blebs

112
Q

What are two other potential causes of emphysema is a patient doesn’t smoke?

A

Air pollution and chronic childhood respiratory infections

113
Q

What is primary emphysema?

A

A genetic form of emphysema present in less than 2% of patients

114
Q

What causes genetic emphysema?

A

Deficiency of enzyme alpha-antitrypsin

115
Q

Emphysema leads to gradual increase in breathlessness with __

A

exertion

116
Q

Emphysema eventually leads to breathlessness even __ __

A

at rest

117
Q

People with emphysema have a prolonged __ __

A

expiratory phase

118
Q

People with emphysema often become __ and suffer from __ __

A

malnourished, muscle loss

119
Q

Why do people with emphysema often become malnourished?

A

Their body’s primary goal is breathing

120
Q

Three characteristics of emphysema

A

1) wheezing
2) pursed lip breathing and tripod position
3) barrel chest

121
Q

What is the hallmark sign of emphysema?

A

Decreased breath sounds throughout

122
Q

What is the primary way to diagnose emphysema?

A

PFTs, decreased FEV1

123
Q

What other ways can emphysema be diagnosed?

A

Hyperinflation on chest x ray, respiratory acidosis on ABGs

124
Q

What is respiratory acidosis?

A

High CO2

125
Q

If patient does not have a history of smoking and has emphysema, what will we check?

A

AAT (alpha-antitrypsin)

126
Q

What is the mainstay of treatment for emphysema?

A

Bronchodilators and anti-inflammatory agents

127
Q

5 other treatment methods for emphysema

A

1) Smoking cessation
2) oxygen supplementation
3) Breathing retraining
4) Relaxation techniques
5) Antibiotics for acute infections

128
Q

What might a patient with emphysema look like?

A

Older, pink skin color, thin, accessory muscle use, barrel chest, severe dyspnea, quiet chest

129
Q

What might a patient with chronic bronchitis look like?

A

Overweight and cyanotic, peripheral edema, rhonchi and wheezing

130
Q

A patient with chronic bronchitis may have an elevated __.

A

Hemoglobin

131
Q

Both chronic bronchitis and emphysema patients will show __ and high co2

A

hypoxemia

132
Q

Three conditions covered under the umbrella term COPD

A

Chronic bronchitis, emphysema, Irreversible or refractory asthma

Pathopharmacology I (33 decks)

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