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32 Cards in this Set
- Front
- Back
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Types of COPD |
asthma Chronic bronchitis emphysema sleep apnea cystic fibrosis |
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Risk Factors |
-Cigarette smoking = 90% of risk -environmental exposure ->ozone, smoke, airborne particulates -occupational dust/chemicals |
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Pathophysiology COPD |
-dyspnea -SOB from exertion to just rest - ^ mucus production - impaired clearing of mucus from resp. track -airway obstruction (mucus, scarring, bronchospasm) -Low TLC = air trapping -freq./severe RTI -persistent cough and sputum, wheezing |
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Pathophysiology Chronic bronchitis |
-^ size of mucus glands, goblet cells -^ mucus production, impaired clearance of mucous from Resp. track -airway fibrosis |
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Patho. Emphysema |
-imbalance of elastase and anti-elastase proteins (tissue degredation) -alveolar dilation and disruption of A-C membrane
inadequate oxygenation |
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Patho. of Chronic Bronchitis and Emphysema |
-non-specifc changes in parenchyma and airways |
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diagnosis |
History: current/past smoker >40yoa SOB on phys. exertion chronic productive cough
Physical Exam: -barrel chest -decreased breath sounds, wheezing -sings of CHF (edema) -clubbing of fingers (rare)
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Diagnosis of Chronic brochitis vs emphysema |
Chronic br: based on history Emphys: based on anatomy |
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Diagnosic tests of COPD |
Oximetry: -O2 saturation (normal >90%) -not as accurate as art. bld measurement
Chest Radiography: -hyper inflated lungs with flattened diaphragm -hyperluncent lungs = ^ blackening from increased transmission of x-rays -Bullae = areas of destroyed lung tissue
Arterial Blood Gases: -^PaCO2 , low PaO2, normal pH, ^HCO3 |
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Pulmonary Fuction Tests findings COPD |
-Changes in Volume (FVC, flow rate) *FEV1/FVC = <.75 *Low FEV1 ->FEV1 <50% = stage 1 ->FEV1 35-49% =stage 2 ->FEV1 <35% = stage 3
^ TLC, FRC, RV = air trapping low diffusion capacity
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Treatment COPD |
Smoking cessation Management of syptoms -bronchospasm -bronchial mucosal congestion and edema -airway inflammation - increased airway secretion Pharmacological Tx -inhaled/oral steriods = antiinflamm. -bronchodilators= dec. bronchospasm -antibiotics -mucolytic agents= mucus clearance supplemental O2 |
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Primary PRevention COPD |
Eliminate: tobacco, occupational exposure, pollution |
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Secondary Prevention |
? |
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Tertiary Prevention |
Avoid exposure to risk particulates Pulmonary and cardiac rehab. -exercise training -education -breathing retraining |
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Other Acute Lung diseases |
Pneumothorax: -spontaneous -tension
Atelectasis: -Obstructive -compression
Pneumonia |
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Types of RLD |
Pulmonary Firbrosis Pneumoconiosis Silicosis Asbestosis Interstitial Lung Disease |
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Pathophysiology RLD |
-Low Lung Volume -Decresed TLC, VC, FRC -normal Airway resistance |
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Pathophysiology Intrinsic RLD |
-increased elastic recoil = low lung volumes -increased expiratory airflow -arterial hypoxemia ->ventil.-perfusion mismatch ->intrapulmonary shunt ->diffusion impariment -hyperventilation at rest -inflammation and scarring -low gas diffusion
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Pathophysiology Extrinsic RLD |
-diseases of extraparenchyma (chest wall, pleura, resp. mm.) - ^ elastic recoil of chest wall and lung = low lung volumes -arterial hypoxemia = atelectasis -structural abnormalities (kyphosis, lateral curvature, kyphosis, sternal angulation) -nueromuscular disorders =CNS, spinal cord, resp. mm -impaired ventilation = resp. failure |
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PFT findings RLD |
changes in FVC, FEV1
low TLC, FRC, RV decreased FVC (<.8) |
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Symptoms Intrinsic RLD |
-progressive exertional dyspnea -dry cough -bloody sputum -pleuritic chest pain
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Symptoms Extrinsic RLD |
Non muscular: -middle aged = dyspnea, decreased exercise tolerance -resp. failure secondary to spinal and chest wall deformity
Muscular: -progressive resp. mm weakness -dyspnea upon exertion
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Diagnosis RLD: Physical Exam of Intrinsic and Extrinsic mm |
Intrinsic Exam: -Velcro crackles -inspir. squeaks or rhonchi -pulm. hypertension
Extrinsic Exam: -massive obesity -abnormal configuration of thoracic cage -pleural disorders -nueromuscular disease |
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Diagnostic exams RLD cont'd |
Chest Radiography (Intrinsic) -most common -air space opacity
Arterial Blood Gases = Low PaCo2, Low PaO2
Extrinsic = Low max. inspiratory and exp. mouth pressures |
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Treatment |
manage symptoms: -obesity -mm weakness -low compliance
Pharmacological Tx: -inhaled or oral corticosteriods -immunosupressive agents -antibiotics
Supplemental Ox External mechanical ventilation |
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Pathophysiology of Asthma |
- ^ IgE levels and airway reactivity to allergens -Inflammatory response (edema, epithelial disruption) -Airway obstruction (bronchospasm, mucus) Outcome: wheezing, SOB, infections. |
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Risk Factors asthma |
Childhood Onset: -indoor allergens -environmental tobacco -^ URI in infancy -Low birthwt
Adult onset: -occupational exposure -organic dusts (chemical, inorganic particles) |
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Risk of Death - asthma |
-Hospital admission for asthma in last year -poor medical management -alcohol abuse -overuse of B2 - brochodilators |
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PFT findings |
Same as Obstructive
**check slides |
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Treatment Asthma |
-Smoking cessation -Manage symptoms ->bronchospasm ->congestion (mucus) ->inflammation -inhaled/oral steriods -supplemental ox.
**same as COPD |
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Primary Prevention |
eliminate: tobacco, occupational exposure, pollution |
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Secondary Prevention |
Avoid risk particulates pulm./cardiac rehab -exercise, education, breathing retraining |
