s/sx are primarily related to expiration and ventilation is "worse on expiration"

increased WOB to remove air from the lungs

emptying lungs is slowed

"air trapping"

Pulmonary Function Test

records the maximum amount of air that can be exhaled as quickly as possible after maximum inhalation

chronic disorder that results in intermittent, reversible airway obstruction

• extremely common, incidence is rising
• bronchioles primarily affected
• inappropriate immune/inflamm response
• triggers
• genetic component
• permanent damage

1) bronchoconstriction/bronchospasm

2) bronchiole edema (via vascular congestion)

2) excess mucus production

3) thickened airways & airway remodeling

asthmatic lung:

smooth muscle constriction

mucus plug

hyperinflation of alveoli

degranulation of mast cell

mucus accumulation

decreased blood flow to the alveoli

alveoli over inflated

increased CO2

Capillary will shunt blood

right ventricle works harder

• increased IgE synthesis and airway inflammation, resulting in mast cell destruction and inflammatory mediator release
• mediator release causes bronchocontriction, increased capilly permeability, and mucus production
• generally presents in childhood or adolescense
• triggers: allergens such as food, pollen, dust, and medications

• not an allergic reaction
• usually presents after age 35 years
• triggers: URI, air pollution, emotional stress, smoke, exercise, and cold exposure

• usually occurs between 3am and 7am
• may be related to circadian rhythms... at night, cortisol and epi levels decrease, while histamine levels increase, leading to bronchoconstriction

• usually occurs 10-15 minutes after activity
• symptoms can linger for an hour
• may be a compensaotry mechanism to warm and moisten the airways
• followed by a refractory period begins within 30 minutes and can last 90 minutes

• caused by a reaction to substances at work
• symptoms develop over time, worsening with each exposure and improving when away from work

• frequently caused by aspirin-- prevents the conversion of prostaglandins, which stimulate leukotriene release, a powerful bronchoconstrictor
• can be fatal
• reactions can be delayed up to 12 hours after drug ingestion

related to bronchospasms

it is usually signaled by coughing

peaking within 15-30 minutes

inflammatory mediators responsible include leukotrienes, histamines, and some interleukins

• peaks within 6 hours of symptom onset
• result of airway edema and increased mucus production
• the alveolar hyperinflation causes air trapping
• bronchospasm, smooth muscle contraction, inflammation, and mucus production combine to narrow the airways

cyanosis

difficulty talking

stridor

debilitating chronic disorders characterized by irreversible, progressive tissue degeneration and airway obstruction

two main conditions: chronic bronchitis and emphysema

smoking

pollution

chemical irritants

genetic mutation (2-5%)

• characterized by inflammation of the bronchi, a productive cough, and excessive mucus production
• "Blue Bloaters"

Frequent respiratory infections

respiratory failure

Hypoventilation/hypercapnia

Hypoxemia/cyanosis

Polycythemia (Increased RBCs)

Clubbing of fingers

Dyspnea at rest

Wheezing

Edema and weight gain

malaise

chest pain

fever (chronic infection)

ALVEOLI

destruction of the alveolar walls leads to large permanently inflated alveoli (without the evidence of fibrosis)

airflow limitation is caused by a loss of elastic recoil and hyperinflation of the alveoli, leading to air trapping

"Pink Puffers"

1) genetic predisposition (enzyme deficient)

2) smoking

Dyspnea upon exertion

diminished breath sounds

wheezing

chest tightness

tachypnea

hypoxia

hypercapnia

activity intolerance

anorexia

malaise

• same as chronic bronchitis (O2 therapy, bronchodilators, corticosteroids, antibiotics, postural drainage/chest physiotherapy, expectorants, increased hydration)
• pursed lip breathing

• chronic bronchitis
• cyanotic/obese
• activity impairment
• not breathless, by "choice" = hypoventilation
• Worse ABG's
• CV problems
• Not fighters

Emphysema

red/puffer = hyperventilation (noticed more in the clinical setting)

thin: wasting, related to work of breathing

pursed lip breathing

ABGs less abnormal