Alterations of Pulmonary Function PDF

Alterations of Pulmonary Function Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 2 Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 3 Pulmonary Disorders Obstructive l...

Alterations of Pulmonary Function Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 2 Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 3 Pulmonary Disorders Obstructive lung diseases Airway obstruction that is worse with expiration Common signs and symptoms Dyspnea and wheezing Common obstructive disorders Asthma COPD Emphysema Chronic bronchitis Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 4 COPD Characterized by persistent airflow limitation Usually progressive Most common chronic lung disease in the world Preventable/treatable Enhanced chronic inflammatory response Exacerbations/comorbidities contribute to severity Riskfactors Tobacco smoke Occupational dusts and chemicals Air pollution indoor and outdoor Any factor affecting lung growth during gestation and childhood Treatment- bronchodilators, mucolytics, antioxidants, anti inflammatory medicine Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 5  Pathogenesis Inhalation of Chronic Changes lead to cigarette smoke inflammatory gas trapping and or other noxious response may progressive particles causes cause airflow limitation chronic parenchymal inflammation tissue destruction (emphysema), and disruption of normal repair airways, lung tissue, structural changes result and defense pulmonary vasculature from repeated injury and mechanisms all affected repair (small airway airflow limitation that is not fully reversible fibrosis) https:// goldcopd.org/ 6 Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 7  COPD Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 8 Chronic Bronchitis Hypersecretion of mucus and chronic productive cough that lasts for at least 3 months of the year and for at least 2 consecutive years. Inspired irritants increase mucus production and the size and number of mucous glands Causes smooth muscle hypertrophy, fibrosis and narrowing of airways Chronic inflammation causes Bronchial edema Mucus is thicker than normal. Bronchodilators, expectorants, and chest physiotherapy used to treat. Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 9 Emphysema Abnormal permanent enlargement of the gas-exchange airways accompanied by destruction of alveolar walls without obvious fibrosis Obstruction results from changes in lung tissues rather than mucus production and inflammation Inherited deficit of α1-antitrypsin (1%) Destruction of alveoli, production of large air sacs (Bullae) and air spaces (Blebs) not effective in gas exchange Loss of elastic recoil/expiration difficult/ air trapping Treatment – smoking cessation, inhaled anticholinergic, bronchodilators, steroids, phosphodiesterase inhibitors, lung volume reduction surgery Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 10  Asthma Chronic inflammatory disorder of the airways Inflammation results from hyper- responsiveness of the airways Can lead to obstruction and status asthmaticus Symptoms include expiratory wheezing, dyspnea, and tachypnea Peak flow meters, corticosteroids, beta-agonists, and anti-inflammatories used to treat Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 11  Bronchoconstriction Changes in bronchioles during an asthma attack sudden contraction of smooth muscle that causes acute dyspnea thick, viscous secretions edema caused by engorgement of pulmonary blood vessels Figure 38.3, Adams et al., 2021, p. 480 12 Pathophysiology: Early vs Late Response Early asthmatic response vasodilation increased capillary permeability mucosal edema bronchial smooth muscle contraction (bronchospasm) tenacious mucous secretion Late asthmatic response begins 4–8 hours after the early response. chemotactic recruitment of lymphocytes, eosinophils, basophils, neutrophils, and lymphocytes occurs. airway scarring increased bronchial hyperresponsiveness impaired mucociliary function with accumulation of mucous and cellular debris, forming plugs in the airways decreased Treg cells leads to airway remodeling if left untreated 13  Asthma Copyright © 2019, Elsevier Canada, a division 14 of Reed Elsevier Canada, Ltd. All rights reserv  Clubbing Modified from Seidel, H.M., et al. (2011). Mosby’s guide to physical examination (7th ed.). St Louis, MO: Mosby. Copyright © 2019, Elsevier Canada, a division 15 of Reed Elsevier Canada, Ltd. All rights reserv  ASTHMA vs COPD ASTHMA COPD ONSET -EARLY IN LIFE (OFTEN CHILDHOOD) -LATER IN LIFE SYMPTOMS -VARY FROM DAY TO DAY -PROGRESSIVE -WORSE AT NIGHT AND EARLY AM CAUSE -SENSITIZING AGENT -NOXIOUS AGENT TRIGGERS USUALLY LENGTHY SMOKING HX NON-SMOKERS (USUALLY R/T ALPHA 1 ANTITRYPSIN DEFICIENCY) INFLAMMATORY -EOSINOPHILS -NEUTROPHILS, MACROPHAGES CELLS -CD4+ HELPER T-CELLS -CD8+ CYTOTOXIC T-CELLS AIRFLOW -USUALLY REVERSIBLE -NOT FULLY REVERSIBLE LIMITATION 16 Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights 17 reserved. Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights 18 reserved. Pneumothorax Presence of air or gas in pleural space Caused by rupture of visceral pleura (surrounds the lungs) Or parietal pleura and chest wall Air separates pleura, loss of negative pressure Lung recoils toward hilum Spontaneous- healthy men 20-40 rupture of bullae and blebs apex of lung 80% emphysemic changes, 10% no hx Secondary caused by trauma, rib #,bullet, stabbing, or mechanical ventilation Open/tension (one way valve) accumulating pressure Pushes lung to other side , displaces heart, vessels, life threatening Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 19 Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights 20 reserved. Pleural Abnormalities Pleural effusion Transudative effusion Exudative effusion Hemothorax Empyema Infected pleural effusion; pus Chylothorax Pulmonary edema Excess water in the lungs Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 21  Pulmonary Pulmonary Edema Edema Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 22 Pulmonary Embolus Pulmonary vascular disorders: pulmonary embolus Occlusion of a portion of the pulmonary vascular bed by a thrombus, embolus, tissue fragment, lipids, or an air bubble Pulmonary emboli commonly arise from the deep veins in the lower leg Virchow triad Venous stasis, hypercoagulability, and injuries to the endothelial cells that line the vessels Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 23 Pulmonary Embolism Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 24  PAH Pulmonary vascular disorders: pulmonary artery hypertension (PAH) Mean pulmonary artery pressure >25 mm Hg at rest Idiopathic pulmonary atrial hypertension (IPAH) Unclear multifactorial mechanisms Diseases of the respiratory system and hypoxemia are more common causes Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 25 Pulmonary Hypertension and Cor Pulmonale Copyright © 2019, Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved. 26 Spirometry Post-bronchodilator spirometry is required to establish diagnosis FEV1/FVC