Obstructive Lung Disease

Question 1

what is obstructive lung disease?

Answer 1

any disease that limits the movement of air out of the lungs

Question 2

how do obstructive lung diseases broadly impact the lungs?

Answer 2

increase total lung volume

increase RV

Question 3

obstructive lung disease can also be referred to as what general term?

Answer 3

Chronic Obstructive Pulmonary Disease

(COPD)

Question 4

T/F: COPD is a specific medical diagnosis

Answer 4

FALSE

it refers to several disorders that can occur independently or in combo with one another

Question 5

COPD include which disorders?

Answer 5

1. Emphysema
2. Chronic asthma
3. Chronic bronchitis + small airway disease

Question 6

what are some risk factors for COPD?

Answer 6

1. exposure to air pollution
2. secondhand smoke
3. occupational dusts and chemicals
4. heredity
5. history of childhood respiratory infections and SES

Question 7

what are the presenting signs of COPD?

Answer 7

1. dyspnea
2. sputum production
3. chronic cough
4. exertional dyspnea
5. reduced function

Question 8

what is one of the most important diagnostic criteria for COPD?

Answer 8

FEV/FVC ratio <0.70 after a bronchodilator has been given

Question 9

what is emphysema?

Answer 9

a pathologic accumulation of air in the lungs

a disease of exhalation

Question 10

what would you expect the diaphragm to look like in a patient with emphysema?

Answer 10

flattened

Question 11

how does emphysema impact lung volume?

Answer 11

increase in residual volume (RV)

increase in total lung capacity

decrease in FEV/FCV ratio

Question 12

what are the 2 main causes of emphysema?

Answer 12

genetic defect

smoking

Question 13

what genetic defect results in emphysema?

Answer 13

alpha-1 antitrypsin (A-1AT) deficiency

Question 14

what is the purpose of A-1AT?

Answer 14

blood protein synthesized in the liver

protects the lungs from degrading actions of powerful enzyme called neutrophil elastase (increases elastin degradation) and other proteases

Question 15

how does smoking result in emphysema?

Answer 15

cigarette smoking inactivates A-1AT leaving the lung susceptible to damage

smoking also causes hyperinflammatory state which means that neutrophils are busy and a lot of elastase is produced

Question 16

what is the collective anatomical/physiological effects of deficiency of A-1AT and cigarette smoking on the lungs?

Answer 16

1. destruction of individual alveoli
2. development of “super” alveoli
3. destruction of CT supports for the very smallest airways allowing them to collapse during expiration

Question 17

A-1AT deficiency can also result in _______

Answer 17

liver disease

Question 18

what FEV/FCV ratio is “bad news”?

Answer 18

<0,5

Question 19

what are the clinical manifestations of emphysema?

Answer 19

1. SOB at rest (first complaint)
2. apprehensive, anxious, addicted to O2
3. thin, cachectic
4. deformed chest w/prolonged expiration
5. absent or non-productive cough
6. accompanying cardiac problems (cor pulmonale)
7. hypoxemia → can worsen to hypercapnia
8. chronic pulmonary metabolic acidosis
9. deconditioning

Question 20

what is the prognosis of emphysema?

Answer 20

usually very poor

Question 21

how is emphysema usually treated?

Answer 21

1. reduce airway edema secondary to inflammation and bronchospasm
2. facilitating the elimination of bronchial secretions
3. preventing and treating respiratory infection
4. increasing exercise tolerance
5. avoiding airway irritants and allergens
6. relieving anxiety and treating depression
7. long-term O2 therapy potentially

Question 22

what types of medications may be given to a patient with emphysema?

Answer 22

1. Beta-2 agonists or anticholinergics
2. anti-inflammatory agents
3. antibiotics
4. mucolytic expectorants
5. mast cell membrane stabilizers
6. antihistamines
7. glucocorticoids

Question 23

List some PT implications for patients with emphysema

Answer 23

1. always use pulse oximeter
2. monitor HR, RR, and BP frequently
3. exercise program may include HITT or aerobic training

Question 24

what is hypoxic drive and how does it relate to emphysema?

Answer 24

emphysema → retain CO2 may have a decrease hypoxic drive

hypoxic drive → a form of respiratory drive in which the body uses O2 chemoreceptors instead of CO2 receptors to regulate the respiratory cycle

increasing O2 through a nasal cannula may prevent this mechanism

Question 25

pulmonary emphysema patients may be nicknamed \_\_\_\_\_\_

Answer 25

pink puffers

Question 26

chronic bronchitis patients may be nicknamed \_\_\_\_\_\_

Answer 26

blue bloaters

Question 27

what is required for the diagnosis of chronic bronchitis?

Answer 27

1. productive cough lasting at least 3 months per year for 2 consecutive years 2. FEV/FVC \< 75%

Question 28

chronic bronchitis is characterized by what?

Answer 28

1. inflammation 2. excessive mucous production 3. scarring of lining of bronchial tubes 4. obstruction of bronchial air flow caused by increased mucous production/reduced mucous clearance

Question 29

how does chronic bronchitis develop?

Answer 29

1. chronic exposure to irritants cause mucus hypersecretion and hypertrophy of mucus producing glands in the largest bronchi 2. destruction of ciliary cells lining airway occurs 3. smooth muscle hypertrophy and atrophy of epithelial cells 4. decrease in radius 5. airway collapses may occur leading to reduced alveoli ventilation, hypoxia and acidosis

Question 30

how would a patient with chronic bronchitis present throughout the day?

Answer 30

recurring productive morning cough production of phelgm and chronic coughing increases over the course of the day wheezing

Question 31

what can cause an exacerbation of chronic bronchitis?

