Obstructive Pulmonary Management & Review

What are the two types of pulmonary dysfunction?

obstructive lung dysfunction

restrictive lung dysfunction

What are examples of obstructive lung dysfunction?

COPD

asthma

cystic fibrosis

What are examples of restrictive lung dysfunction?

pulmonary fibrosis

pneumonia

atelectasis

pleural effusion

obesity

pregnancy

post-op

lung CA

What are the lungs covered in?

visceral and parietal pleura

What is between pleura to help maintain lung inflation?

negative pressure

What are the functions of the upper respiratory tract?

provides open airway

routes food & air appropriately

voice production

ventilation

What are the components of the upper respiratory tract?

nasal cavities

pharynx

larynx

T/F: upper respiratory tract has gas exchange

false

What are components of the lower respiratory tract?

trachea

bronchi

bronchioles

alveoli

What are the functions of the lower respiratory tract?

conducts air from upper respiratory tract to lungs

performs gas exchange

carries

What supports the anterior and lateral wall of trachea?

16-20 rings of cartilage

What composes the posterior wall of the trachea?

tracheal muscle (trachealis)

The bronchial tress has less —- and more ——?

less cartilage

more smooth muscle and elastic fibers

Where does the mainstem bronchi divide?

at carina (at level of rib 2)

Which bronchi is more vertical, wider, and sits at a 25 degree angle?

right bronchi

Which bronchi is more horizontal, and sits at a 40-60 degree angle?

left bronchi

What structure is hair-like that waves mucus up to the carina and throat?

cilia

How can cilia become paralyzed?

toxic gas inhalation

smoking

infection

T/F: each terminal bronchiole has no cilia

true

What are bronchioles lined with?

alveolar ducts

Alveolar ducts lead to what?

alveolar sac

Where does gas exchange occur?

in capillary beds surrounding the alveolar sac

How do alveoli communicate with each other?

through kohn’s pores

How do alveoli communicate with bronchioles?

via lambert’s canal

Why are alveolar wall the primary site for gas exchange?

because they are very thing and capillary beds surround the outer walls

Type I cells located in the alveoli are large and flat that make up most of?

alveolar surface

Type II cells in the alveoli produce surfactant to?

help reduce surface tension of alveoli

What are the functions of surfactant?

decreases surface tension of alveoli as size decreases during exhalation

increases surface tension of alveoli as size increases during inhalation

stabilizes alveolar cell membrane to prevent collapse

permits decrease inflation pressure to inflate alveoli

improves lung compliance and decreases work of breathing

What are the lines of defense?

1. limit entry, expel agent (physical barriers)

2. mucociliary transport

3. inflammatory response

What are the physical barriers in the first line of defense?

nasal hairs

nasal mucosa

What is the function of nasal hairs?

filters our particles

What is the function of nasal mucosa?

warms and humidifies inhaled air, hydrates and enlarges airborne particles

What are the reflex actions that can occur during first line of defense?

sneezing

coughing

gagging

bronchospasm

What is the function of the second line of defense?

foreign agents are trapped in a mucus layer and is transported toward trachea by cilia

What two items are found to work within the second layer of defense?

goblet cells

cilia

How is mucus production increased?

by inflammation

How can mucus consistency altered?

by disease

What agents are found in the third line of defense?

alveolar macrophages

b lymphocytes

t lymphocytes

polymorphonuclear leukocytes

mast cells

Ribs 1-7 connect where?

sternum and vertebral column

What ribs are true ribs?

1-7

What ribs are false ribs?

8-12

Ribs 8-10 are attached where?

to cartilage of rib above

What ribs are floating ribs?

11-12

What direction do the upper ribs move when increasing diameter?

anterior-posterior

What direction do the lower ribs move when increasing diameter?

transverse

Define elasticity

ability to return to resting shape after being stretched or compressed

What structures are highly elastic?

lungs

chest wall

What is the tendency of the lungs?

to recoil in and collapse

What is the tendency of the chest wall?

to spring outward

Define compliance

ease with which the lungs expand or the chest wall stretches during inhalation

What is the relationship between elasticity and compliance?

inversely related; as one goes up, the other goes down

What greatly enhances lung compliance?

surfactant

What allows for expansion of lungs to be easier?

lower surface tension

slide 23: are those the steps that inhaled air takes?

