This is airway obstruction that is worse with expiration.

more foce required to exhale, slowed emptying of the lungs

causes increase in breathing, ventilation/perfusion mismatch (VQ)

decrease forced expiratory volume in one second (FEV1)

this is an inflammatory disorder of the airway

IgE, Mast cell degranulation, inflammatory mediators

Airway hyperresponsiveness to allergens

type 1 hypersentivity

genetic predispostion

this causes;

bronchial smooth muscle spasm, constriction, vascular congestion, increase vascular permeability, mucosal edema, thick mucus, hyperinflation of alveoli

an estimate 20.3 million americans have this

6.3 of them are children

increased over past decades

mortality and morbidity have stabilized= better management

14 million people in the U.S

4th leading cause of death

major cause of smoking

others: genetic, occupational, air pollution

inflammation of major and small airways

hypersecretion of mucus and chronic productive cough that continues for at least 3 months of the year for at least 2 consecutive years =smokers, occupational exposure to air pollutants

causes; increase mucus production in response to inhaled irritants

increase size and number of mucous glands and goblet cells

impaired mucocilliary action

inflammation an thickening of epithelium

injury to bronchial wall

increase risk for infection

airway obstruction by:

• excessive bronchial secretion
• thick mucus, mucous plugs
• hypertrophied cronchial smooth muscle narrow the airway

initally large bronchioles= progresses to smaller branches

colapse of a bronchiold early in exhalation traps air in dital parts

prolonged exhalation

Chronic bronchitis

manisfestations

• productive cough (smokers cough)
• decrease activity tolerance, and FEV1 on spirometry
• wheezing, dyspnea, SOB
• hypoxemia= decrease pO2 and SpO2
• cyanosis, pulmonary hypertension
• cor pulmonale- right heart failure

complications are; frequent chronic infections,

cardiac problem= right heart failure dysrhythmias, atrial fibrillation

respiratory failure

CXR, PFTs, decrease FEV1, increase functional reserve capacity

ABGS: increase pCO2/decrease pH= respiratory acidosis

physical exam- barrel chest, increase AP diameter

prevention by not smoking- pathologic changes are irreversible

stop smoking- if stop before S/S, decrease risk for Chronic Bronchitis

bronchodilators (metere dose inhaler)

B-adrenergic drugs- albuterol, metaproterenol (alupent)

anticholinergic drugs (parasympatholytic)- block ACH in bronchial smooth muscle, atropine, ipratropium bromide (atrovent)

Corticosteroids - anti-inflammatory effects

• MDI- beclomethasone (beclovent, vanceril)
• triamcinolone (azmacort)

Oral/IV

• Prednisone (po)
• Hydrocortisone(IV)
• Methlprednisolone (IV)

Nebulizer treatment (albuterol)

chest physcial therapy (CPT): deep breathing, postural drainage and percussion

breathing techniques: pured lip breathing

nutrition

recognize early sign if infection

Oxygen therapy

Low flow dose;

• Chronic CO2 retention- central chemorecptors no longer act as stimulus for breathing
• O2 levels become stimulus for breathing
• if supplemental oxygen causes pO2>60, the patient becomes apneaic
• But this has been shown to be benefical to deter cardiac complications

this is an abnormal permanent enlargement of gas exchange airways (acini)

destruction of alveolar walls

obstruction from changes in lung tissue

loss of elastic recoil

noncompliant, stiff lungs

Carbon dioxide retention

(emphysema)

Emphysema (pathophysiology)

causes;

• elastic tissue destruction
• thinning and destruction of alveolar wall
• confluent adjacent alveoli- bullae
• deformation fo fibrosis of respiratory bronchioles
• obstruction (collapse) during expiration

Emphysema: manifestations

• Dyspnea
• tachypnea, prolong exhalation, decrease FEV1
• no cough
• wheezing
• weight loss
• barrel chest
• 3 pint position

Complication of emphysema

pneumothorax

pulmonary failure: respiratory acidosis/hypercapnia

hypoxia, coma

Cor pulmonale- right heart failure

Emphysema evaluation

CXR- hyperinflation of lungs, flat diaphragm

PFTs: decrease FEV1, increase FRC and TLC

• Smoking cessation must occur before irreversible damage becomes extensive
• bronchodilaors- Anticholinergic MDI (parasymphatholytic) block ACH in bronchial smooth muscle, atropine, ipraropium brominde, and B adrenergic agonist

• this is bronchiolar and bronchial injury
• bronchospasm, respiratory infection, hypersecretion of mucus, obstruction in bronchioles

• this is destruction of acini, occasional respriatory infection, destruction of alveolar wall

Chronic Bronchitis

Blue Bloaters

• cough, mucus, no barrel chest, dyspnea late, no air hunger, cyanosis, cor pulmonale, obese

pink puffers

• barrel chest, dyspnea early, hunched over, hyperventilation, adequate oxgenation, weight loss

decreased hypoxemia, pulmonary hypertension, Cor pulmonale, respiratory failure, cardiac failure,

sugical: lung reduction surgery