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46 Cards in this Set

  • Front
  • Back
What is the definition of asthma?
• an airway disease characterized by reversible inflammation & bronchoconstriction
• disease of airways causing increased responsiveness of tracheobronchial tree to stimuli
Name and describe the different types of COPD
• Chronic bronchitis: chronic productive cough for 3 months during each of 2 or more consecutive years

• Emphysema: an airway disease that leads to destruction of alveoli & gas trapping

* Asthma is also a type of COPD
What is the "triad" of asthma signs & symptoms?
• dyspnea
• cough
• wheezing
Name and describe the 3 types of asthma
• Allergic asthma: usually developing in early life due to an allergic component

• Idiosyncratic: negative family hx, skin tests, & provocative tests; develop asthma symptoms after an URI

• pt's who do not fit clearly into either category: have non-allergic or mixed etiologies
What are types of stimuli that can cause asthma exacerbation?
• allergenic
• emotional
• environmental
• exercise-induced
• infectious
• occupational
• pharmacological
What are some pharmacological agents that can exacerbate asthma?
• Aspirin
• Beta-adrenergic antagonists
• food coloring agents (ex tartrazine)
• sulfiting agents
What is Samter's triad?
typical aspirin-sensitive respiratory syndrome usually affecting adults:

• aspirin allergy
• nasal polyps
• asthma
What is the most common stimuli which evoke acute exacerbation of asthma?
• RSV (in children)
• rhinovirus & influenza virus (in adults)
What is the mechanism of exercise-induced asthma?
thermally produced hyperemia and engorgement of micro-vasculature of bronchial wall
What is the hallmark of asthma?
• a reduction in airway diameter resulting contraction of smooth muscle
• vascular congestion
• edema of bronchial wall
• thick tenacious secretion
A person experiencing acute exacerbation of asthma will have what physical changes?
• alterations in respiratory muscle function
• changes in elastic recoil
• decreased FEV1 & flow rates
• hyperinflation of lungs and thorax
• increased airway resistance
• increased work in breathing
What is the usual cause of an inspiratory wheeze?
foreign body
Describe how a patient with asthma exacerbation will be both hypoxic and hypocapnic
• patient is unable to take in oxygen and stimulated to hyperventilate due to hypoxia

• hyperventilation will eventually cause hypocapia (by blowing off excess CO2)

• but the patient is still unable to take in oxygen
What are clinical features of asthma (besides the triad of symptoms)?
• accessory muscles become active

• inspiratory & expiratory wheezing; can be high-pitched if severe or prolonged (expiratory is more common)

• pulsus paradoxus: exaggerated fall in BP during inspiration

• prolonged expiration

• thick, productive mucus w/ cough at termination of episode
What can happen to wheezes in extreme cases of asthma?
• wheezing may lessen or disappear
• implies excessive mucus plugging and impending suffocations (requires intubation)
Percussion of the chest in patients with asthma exacerbation will yield what physical finding?
hyperresonance (due to chest hyperinflation)
The presence of a solitary inspiratory wheeze or stridor may indicate what?
• soft tissue mass (poss. malignancy)
• thyroid enlargement
• upper airway obstruction
• vocal cord dysfunction (paralysis)
How is asthma diagnosed?
• asthma is a reversible airway obstruction, so there needs to be a 12% or greater increase in FEV1 after 2 puffs of a beta-adrenergic agonist

• when spirometry is normal, provocative test to induce an attack (ex. histamine, methacholine, isocapnic hyperventilation, cold air, or exercise)
What is FVC?
Forced volume capacity (volume of air forceably exhaled after deep inspiration)
Describe the different percentage values when interpreting spirometry
• > 80% of predicted: normal
• 60-79%: mildly reduced
• 40-59%: moderately reduced
• < 40%: severe
Name and describe the two general patterns of abnormal spirometry
• Obstructive:
- cannot get the air out because airways collapse on expiration
- lungs are hyperinflated (increased TLC & RV)

