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SPC Pulm Disease

SPC Pulmonary Disease Exam 2 Review

What is Chronic Bronchitis? Cough > 3mths in 2 consecutive years
What is Emphysema? A permanent enlargement of the air spaces distal to the terminal bronchioles w/ destruction of bronchiole walls
What is COPD? Chronic Obstructive Pulmonary Disease. Can be one, two, or all of CB, Emphysema, or Asthma
Panlobular Emphysema Genetic defect, effects lower lungs, Apha1-antitrypsin deficiency
Centriacinar Emphysema The most common form of emphysema, strongly associated w/ cigarette smoking and w/ CB
Emphysema risk factors Alpha1-antitrypsin deficiency, age, tobacco use, occupational exposure, indoor/outdoor air polution, socioeconomic status, respiratory infections
Main PFTs used to measure COPD airflow limitations: FVC, FEV1, and FEV1/FVC
COPD chest radiographs show: Flat diaphragms, long and distended heart shadow, widened intercostal spaces - all caused by hyperinflation
Emphysema is detected by: Spirometry can tip off but CT scan needed - can determine centriacinar or panacinar
Pink Puffer: Type A COPD - emphysema, red complexion, pursed-lip breathing
Blue Bloater: Type B COPD- chronic bronchitis, bluish color (cyanosis)
Emphysema features: Barrel chest, pursed-lip breathing, accessory muscle use, decreased breath sounds, decreased DLCO & DL/VA
Chronic Bronchitis features: Sputum, cyanosis, peripheral edema, neck vein distention, wheezes & crackles, typically normal DLCO & DL/VA
COPD therapeutic options: Smoking cessation/prevention, flu / pneumonia shots, occupational exposure, inhaled corticosteroids (first, continued), long-term oral corticosteroids (last, stopped), ALpha1-antitrypsin augmentation therapy, mucolytic agents, exercise rehab, surgery
What best identifies emphysema and CB? Spirometry
What is asthma? Reversible broncial smooth muscle constriction (bronchospasm), airway inflammation, increased airway responsiveness to an assortment of stimuli
What is remodeling? Damaged cilia, basement membrane of the mucosa may become thicker than normal (fibrosis)
Asthmatic episode major pathologic & structural changes: Bronchospasm, excessive prod of thick, whitish bronchial secretions, hyperinflation of alveoli (air trapping)
Extrinsic Asthma: Childhood, increase in IGE, immediate (Type I) anaphylactic hypersensitivity reaction = allergies
Intrinsic Asthma: Adults ,normal or decreased IGE, non-allergic
Asthma exacerbations: NDSAIDs, food additives/preservatives, exercise-induced bronchoconstriction, GERD
Asthma monitoring tests: FEV1, FEV1/FVC, PEFR
Bronchodilator is working in asthma pt when: >12% increase in FEV1 or >60L/m increase in PEFR
What is FENO? Fractional Expired Nitric Oxide, determines airway inflammation
What is Pulsus Paradoxus? Systolic BP that is more than 10mmHg lower on inspiration than on expiration
Pulsus Paradoxis during an asthma attack: Caused by the major intrapleural pressure swings that occur during inspiration and expiration
Asthma xray findings: Barrel Chest - hyperinflation
Asthma management goals: Attain & maintain control of the clinical manifestations, maintain normal activity levels and pulm func, prevent asthma exacerbations, avoid adverse effects from meds, prevent asthma mortality
Asthma controller meds: Serevent Diskus, Flunisolide, Singulair, Xolair
Asthma rescue meds: Albuterol (1hr continuous)
Acute asthma exacerbation signs: Increase RR, accessory muscle use, end-expiratory wheeze, increased pulse, pulsus paradoxus
What is varicose (fusiform) bronchiectasis? Bronchi are dilated and constricted in an irregular fashion similar resulting in a distorted, bulbous shape
What is cylindrical (tubular) bronchiectasis? Bronchi are dilated and rigid and have regular outlines similar to a tube
What is cystic (saccular) bronchiectasis? Bronchi progressively increase in diameter until they end in large, cystlike sacs in the lung parenchyma
Prevelance of noncystic fibrosis bronchiectasis: Relatively low in developed nations
Most common cause of NCFB? Obstruction or Infection
Bronchiectasis leads to: Atelectasis, Varicose, Cylindrical or Cystic bronchiectasis
Bronchiectasis causes: foreign body aspirations, hilar adenopathy, bronchial airway mucoid impaction, tracheobronchial/vascular/lymphatic abnormalities, advanced age, malnutrition, sociolymphatic disadv, alpha1-antirtypsin deficiency
Best way to diagnose NCFB? High resolution computed tomography (HR-CT) scan
Often found in bronchiectasis secretions: Haemophilus influenzae, Streptococcus, Pseudomonas aeruginosa, and various anaerobic organisms
Bronchiectasis care: CPT, postural drainage, expectorants, antibiotics (7-10 days), immunizations
Cor Pulmonale tx: O2 1-2 L/m = PaO2 > 50% & SaO2 > 80%
Emphysema: PFT Paramenters incr / dcr: Decreased: FEF25-75%, FEV1, DLCO. Increased: RV, TLC
Asthma Tx: Ipratropium Bromide (Atrovent) - Anticholinergic
Created by: vgflgirl