What are the main inspiratory muscles?

diaphragm

external intercostals

What are the accessory inspiratory muscles

SCM

scalenes

serratus anterior

pec major and minor

upper traps

erector spinae

lats dorsi

What are the main expiratory muscles?

abdominals: rectus, transverse, external oblique, internal oblique

internal intercostals

What are the mechanics of inhalation?

active contraction of diaphragm and external intercostal muscles

thoracic and lung expansion

negative intrapleural pressure & falling alveolar pressure

air flows into and inflates lungs

What are the mechanics of exhalation?

passive relaxation of inspiratory muscles to resting position

elastic recoil of lungs causes alveolar pressure to rise

air flows out of lungs

Define ventilation

cyclic process of inhalation and exhalation, moving air into and out of lungs

Define minute ventilation

amount of air moved into and out of lung per minute

What is the normal minute ventilation?

5-10L/min at rest

15-20x during exercise

An increase in what stimulates ventilation?

in hydrogen ion concentration

T/F: Dependent portions of lungs receive better ventilation

true

What is the movement of gases into and out of blood that occurs through the alveolar-capillary membrane?

diffusion

O2 from alveolar air goes into?

blood

CO2 from blood moves into?

alveolar air

Diffusion moves from —- to —- concentration

high to low

Diffusion is affected by?

concentration and solubility of gases

membrane thickness

surface area

pathology (fibrosis, fluid, edema)

Rate of O2 extraction is regulated by?

O2 demand

Tissue extraction and use of oxygen is regulated by?

tissue metabolism and overall demand

CO can increase how much during strenuous exercise?

more than 5x

Tissue extraction and use of oxygen is dependent on blood flow, why?

because as blood flow increases there is an increase of O2 availability to working tissues

How is partially desaturated blood and CO2 removed from cells?

by venous circulation to right side of the heart and lungs

The pulmonary plexus is formed from ?

branches of sympathetic trunk and vagus nerve

What type of neurotransmitters are used in the sympathetic system?

adrenergic

What type of neurotransmitters are used in the parasympathetic system?

cholinergic

What are functions that occur during sympathetic stimulation?

bronchodilation

slight vasoconstriction

inhibition of glandular secretion

What are the functions that occur during parasympathetic stimulation?

bronchoconstriction

indirect vasodilation

glandular secretion

What can be seen with impaired breathing mechanics?

ineffective or unbalanced breathing pattern

impaired lung expansion

impaired thoracic/chest wall mobility

ventilatory muscles weakness/fatigue

Patients with COPD have trouble with?

getting air out

COPD is used to describe what ?

emphysema and chronic bronchitis

Patients with COPD will likely have a —?

mix of emphysema and chronic bronchitis with one predominating

What are general characteristics of COPD?

progressive airway obstruction

poor gas exchange, air trapping, and hyper-inflated lungs

increased use of accessory muscles and altered breathing patterns

prone to recurrent respiratory infections

In COPD, progressive airway obstruction involves what?

inflammation of bronchial walls (chronic inflammation leads to narrowing of small airways causing destruction of bronchioles)

destruction of lung parenchyma resulting in loss of lung tissue elasticity

permanent destruction of alveoli walls

What are the two types of COPD clinical presentation?

pink puffer

blue bloater

Pink puffer is correlated with what disease?

emphysema

What are characteristics of pink puffer?

increasing SOB over last 3-4 yrs

thin build with recent weight loss

chest is over expanded (barrel chest) therefore increase A-P diameter

cough may be productive (with small amounts of white sputum) or absent

increased work of breathing to maintain normal oxygenation

What are S/S of emphysema?

dyspnea especially on exertion

cough

decreased breath sounds with prolonged expiratory phase

possible end-expiratory wheeze with force expiration

increased symptoms with acute respiratory infections

posture: leans forward and on UE

increased used of accessory muscles

barrel chest

hyper-resonance to percussion

flattened diaphragm

Define emphysema

enlargement of the air spaces distal to the terminal bronchioles accompanied by destruction of alveolar walls

Diagnosis of emphysema is based on?

long term structural and functional changes to lung tissue

What is loss with the destruction of alveoli?

massive loss of surface area for gas exchange as the disease progresses

What is the most common etiology of emphysema?

cigarette smoking

environmental exposure

In emphysema, where is alveoli destruction start?

in apex of upper lobes and spreads downward

With typical emphysema, alveoli destruction is limited to?

central part of respiratory bronchiole

What is the cause of the rarer form of emphysema?

antitrypsin deficiency

What is the description of the rarer form of emphysema?

destruction of whole alveoli

more common in lower lobe

What are the mechanics of the barrel chest?

air gets traps

increased residual volume and hyper-inflated lungs

increases A-P diameter

horizontal ribs

slide 49

What is bullae?

abnormal air spaces in lungs and can be seen in chest x-ray