OBSTRUCTIVE LUNG DISORDER

resonant

normal lung percussion sound

dull

normal heart percussion sound

crackles / rales

auscultation sound of fluid-filled alveoli

wheezing

• auscultation sound of when there’s bronchospasm

• can be heard during exhalation

stridor

• auscultation sound caused by an obstruction or narrowing in the upper airway

• can be heard during inhalation

Tidal volume

Volume of air that goes in and out of the lungs in normal breathing

500 ml

avg TV

Inspiratory Reserve Volumes

Volume of air that can still be inhaled after normal inspiration

3000 ml

avg Inspiratory Reserve Volumes

Expiratory Reserve Volumes

Volume of air that can still be exhaled after normal expiration

1100 ml

avg Expiratory Reserve Volumes

Residual Volume

Volume of air that is left in the lungs after forceful expiration/ keep the alveoli open

1200 ml

avg Residual Volume

Dead Space Volume

Volume of air that does not participate in gas exchange

150 ml

avg Dead Space Volume

Functional Volume

Volume of air that actually participates in gas exchange

350 ml

avg Functional Volume

TV – DSV = FV

formula for Functional Volume

Inspiratory Capacity

Total volume of air maximally inhaled

TCV + IRV = IC

formula for Inspiratory Capacity

Functional Residual Capacity

Total volume of air left on the lungs after normal expiration

ERV + RV = RC

formula for Functional Residual Capacity

Vital Capacity

Total volume of air maximally inhaled and maximally exhaled

TV + IRV + ERV = VC

formula for Vital Capacity

Total Lung Capacity

Total volume of air the lungs can hold

• RV + IVC = TLC

• FRC + IC = TLC

formula for Total Lung Capacity

Chronic Airflow Limitations

• A group of chronic lung diseases that includes:

  • Asthma

  • Chronic Bronchitis

  • Emphysema

  • Bronchiectasis

• COPD

Bronchial asthma

• obstructive lung disease characterized by bronchospasm

• ETIOLOGY:

  • Idiopathic = intrinsic

  • Allergens = extrinsic

    • dusts, pollens, danders, furs, strong perfume

increasing, hyperventilate, alkalosis, acidosis

BRONCHIAL ASTHMA

• initial attack → bronchospasm → patient compensates by (decreasing / increasing) the RR and depth (?) → respiratory ? → respiratory ? (later)

hyperinflated lung

chest xray result for bronchial asthma

• decreased ERV

• increased FRC

• increased RV

Spirometry Result for Bronchial Asthma

• orthopneic, tripod, leaning forward

• bronchodilator

• yearly

• 5 years

• anti infective

MANAGEMENT FOR BRONCHIAL ASTHMA:

• position: ?, ?, ?

• ? inhalation

• promote rest

• provide safety measures

• prevent infection

• hand washing

• physical distancing

• wearing of masks

• avoid crowded places

• avoid sick people

• vaccination

  • flu vaccines - ?

  • pneumococcal vaccine - every 5 years / lifetime

• treat infection - ? drugs

xanthine derivatives / methylxanthines

• drugs for bronchial asthma

• ex: theophylline, aminophylline

• adverse effects:

  • tachycardia

  • palpitation

  • tremors

sympathomimetic b-dilator

• drug for bronchial asthma

• beta agonists

• ex: salbutamol (ventolin), salmeterol, terbutaline

• adverse effects:

  • tachycardia

  • palpitation

  • tremors

T

T or F: anticholinergic bronchodilators are only inhaled (no oral, no parenteral)

anticholinergic bronchodilators

• drug for bronchial asthma

• inhalation only (no oral, no parenteral)

• ex: ipratropium (atrovent), combivent (tiotropium combination)

steroids

• drug for bronchial asthma

• decreases swelling, anti-inflammatory

• oral, parenteral, inhalation

• ex: prednisone, hydrocortisone, budesonide, beclomethasone

peak flow meter

a tool that measures the peak expiratory flow rate (PEFR)

peak expiratory flow rate

the amount of air a person can quickly force out of their lungs in one breath.

80%-100%

• peak flow meter interpretation

• green

• personal best

50%-80%

• peak flow meter interpretation

• yellow

• with caution

• narrowing airways

<50%

• peak flow meter interpretation

• red

• medical emergency

leukotriene receptor antagonist

• drug for bronchial asthma

• stops bronchospasms

• ex: montelukast

status asthmaticus

uncontrolled asthma attack for more than 30 mins

Chronic bronchitis

• aka: “blue bloater”

• chronic inflammation of the bronchioles

• large airways (trachea, bronchi)

  • mucus hypersecretion

  • inflammation

Chronic bronchitis

CLINICAL DX:

• Productive cough for 3 months for 2 consecutive years = ?