• Restrictive:
- cannot get the volume in because lungs are scarred or infiltrated or muscles are weak
- decreased lung volumes (TLC, RV, FRC)
What will the FEV1/FVC ration be in obstructive disease?
• reduced FEV1/FVC ratio
• less than 75% indicates obstruction
Give examples of restrictive lung disease
• Interstitial lung disease (ex. pulmonary fibrosis, pulmonary edema, intersitial pneumonias)

• Neuromuscular weakness (ex. myasthenia gravis, ALD, diaphragm paralysis)
Describe the spirometry in restrictive disease
• decreased FVC & FEV1
• normal FEV1/FVC ratio
What 4 components should be incorporated in asthma management?
• objective measures of lung function
• environmental control measures & avoidance of risk factors
• comprehensive pharmacologic therapy
• patient education
List the different classification of asthma
• intermittent
• mild persistent
• moderate persistent
• severe persistent
What are characteristics of intermittent asthma?
• symptoms occuring < once a week
• brief exacerbations
• nocturnal symptoms < twice a month
• asymptomatic w/ normal lung function between exacerbations
What are characteristics of mild persistent asthma?
• symptoms occuring more than once a week but less than once a day
• exacerbation affect activity and sleep
• nocturnal symptoms occuring more than twice a month
What are characteristics of moderate persistent asthma?
• daily symptoms
• exacerbations affect activity & sleep
• nocturnal symptoms occuring more than once a week
• FEV1 or peak flow rate 60-80% of predicted, w/ variabilty > 30%
What are characteristics of severe persistent asthma?
• continuous symptoms and frequent exacerbations
• frequent nocturnal asthma symptoms
• physical activities limited by asthma symptoms
• FEV1 or PEF rate < 60%, with variability > 30%
What are the DOC for treatment of chronic asthma and prevention of acute asthma exacerbations?
glucocorticoids (steroids)
What is the MCC of patients not responding to asthma therapy?
improper use
What is the definition of COPD?
a chronic obstruction to airflow due to chronic bronchitis or emphysema
What is the definition of chronic bronchitis?
• a condition associated w/ excessive tracheobronchial mucus production
• causing a cough w/ expectoration for at least 3 months of the year for two consecutive years
What is the definition of emphysema?
• an abnormal permanent enlargement of the air spaces distal to the terminal bronchioles
• accompanied by destruction of their walls and w/out obvious fibrosis
Hyperplasia and hypertrophy of mucus producing glands in the submucosa of cartilaginous airways is associated with which form of COPD?
chronic bronchitis
Why can patients with chronic bronchitis develop an early diastolic gallop (S3)?
• COPD is a common cause of corpulmonale
• Corpulmonale will cause right-sided heart failure and cause the subsequent gallop
What are "blue bloaters"?
• patients with chronic bronchtis that develop right ventricular failure
• referred to as "blue bloaters" due to cyanosis and edematous presentation
Patients with chronic bronchitis have PaCO2 and PaO2 levels in this range
• PaCO2: high 40's to low 50's
• PaO2: 45-60
What are the 3 classifications of emphysema?
• Centriacinar emphysema
• Panacinar emphysema: seen in alpha 1-antitrypsin deficiency
• Distal acinar emphysema: leads to formation of bullae
What are total lung capacity (TLC), residual volume (RV), PaO2, & PaCO2 levels in patients with emphysema?
• TLC and RV are increased
• PaO2 is often in mid 70's
• PaCO2 is low to normal (patients often try to breathe off excess CO2)
What are physical exam findings of a patients with COPD?
• barrel chest
• diffusely decreased breath sounds
• hyperresonance on percussion
• prolonged expiration
• wheezing
What are causes of COPD?
• Smoking (#1)
• Air pollution
• Airway hyperresponsiveness
• Alpha 1-antitrypsin deficiency (only genetic risk factor known)
What are the most frequently cultured pathogens during COPD exacerbation?
• Streptococcus pneumoniae
• Haemophilus influenzae
What are chest x-ray findings for a patient with COPD?
• flattened diaphragm
• increased retrosternal air space
• long narrow heart shadow
What medication reduces mortality rates in patients with advanced COPD?