Answer 31

upper and lower respiratory infections exposure to environmental irritants such as dust, fumes or air pollution

Question 32

describe what "blue bloater" means

Answer 32

chronic bronchitis patient, has the following: 1. decreasing ventilation 2. increasing RV and decreasing expiratory flow 3. terrible V/Q mismatch 4. hypoxemia, hypercapnia, cyanosis, polycthemia 5. cor pulmonale secondary pulmonary HTN

Question 33

list some PT implications for patients with chronic bronchitis

Answer 33

1. reduce exposure to irritants 2. bronchodilators (B-2 agonsits) 3. mucolytics 4. no evidence for use of antibiotics, oral corticosteroids, expectorants, or postural drainage 5. NSAIDs

Question 34

what is asthma?

Answer 34

episodic, reversible, obstructive lung disease characterized by bronchospams resulting from an exaggerated inflammatory response of the airway smooth muscle to various stimuli (allergens) Bronchial hyperactivity

Question 35

what are the clinical manifestations of asthma?

Answer 35

episodic dyspnea coughing and wheezing

Question 36

what are the 2 main types of asthma?

Answer 36

Intrinsic (nonallergic/non-immune cause) Extrinsic (allergens)

Question 37

what is extrinsic asthma?

Answer 37

results from an allergic reaction to specific triggers mast cells, sensitized by IgE antibodies, degranulate and release bronchoactive mediators after exposure to a specific antigen

Question 38

what is intrinsic asthma?

Answer 38

how no known allergic cause or trigger adult onset most often secondary to chronic or recurrent infections of the bronchi, sinuses, or tonsils and adenoids

Question 39

what are some other recognized types of asthma?

Answer 39

1. adult-onset 2. exercise-induced (can be outgrown) 3. aspirin sensitive 4. Aspergillus-hypersensitive 5. Occupational asthma

Question 40

describe the pathogenesis of asthma

Answer 40

there is an inflammatory response consisting of: * cellular infiltration * epithelial disruption * mucuosal edema * mucous plugging of airways

Question 41

what is the product of inflammatory mediators in asthma?

Answer 41

1. bronchial smooth muscle spasm 2. vascular congestion 3. increased vascular permeability 4. edema formation 5. production of thick, tenacious mucus 6. impaired mucociliary function

Question 42

T/F: there is difficulty with breathing air in during asthma

Answer 42

FALSE difficulty with expiration results in air trapping in distal alveoli and hyperinflation

Question 43

T/F: asthma results in an increase in blood pH?

Answer 43

FALSE a decrease (acidosis) due to more retention of CO2 (hypercapnia)

Question 44

what should you ensure your asthmatic patient always has?

Answer 44

their rescue inhaler

Question 45

what is an exercise-induced bronchospasm in an asthmatic patient?

Answer 45

acute, reversible, usually self-terminating airway obstruction that develops 5-15 minutes after vigorous exercise usually the episode subsides spontaneously in 30-60 minutes be sure to warm up

Question 46

T/F: Cystic fibrosis can be considered an obstructive lung disease

Answer 46

TRUE almost all persons w/cystic fibrosis develop obstructive lung disease assocaited with chronic infection that leads to progressive loss of pulmonary function

Question 47

what is a cystic fibrosis?

Answer 47

genetic disease that causes a disorder of ion transport (sodium and chloride) in the lungs and in exocrine glands of the liver, pancreas, digestive, and male reproductive organs characterized by secretion of a thick mucous which is very difficult to move

Question 48

how does cystic fibrosis impact ion exchange?

Answer 48

CFTR proteins are incorrectly manufactured which results in Cl- not being transported to epithelial surfaces and remains trapped in cells Cl- is necessary for water to move, without the movement of water, mucus becomes thick and hard to expel

Question 49

what is the result of thickened mucus production in cystic fibrosis (for more than just the lung)?

Answer 49

* reduced movement of cilia in the bronchiole tubes * obstructs the tubular network in the pancreas which reduces release of digestive enzymes and insulin * obstruction of the terminal ileum by thick meconium in new borns * results in biliary fibrosis and portal hypertension

Question 50

give a more detailed description of how mucous in cystic fibrosis impacts the lungs

Answer 50

increase in mucous results in bronchial obstruction which predisposes the lungs to infection and causes patchy atelectasis disease can progress to bronchitis, followed by bronchiectasis, pneumonia, fibrosis and formation of large cystic dilations

Question 51

what is patchy atelectasis?

Answer 51

a complete or partial collapse of the entire lung or area (lobe) of the lung

Question 52

how has the prognosis for cystic fibrosis changed in the last 60 years?

Answer 52

1938 → 6 months to live, couldn't distinguish CF from celiac disease Now → median survival is 36.8 years

Question 53

what is the most common cause of death from cystic fibrosis?

Answer 53

pulmonary failure

Question 54

how is cystic fibrosis diagnosed?

Answer 54

1. genetic screening 2. sweat test 3. pancreatic elastase (marker for pancreatic insufficiency) 4. pulmonary function tests * FEV1 * VC 5. assessed for DM

Question 55

how are digestive problems from CF managed?

Answer 55

1. digestive enzymes, vitamin supplementation 2. enemas and mucolytic agents to treat intestinal blockages 3. Diets rich in proteins and calories 4. PT interventions

Question 56

how does CF impact the musculoskeletal system?

Answer 56

1. Osteoporosis risk increases 2. muscular dysfunction 3. thoracic cage deformation → reduced capacity for posture and thoracic cage movement and altered spinal movement results in reduced total lung capacity 4. poorer postural control 5. reduced ventilation capacity

Question 57

how is CF treated?

Answer 57

1. Pharmacologically * bronchodilator * hypertonic saline solutions * pancreatic enzymes * high dose NSAIDs * prophylactic antibiotics 2. Treatment * TherEx * airway clearance techniques * lung transplants