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Pulmonary Diseases

Obstructive Pulmonary disease

TermDefinition
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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