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Pulmonary Diseases
Obstructive Pulmonary disease
| Term | Definition |
|---|---|
| Obstructive Pulmonary Disease | Most common pulmonary disease Conditions characterized by increased airflow resistance as a result of airway obstruction or narrowing |
| Airway obstruction Causes | • Accumulated secretions • Edema • Inflammation of the airways • Bronchospasm of smooth muscle • Destruction of lung tissue |
| Asthma Definition | Chronic inflammatory disorder of airway Reduction in airway diameter and increased airway resistance Inflammation, constriction of smooth muscle, excess mucous Hypertrophy of mucous glands+ smooth m., thickening of basement membrane, air trapping |
| Airway hyperresponsiveness | The predisposition of the airways of patients to narrow excessively in response to stimuli that would produce little or no effect in healthy subjects |
| Degree of bronchoconstriction related to: | • Degrees of airway inflammation • Airway hyper-responsiveness • Exposure to triggers (ex. infection, allergens) |
| Asthma Early Phase Response | Irritant attaches to IgE receptors on mast cells releasing histamine (inflammatory mediator) Bronchial smooth muscle constriction Increased vasodilation and permeability Epithelial damage 30-90 min peak after exposure, last another 30-90 minutes |
| Asthma Late Phase Response | Inflammatory cells (eosinophils/ neutrophils) infiltrate airway: mediators induce further inflammation (mast cells to degranulate) Histamine and other mediators released Hyper-responsiveness of airway 5-12 hrs after exposure, more severe, last hrs-days |
| Asthma Clinical Manifestations | Unpredictable, episodic, variable, abrupt or gradual onset Wheezing, dyspnea, chest tightness, coughing, prolonged expiration, tripod position and use of accessory muscles, anxiety, Changes in vitals |
| Asthma Triggers | • Allergens • Tobacco and marijuana smoke • Nose and sinus conditions • Medications and food additives • Gastroesophageal reflux disease (GERD) • Genetics • Air pollutants • Emotional stress |
| Asthma Status Asthmaticus | Life-threatening medical emergency Extreme form of acute asthma attack Hypoxia, hypercapnia, acute respiratory failure Forced exhalation increases intrathoracic pressure on great vessels/heart Hyperventilation, fatigued, CO2 retained |
| Asthma Diagnostic Studies | Detailed history and physical exam Family history of asthma, allergies and eczema Spirometry and Peak expiratory flow Allergy assessment Oximetry Chest X-ray ABGs Blood Work Sputum sample |
| Asthma Interprofessional Care | Partnerships between HCP and patients/families Identification and avoidance or elimination of triggers Patient and family teaching Continuous assessment of asthma control and severity Appropriate medications Asthma action plan Regular follow-up |
| Categories of Asthma Medications | Reliever Medications and Controller Medications |
| Reliever Medications | Bronchodilators • Short-acting inhaled beta-adrenergic agonists (ex. Salbutamol/Ventolin) Anticholinergics/Short-Acting Muscarinic Antagonists • Ex. Ipratropium/Atrovent |
| Controller Medications (Anti-inflammatory medications) | • Corticosteroids • Inhaled (ex. fluticasone) • Oral (ex. prednisone) • Leukotriene modifiers (ex. montelukast) • Anti-IgE (ex. omalizumab) |
| Controller Medications (Bronchodilators) | • Long-acting inhaled B-2 adrenergic agonists (ex. salmeterol inhalation) • Long acting oral B-2 adrenergic agonists (ex. oral salmeterol) • Methylxanthines (ex. theophylline) |
| Asthma Patient Education Related to Medication Therapy | Name, dosage, method of administration, frequency of use, indications, adverse effects, consequences of improper use, importance of adherence |
| Chronic Obstructive Pulmonary Disease (COPD) | Persistent airflow limitation, usually progressive Chronic inflammatory response in the airways and lungs Causes tissue destruction, disrupts defense mechanisms and repair process of the lungs Preventable |
| Medications given by inhalation (Asthma) | Most used • Lower dose required • Systemic adverse events are fewer and less intense • Onset quicker • Use with metered dose inhaler +/- spacer |
| Causes of COPD | • Cigarette smoking and other noxious particles/gases • Occupational chemicals and dusts • Infection • Heredity • Aging |
| COPD Clinical Manifestations | Intermittent cough, dyspnea Barrel chest Weight loss/anorexia Prolonged expiratory phase Wheeze, Decreased lung sounds Tripod positioning, Use of intercostal/accessory muscles Purse lips on expiration Edema in ankles |
| Airflow limitations COPD | During forced exhalation caused by loss of elastic recoil and are not fully reversible |
| Airflow obstruction COPD | Caused by mucus hypersecretion, mucosal edema, and bronchospasm |
| Air Trapping COPD | Occurs due to inability to expire air • Chest hyper-expands and becomes barrel shaped because respiratory muscles cannot function effectively |
| Cor pulmonale | Complication of COPD Hypertrophy of right side of heart, with or without heart failure as a result of pulmonary hypertension |
| Acute respiratory failure | Overall decline in lung function, deterioration in health status, risk of death • Patients wait too long to contact their HCP when symptoms suggest AECOPD |
| COPD Complications | • Cor pulmonale • Acute exacerbation of COPD • Acute respiratory failure • Depression and anxiety |
| Acute exacerbation of COPD | sustained worsening of COPD symptoms • Many exacerbations caused by infection (bacterial) |
| COPD Interprofessional Care | Prevent disease progression Reduce frequency/severity of exacerbations Alleviate breathlessness/other symptoms Improve exercise tolerance Treat exacerbations and complications Improve health status and quality of life Reduce associated mortality |
| COPD Medications | Bronchodilator therapy B-2 adrenergic agonists Anticholinergic meds Long-acting theophylline preparations Corticosteroids (oral for exacerbations) NSAIDs Antibiotics for exacerbations with purulent sputum Influenza immunization Pneumonia vaccine |
| COPD Oxygen Therapy | Nasal cannula 1-6L Simple face mask 6-12L 35-50% Partial rebreathing mask 6-10L 40-60% Nonrebreathing mask 60-90% Venturi mask 24%, 28%, 31%, 35%, 40% and 50% |
| COPD Pulmonary Rehabilitation | Optimize functional status Aerobic conditioning and upper/lower body Breathing exercises, Energy conservation Nutrition Smoking cessation Environmental factors Health promotion Patient education/self-management Psychological support, counselling |
| Asthma Status Asthmaticus Precipitating factors | Viral illness, environmental pollutants/allergens, food allergy, poor adherence to/stopping medication regimen |
| Wheezing | Unpredictable sign for gauging severity of attack Minor attacks: loud wheezing Severe attacks: no audible wheeze As attack progresses: wheeze heard on inspiration Silent chest: severe obstruction and impending respiratory failure |
| Histamine | • Bronchospasm • Increased mucus secretion • Edema formation • Wheeze • Cough • Shortness of breath • Chest tightness • Increased amount of tenacious sputum |
Created by:
selenay15
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