DX TEST:

• CXR – Pneumonia

• ABG – respiratory acidosis

• Pulse ox – low O2 saturation

Bronchiectasis

• Abnormal and permanent dilatation and destruction of bronchi and bronchioles

• It results from inflammation and destruction of the structural components of the bronchial wall brought about by:

  • chronic pulmonary infection (P. aeruginosa, H. influenzae)

  • tumor or foreign body

  • congenital abnormalities

• The structure of the wall tissue changes, resulting in the formation of saccular dilatations which collects purulent materials causing more dilatation, structural damage & more infection

Bronchiectasis

ASSESSMENT FINDINGS:

• Chronic cough (copious, purulent, blood-streak sputum) 

• Fatigue, weight loss, anorexia, dyspnea

• CXR & bronchoscopy – reveals increased size of bronchioles, atelectasis & changes in the pulmonary tissues

• Sputum C/S identify causative microorganism

Emphysema

• aka: “pink puffer”

• over distention, inelasticity of alveoli

• acinus (respiratory bronchiole, alveolar ductsm and alveoli)

  • loss of elastic recoil

• A chronic disease characterized by loss of lung elasticity & hyperinflation of the lung.

• most common COPD

Emphysema

Alpha 1 antitrypsine deficiency and chronic asthma may cause?

Emphysema

COMPLICATIONS OF ?:

• Pneumonia

• ARF

• Polycythemia – inc RBC (secondary)

• Erythrocytosis

• Spontaneous Pneumothorax - rupture of blebb bullae

• Pulmonary hypertension

• Cor pulmonale

• Right sided heart failure

Emphysema

DIAGNOSTIC TESTS:

• CXR – Barrel chest / Pneumonia

• ABG – Respiratory acidosis

• Pulse Ox – low O2 saturation

• Spirometry:

  • ↓ERV, ↑ RV, ↑ FRC, ↑ TLC

• 1-2 lpm

• 28%, 4 lpm

O2 THERAPY FOR COPD

• nasal cannula = ? to ?

• venturi mask = ? O2, with ? flowrate

SPONTANEOUS PNEUMOTHORAX

• Air accumulates within the pleural space without an obvious cause (no antecedent trauma to thorax)

• Rupture of a small bleb on the visceral pleura most frequently produces this type of pneumothorax.

pulmonary hypertension

• ↑ pulmonary arterial pressure (N g)

• ↑ pulmonary arterial systolic pressure > 30 mmHg

• Mean pulmonary arterial pressure > 15 mmHg

25/9 mmHg

normal pulmonary arterial pressure

cor pulmonale

• aka: right-sided heart failure

• enlargement of the right ventricle due to high blood pressure in the lungs usually caused by chronic lung disease

• enlargement, distention, hypertrophy of the right ventricle due to ↑ pressure or the pulmonary circulation 

bronchial asthma

ASSESSMENT FINDINGS:

• Audible wheezing & RR (acute episode)

• Wheezing is louder during exhalation

• Dyspnea, cough, use of accessory muscle of respiration, barrel chest (chronic severe asthma)

• Cyanosis, poor O2 saturation (pulse oximetry)

• Change of LOC & tachycardia due to hypoxemia

PULMONARY FUNCTION TEST

 most accurate test for asthma

30 mins

Use bronchodilator ? before exercise to prevent or reduce exercise-induced asthma.

eosinophil, IgE

LABORATORY ASSESSMENT FOR ASTHMA:

• elevated ? count and ? levels

beta 2 agonist

Albuterol (Ventolin), Bitolterol, Pirbuterol, Salmeterol, Formoterol

Methylxanthines

• Theophylline, Aminophylline, Oxtriphylline

• Monitor for SE: excessive cardiac & CNS stimulation (check pulse & BP)

Mast cell stabilizer

reduces bronchoconstriction and edema but does not stop asthma attacks

Cromolyn sodium

drug that helps prevent atopic asthma attacks (prevent mast cell membranes from opening when an allergen binds to IgE) but are not useful during an acute episode

Montelukast, Zafirlukast

drugs that inhibit substance that mediate allergic response/prevent asthma attack

Corticosteroids

• oral – Prednisolone, Prednisone

• inhaler – Budesonide, Fluticasone, Beclomethasone, Triamcinolone, Flunisolide

Omalizumab

• monoclonal antibodies that was only approved in 2003

• binds to IgE receptor sites on mast cells & basophils, preventing the release of chemical mediators for inflammation

aerobic

Type of exercise recommended for asthma

• 2-4 lpm

• 24%-40%

O2 therapy for asthma:

• ? to ? via nasal cannula

• ? to ? via venturi mask

pneumonia

• one of the most common complications of COPD:

• Advise clients to avoid crowded places and

• stress the importance of receiving a pneumonia

• vaccination and a yearly influenza vaccine “flu shot.”