Obstructive pulmonary conditions - eval, background, impact, Tx

BODE index for COPD takes into account:

BMI, airflow obstruction, dyspnea, exercise capacity

BODE

• predictor of ___ and ____ of acute COPD exacerbations

• score ___-___

• higher number = ____

number, severity, 0, 3, more severe

orthostatic hypotension =

• decrease by ____ SBP

• decrease by ____ DBP

20, 10

normal RR for adult = ____

normal RR for infant = ____

12-20, 20-40

chronic bronchitis = ____ bronchial airways

build up of ____, lots of ____ → airway ____ almost fully on ____ causing obstruction

inflamed, mucus, swelling, closes, exhalation

chronic bronchitis = ___ airway

emphysema = ____ airway

proximal, distal

emphysema = lose ____ around ____

after inhale, dont get ____ → air gets ____ causing obstruction

elasticity, alveoli, elastic recoil, stuck

asthma = immune system sensitive to ____

• muscles ____, increased ____ and ____ production causing obstruction

irritants, tighten, swelling mucus

bronchiectasis = _____ airway

• d/t repeated ____

• lose ____ and ____ capacity

enlarged and dilated, infection, elasticity, exhalation

genetic obstructive condition

cystic fibrosis

cystic fibrosis

• ____ mucus in pancreas and lung spaces, promotes ____, impedes ____

if mucus in airway = creates _____

inflammation creates ____

thicker, infection, gas exchange, obstruction, scar tissue

obstructive conditions can cause

• _____ mm dysfunction and ____ abnormalities

• ____ and ____ mismatching

• ____ abnormalities

respiratory, chest wall, ventilation, diffusion, diffusion

respiratory mm dysfunction

• overtime, air = ____ (increased ___)

• ___/___ adapt

  • ____ diaphragm occurs

    • decreased _____ and decreased _____

trapped, RV, chest wall, ribcage, flattened, ROM, ventilation

chest wall deformities

• overtime, air = ____ (increased ___)

• ___/___ adapt

  • when rib changes, ____ alignment changes

  • altered direction of ____ and/or ____ relationships

    • ____ deformity

    • ____ mm align more horizontally

trapped, RV, chest wall, ribcage, muscle fiber, contraction, length-tension, barrel chest, intercostal

ventilation/perfusion

• typically, should be ___:___ ratio

  • changes in _____ alter ration but will ____ over time

  • standing = more ventilation and perfusion in the _____ of the lungs

1, 1, position, equalize, base

ventilation perfusion mismatching

• atypical ventilation can occur from:

  • decreased chest wall ____/____

  • _____ mm alignment

  • ____ airway diameter = ____ resistance

  • ____ RV = ____ dead space

*perfusion would still be intact, thus resulting in mismatch

compliance, elasticity, respiratory, decreased, increases, increased, increased

ventilation perfusion mismatching

• atypical perfusion can occur from:

  • hypoxic vasoconstriction; ____ mechanism in response to inadequate ____

  • if area of lung wont ventilate = _____ blood flow to area bc dont need ____

    • can lead to total lung _____ and _____ ventricular failure

physiologic, ventilation, shut off, O2, collapse, right

diffusion abnormalities

• improper diffusion caused by

  • ____ pressure gradients (bc decreased ____ = increased ____)

  • ____ surface area (bc decreased ____ = increased ____)

  • ± ____ membrane thickness

decreased, ventilation, RV, decreased, ventilation, RV, increased

main cause of ventilation problems with obstructive disorder is the increased amount of _____

air stuck in lungs

5 factors affecting ventilation

compliance, length tension, elasticity, pressure gradients, airway resistance

compliance

• decreased bc ____ ability to _____

  • requires more effort to get air ____

decreased, expand, out

length tension

• _____ deformity alters ____ for mm

barrel chest, line of pull

elasticity

• _____ ability to come back to ____ shape

decreased, normal

pressure gradients

• ____ pressure gradients bc lungs are staying too inflated (____ RV), less room to _____

decreased, increased, expand

airway resistance

• ____ diameter d/t inflammation (____) and excess _____

decreased, bronchoconstriction, mucus

3 factos affecting central gas exchange

pressure gradients, surface area, membrane thickness

pressure gradients

• loss of ____ makes it hard to get air ____ and generate a pressure gradient

elasticity, out

surface area

• ____ destroyed (_____) which ____ surface area

alveoli, emphysema, decreases

membrane thickness

• ____ secretion = ____ thickness = ___ ability for gas to easily ____

increased, increased, decreased, exchange

goals for Tx of obstructive disorders

• optimize ____ and _____

• minimize ____ and ____

• prevent ____/_____

• facilitate ____ work

ventilation, perfusion, hypoxia, hypercarbia, exacerbation, infection, subthreshold

behavioral Tx of obstructive disorders

• ____ cessation

• ____ factor avoidance

• ____

• ____ clearance

• breathing ____

• formal ____ rehab

smoking, risk, exercise, airway, retraining, pulmonary

pharm Tx for obstructive disorders

bronchodilators, mucolytic agents, corticosteroids, vasodilators, supplemental o2, non-invasive positive pressure ventilation

invasive tx for obstructive disorders

• ____ventilation

• lung ____

• lung _____

mechanical, resection, transplantation

exercise

• mild disease = can ____ most things (___ of diaphragm, ___, etc)

• chronic disease = work to ____ gas exchange in ____

improve, strength, compliance, optimize, periphery

bronchodilators

• open airways = ____ resistance = ____ ventilation

• beta ____

  • ______ agents

decreased, increased, 2 agonist, symapthophrenic

side effects of bronchodilators

• beta 2 agonist = ____ agents

• ____, ____ contractility, ____ baseline ____

  • consider if already have ____

sympathophrenic, tachycardia, increased, increased, HTN

mucolytic agents

• help get rid of ____

mucus

corticosteroids

• ______

• side effects: decreased ____, weakened _____ and ____, frail ____

anti-inflammatory, BMD, immune system, mm, skin

supplemental O2

• ____ pressure gradient of ____

increases, O2