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Pulmonary Disorders - Coggle Diagram
Pulmonary Disorders
Chronic Obstructive Pulmonary Disorder COPD
Chronic Bronchitis
Hypersecretion of mucus in airways
• Patient can not get air into lungs
• Cough present for 3 months of year for 2
consecutive years
Hypoxia and cyanosis result
Combination of chronic bronchitis,
emphysema, and hyperreactive airways
• Narrowing of bronchioles, excessive mucus, loss
of alveolar recoil, smooth muscle hypertrophy
Smoking is major cause
Genetic and environmental factors
• AAT deficiency
‒ Alpha-1 antitrypsin
‒ Increases risk of pulmonary damage
Emphysema
Overdistension of alveoli
• Loss of elastic recoil
Air trapping
• High residual volume
• High carbon dioxide in lungs
Cor Pulmonale
Decreased oxygenation in lungs leads to
pulmonary vasoconstriction
Increased workload on RV may lead to right-
side heart failure
RV failure caused by pulmonary disease
called cor pulmonale
Signs and symptoms
• JVD, ascites, hepatomegaly, ankle edema
Changes in Breathing Stimulus
Normal breathing stimulus: increased CO2
In severe COPD, CO2 levels chronically
elevated
Chemoreceptors and respiratory center
become insensitive to high CO2
• Respiratory drive then comes from peripheral
chemoreceptors and O2 levels (hypoxic drive)
• Oxygen titration to keep hypoxic drive
• Use caution with agents that depress respiratory drive (tranquilizers, sedatives, and opiates)
Diagnosis
COPD Assessment Test (CAT)
• Patient questionnaire
PFT’s
• FEV1: Significant decrease due to prolonged, CBC, chest x-ray, ABG’s, ECG
CBC, chest x-ray, ABG’s, ECG
Treatment
Stepwise approach with medications
• SABA’s, LABA’s, long-acting anticholinergic (anti-muscarinic) agents (LAMA’s)
• IC’s
• Leukotriene antagonists
Smoking cessation, pulmonary rehabilitation,
vaccinations
Oxygen therapy: continuous oxygen when PaO2
less than 55 mm Hg or SaO2 less than 88%
Asthma
Hyperreactive airway disease of bronchioles
Reversible airway constriction
Each attack leads to inflammatory changes
• Bronchial remodeling
Different etiologies, multifactorial genetics
• Allergies, occupational exposure, viral infections, GERD (especially nocturnal asthma), exercise-
induced
Bronchoconstriction, bronchial edema,
viscous mucus, thickened bronchial basement membrane
T cells, IgE’s, leukotrienes (bronchiole constriction), histamine (inflammation),
eosinophils all play a role
Symptoms
Prolonged expiration
Wheezing
Cough
Dyspnea
Chest tightness
Use of accessory muscles
Severity depends on degree of bronchial
constriction and reversibility
Diagnosis
PFT’s: FVC and FEV1
• Diagnose and evaluate the severity of attack
During an acute asthma attack
• FEV decreases
• Diminishes the overall FEV1/FVC ratio
Reassess ratio after bronchodilator use
• Asthma
‒ Increase of 12% or greater and 200 ml increase in FVC
after bronchodilator
Treatment
Stepwise approach
Medications
• Maintenance: daily
‒ LABA
‒ IC
‒ Anti-leukotriene (if needed)
Cromolyn sodium
• Stabilizes mast cells
• Reduce allergic response
Bronchial thermoplasty
Limit exposure to
allergen
Sleep-disordered breathing. (SDB)
Obstructive sleep apnea (OSA), central sleep
apnea (CSA), or combination
• Apnea
‒ Reduction in airflow by 90% for at least 10 seconds
• OSA
‒ Intermittent collapse of upper airway tissues
• CSA
‒ Loss of respiratory drive from brainstem
Result in sleep disturbance, daytime
sleepiness, hypoxemia
Symptoms
• Loud snoring, choking or gasping during sleep, un restful sleep, and daytime sleepiness
Obesity a risk factor
Other risks include nasal blockage, airway anatomy
OSA worsened by alcohol and sedative-
hypnotic medications
Diagnosis
• Sleep study (polysomnography)
Treatment
• Behavioral changes
• CPAP (continuous positive airway pressure)
device
‒ Prevents airway closing
• Oral appliance that pulls the tongue forward may
help
• Surgery to open upper airway structures
Bronchiectasis
Uncommon disease
Untreated infections lead to chronic
inflammation and dilatation of bronchi• Pseudomonas aeruginosa, Haemophilus
influenzae, Staphylococcus aureus, adenovirus and influenza, aspergillus
Bronchiole wall destroyed and replaced by
fibrous tissue
Bronchioles irreversibly dilated
Patients present with persistent cough and
purulent sputum, hemoptysis may occur
Reduced PFT’s
Treatment involves treating underlying
infection
• Mucolytic agents and bronchodilators