Chronic Obstructive Pulmonary Diseases (COPD) and Asthma & OSA

Overview of Obstructive Pulmonary Diseases

These conditions block airflow, especially when breathing out.

• Asthma → reversible airway narrowing

• COPD (Chronic Bronchitis + Emphysema) → not fully reversible, gets worse over time

• OSA → airway collapses during sleep, not a lung disease but affects breathing

Pulmonary Diagnostic Tests

• Pulse oximetry – oxygen saturation

• Capnography – CO₂ levels

• Pulmonary function tests (PFTs) – airflow & lung capacity

• Bronchoscopy – look inside airways

• Thoracentesis – remove pleural fluid

• Exercise testing – how breathing affects ADLs

Pulmonary System Assessment

• Inspection – breathing effort, chest shape

• Palpation – chest expansion

• Percussion – air vs fluid

• Auscultation – wheezes, crackles

What is Obstructive Sleep Apnea (OSA)?

OSA is when breathing repeatedly stops during sleep:

• Stops ≥10 seconds

• Happens ≥5 times per hour

Why it happens

When sleeping:

• Muscles relax

• Tongue & soft tissues fall back

• Upper airway gets blocked

Risk factors

• Obesity

• Short neck

• Large uvula

• Smoking

• Enlarged tonsils/adenoids

Treatment (non-surgical)

• CPAP (continuous positive airway pressure)

  • Keeps airway open during sleep

• Positioning devices

• Weight loss

• Smoking cessation

What is asthma?

• Chronic inflammatory disease

• Airways tighten suddenly

• Reversible

• Affects airways only, not alveoli

What’s happening in the lungs

• Swelling of airway walls

• Bronchospasm

• Thick mucus

• Narrow airways (bronchoconstriction)→ ↓ airflow

Asthma triggers

• Smoke (cigarette, wood)

• Pollution

• Animals (fur/dander)

• Mold, pollen

• NSAIDs / aspirin (in some patients)

• MSG

• Exercise

• Cold air

Prevalence of Asthma

More common in adult women than men

Slightly more prevalent among African-Americans than Caucasians

Number of people with asthma continues to grow

Signs & symptoms

• Wheezing

• Shortness of breath

• Chest tightness

• Prolonged expiration

• Accessory muscle use

• Severe attacks → hypoxia, hypoxemia - ↓ LOC, tachycardia

Intervention

Management

Tailored to meet the patients triggers

Use peak flow meter and adjust accordingly

Green – asthma control

Yellow – use prescribed reliever drug* rescue inhaler

Red Zone – need reliever drugs & seek medical help!

*continuously in yellow might need a better plan. 

Asthma medications

Rescue meds

• Short-acting beta₂ agonists (SABA)

  • Example: albuterol

  • Used during attacks

Controller meds

• Inhaled corticosteroids (avoid systematic s/s from oral)

• LABAs (long-acting beta₂ agonists)

• Leukotriene modifiers (montelukast)

• Monoclonal antibodies (IgE)

⚠ Always give SABA before LABA

Other treatment

Exercise and activity to promote ventilation and perfusion

Oxygen therapy via mask or nasal cannula (acute asthma attack)

Overview of Beta2-Agonists Bronchodilators

Suffix: TEROL

Action: Dilates bronchi

SE:  (from activating sympathetic nervous system)

–Tachycardia

–Palpations

–Irregular heart reate

–Tremors

–Anxiety/insomnia

–Thrush ( rinse mouth after inhaler use)

–Avoid caffeine (increases Ses)

SABA (Short Acting Beta Agonists)

–ex albuterol

–Rescue Inhaler: Quick relieve of acute symptoms

–Usually administered as 2 puffs prn

SABA (Short Acting Beta Agonists)

–ex albuterol

–Rescue Inhaler: Quick relieve of acute symptoms

–Usually administered as 2 puffs prn

_{REMEMBER ALWAYS ADMINISTER SHORT ACTING THEN LONG ACTING!}

Overview of Muscarinic Antagonist or anticholinergic bronchodilator

What is Leukotriene Modifiers: Montelukast. How to take it?

Used as additional treatment in addition to other medications such as SABA and LABAs or corticosteroids DOES NOT replace other therapies—important pt teaching point

Administered as a once a day pill

Must take daily as it’s effectiveness requires regular use

What is Theophylline; toxicity; s/e

• methylxanthine

• Used to help open the airways in asthma and COPD

• Works by relaxing bronchial smooth muscle → easier breathing

Blood levels  10-15

Toxicity: >20

SE: HA, GI distress, N/V/D

Signs of toxicity: tachycardia, palpitations, seizures

Asthma Prevention and Treatment key takeaways

What is Status asthmaticus? It can cause? Treated with?

