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46 Cards in this Set
- Front
- Back
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What is the definition of asthma?
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• an airway disease characterized by reversible inflammation & bronchoconstriction
• disease of airways causing increased responsiveness of tracheobronchial tree to stimuli |
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Name and describe the different types of COPD
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• 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 |
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What is the "triad" of asthma signs & symptoms?
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• dyspnea
• cough • wheezing |
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Name and describe the 3 types of asthma
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• 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 |
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What are types of stimuli that can cause asthma exacerbation?
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• allergenic
• emotional • environmental • exercise-induced • infectious • occupational • pharmacological |
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What are some pharmacological agents that can exacerbate asthma?
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• Aspirin
• Beta-adrenergic antagonists • food coloring agents (ex tartrazine) • NSAIDS • sulfiting agents |
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What is Samter's triad?
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typical aspirin-sensitive respiratory syndrome usually affecting adults:
• aspirin allergy • nasal polyps • asthma |
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What is the most common stimuli which evoke acute exacerbation of asthma?
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infections
• RSV (in children) • rhinovirus & influenza virus (in adults) |
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What is the mechanism of exercise-induced asthma?
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thermally produced hyperemia and engorgement of micro-vasculature of bronchial wall
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What is the hallmark of asthma?
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• a reduction in airway diameter resulting contraction of smooth muscle
• vascular congestion • edema of bronchial wall • thick tenacious secretion |
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A person experiencing acute exacerbation of asthma will have what physical changes?
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• 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 |
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What is the usual cause of an inspiratory wheeze?
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foreign body
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Describe how a patient with asthma exacerbation will be both hypoxic and hypocapnic
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• 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 |
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What are clinical features of asthma (besides the triad of symptoms)?
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• 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 |
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What can happen to wheezes in extreme cases of asthma?
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• wheezing may lessen or disappear
• implies excessive mucus plugging and impending suffocations (requires intubation) |
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Percussion of the chest in patients with asthma exacerbation will yield what physical finding?
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hyperresonance (due to chest hyperinflation)
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The presence of a solitary inspiratory wheeze or stridor may indicate what?
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• soft tissue mass (poss. malignancy)
• thyroid enlargement • upper airway obstruction • vocal cord dysfunction (paralysis) |
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How is asthma diagnosed?
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• 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) |
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What is FVC?
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Forced volume capacity (volume of air forceably exhaled after deep inspiration)
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Describe the different percentage values when interpreting spirometry
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• > 80% of predicted: normal
• 60-79%: mildly reduced • 40-59%: moderately reduced • < 40%: severe |
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Name and describe the two general patterns of abnormal spirometry
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• 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) |
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What will the FEV1/FVC ration be in obstructive disease?
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• reduced FEV1/FVC ratio
• less than 75% indicates obstruction |
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Give examples of restrictive lung disease
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• Interstitial lung disease (ex. pulmonary fibrosis, pulmonary edema, intersitial pneumonias)
• Neuromuscular weakness (ex. myasthenia gravis, ALD, diaphragm paralysis) |
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Describe the spirometry in restrictive disease
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• decreased FVC & FEV1
• normal FEV1/FVC ratio |
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What 4 components should be incorporated in asthma management?
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• objective measures of lung function
• environmental control measures & avoidance of risk factors • comprehensive pharmacologic therapy • patient education |
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List the different classification of asthma
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• intermittent
• mild persistent • moderate persistent • severe persistent |
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What are characteristics of intermittent asthma?
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• symptoms occuring < once a week
• brief exacerbations • nocturnal symptoms < twice a month • asymptomatic w/ normal lung function between exacerbations |
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What are characteristics of mild persistent asthma?
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• 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 |
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What are characteristics of moderate persistent asthma?
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• 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% |
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What are characteristics of severe persistent asthma?
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• continuous symptoms and frequent exacerbations
• frequent nocturnal asthma symptoms • physical activities limited by asthma symptoms • FEV1 or PEF rate < 60%, with variability > 30% |
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What are the DOC for treatment of chronic asthma and prevention of acute asthma exacerbations?
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glucocorticoids (steroids)
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What is the MCC of patients not responding to asthma therapy?
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improper use
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What is the definition of COPD?
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a chronic obstruction to airflow due to chronic bronchitis or emphysema
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What is the definition of chronic bronchitis?
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• 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 |
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What is the definition of emphysema?
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• an abnormal permanent enlargement of the air spaces distal to the terminal bronchioles
• accompanied by destruction of their walls and w/out obvious fibrosis |
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Hyperplasia and hypertrophy of mucus producing glands in the submucosa of cartilaginous airways is associated with which form of COPD?
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chronic bronchitis
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Why can patients with chronic bronchitis develop an early diastolic gallop (S3)?
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• COPD is a common cause of corpulmonale
• Corpulmonale will cause right-sided heart failure and cause the subsequent gallop |
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What are "blue bloaters"?
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• patients with chronic bronchtis that develop right ventricular failure
• referred to as "blue bloaters" due to cyanosis and edematous presentation |
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Patients with chronic bronchitis have PaCO2 and PaO2 levels in this range
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• PaCO2: high 40's to low 50's
• PaO2: 45-60 |
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What are the 3 classifications of emphysema?
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• Centriacinar emphysema
• Panacinar emphysema: seen in alpha 1-antitrypsin deficiency • Distal acinar emphysema: leads to formation of bullae |
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What are total lung capacity (TLC), residual volume (RV), PaO2, & PaCO2 levels in patients with emphysema?
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• 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) |
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What are physical exam findings of a patients with COPD?
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• barrel chest
• diffusely decreased breath sounds • hyperresonance on percussion • prolonged expiration • wheezing |
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What are causes of COPD?
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• Smoking (#1)
• Air pollution • Airway hyperresponsiveness • Alpha 1-antitrypsin deficiency (only genetic risk factor known) |
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What are the most frequently cultured pathogens during COPD exacerbation?
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• Streptococcus pneumoniae
• Haemophilus influenzae |
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What are chest x-ray findings for a patient with COPD?
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• flattened diaphragm
• increased retrosternal air space • long narrow heart shadow |
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What medication reduces mortality rates in patients with advanced COPD?
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oxygen
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