• Severe, life-threatening, acute episode of airway obstruction

• Intensifies once it begins, often does not respond to common therapy

• Can cause:

  • Pneumothorax

  • Respiratory arrest

• Treated with:

  • IV steroids

  • Bronchodilators (potent)

  • Oxygen

  • Epinephrine

Management & Teaching for Intermittent and persistent asthma

Avoid triggers of acute attacks

Pre-medicate before exercising

Short-term (rescue or reliever) medication

Long-term or controller medication

Assessment during acute exacerbation

Respiratory and heart rate

Use of accessory muscles

Percussion and auscultation of lungs

Peak Expiratory Flow Rate (PEFR )to monitor airflow obstructin/airway function

–Maximum rate a person can exhale after full inhalation

ABGs

Pulse oximetry

Management during Acute asthma exacerbations

O2 via nasal cannula or mask to achieve a PaO2 of at least 60 mm Hg or O2saturation greater than 90%

–Continuous oxygen monitoring with pulse oximetry

Bronchodilator treatment

–Short-acting β2-adrenergic agonists (SABAs)

What happen to the body during Severe and life-threatening exacerbations

“Silent chest” - it means air is NOT moving

Severely diminished breath sounds

Absence of wheeze after patient has been wheezing

Patient is obviously struggling

Life-threatening situation

2 main disease of COPD

1. Chronic Bronchitis

2. Emphysema

Most patients have features of both.

Main Cause of COPD

• Chronic exposure to irritants

• Cigarette smoking is the #1 cause

• Also includes:

  • Secondhand smoke

  • Occupational dust/chemicals

  • Air pollution

What is chronic bronchitis?

• inflammation of bronchi and bronchioles

• Affects airways only (NOT alveoli)

• Caused by long-term irritation

• Airways become:

  • Swollen

  • Narrowed

  • Filled with thick mucus

Sign and symptoms of Bronchitis

What is acute bronchitis?

Acute infection or inflammation of the airways or bronchi

Commonly follows a viral illness

Symptoms similar to those of pneumonia but does not demonstrate pulmonary consolidation and chest infiltrates

–Cough

–Productive/non

–Sore throat

–Post nasal drip

–Fatigue

What is emphysema?

• Destruction of alveoli

• Loss of lung elasticity

• Alveoli stretch and form bullae (air pockets)

• Damage is permanent

• Air gets trapped during exhalation

• Lungs become hyperinflated

Sign and symptoms of emphysema

What Happens in COPD Overall

• Alveoli damage

• V/Q mismatch- V (ventilation) = air getting to the alveoli Q (perfusion) = blood flowing past the alveoli

• Increased oxygen demand

• Pulmonary hypertension

• Leads to Cor Pulmonale (right-sided heart failure)

Signs of right-sided heart failure:

• Peripheral edema

• Jugular vein distention

• Weight gain

Breathing Positions & Techniques (VERY TESTED)

Tripod Position
Leaning forward

• Uses accessory muscles

• Increases lung expansion

• Decreases work of breathing

Pursed-Lip Breathing

Inhale through nose → Exhale slowly through puckered lips

Helps by:

• Keeping airways open longer

• Releasing trapped air

• Slowing breathing

• Improving gas exchange

Often combined with tripod position

Diagnostic Tests for COPD

• Pulse oximetry – oxygen saturation

• ABGs – oxygen, CO₂, acid-base status

• Pulmonary Function Tests (PFTs) – confirms COPD

• Chest X-ray

• CBC

  • Chronic hypoxia → polycythemia (can occur)

• Sputum cultures (look for any infection)

• Serum electrolytes

What is Pulmonary Function Test?

A non-invasive breathing test measuring lung capacity, airflow, and gas exchange to diagnose lung diseases such as COPD or Asthma.

Drug Therapy

Bronchodilators

• Beta-agonists

• Cholinergic antagonists

• Methylxanthines (Theophylline)

👉 Open airways

Corticosteroids

• Reduce inflammation

• Inhaled or systemic

Mucolytics

• Thin thick secretions

• Make coughing easier

NSAIDs

Other Therapies

Exercise Conditioning

Suctioning

Hydration

Vibratory Positive Pressure Devices (PEEP)

–Holds airway open – breath into it.

Surgical Management

Lung reduction surgery removes the most damaged parts of the lungs (usually from emphysema).

Median Sternotomy

• Surgeon makes an incision down the middle of the chest

• Chest is opened to access both lungs

• More invasive

• Longer recovery time

VATS (Video-Assisted Thoracotomy Surgery)

• Minimally invasive

• Small incisions

• Camera and instruments inserted into chest

• Less pain

• Shorter recovery

• Fewer complications

VATS is preferred when possible

This helps the healthier lung tissue work better and makes breathing easier.

⚠ It does not cure COPD, but it can:

• Improve breathing

• Improve exercise tolerance

• Improve quality of life in selected patients

Postoperative Care & Monitoring (After Surgery)

Key postoperative priorities:

• Airway & breathing

  • Monitor oxygen levels

  • Watch for respiratory distress

• Chest tube management

  • Prevent pneumothorax

  • Monitor drainage and air leaks

• Pain control

  • Pain can limit deep breathing → increases pneumonia risk

• Early mobilization

  • Prevents atelectasis and blood clots

• Pulmonary hygiene

  • Incentive spirometry

  • Deep breathing and coughing exercises

Possible Complications (Why Close Monitoring Is Needed)

COPD patients are high risk for complications such as:

• Pneumothorax (collapsed lung)

• Respiratory failure

• Infection or pneumonia

• Prolonged air leaks

• Cardiac complications

Community-Based Care

Home care management - Helping the patient manage COPD in their daily life at home.

–Long-term use of oxygen

–Pulmonary rehabilitation program

Teaching for self-management

–Drug therapy (how to take the medicine in times of exacerbation)

–Manifestations of infection (COPD patients are high risk for respiratory infections.)

–Breathing techniques (pursed lip)

–Relaxation therapy (COPD often causes anxiety, which makes breathing worse.)