obstructive+lung+disease

8/7/2019 Obstructive+lung+disease

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Obstructive lung disease

Dr Rebecca ScholesApril [email protected]


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COMMONWEALTH OF AUSTRALIACopyright Regulations 1969

WARNINGThis material has been reproduced andcommunicated to you by or on behalf of

Monash University pursuant to Part VB ofthe Copyright Act 1968 (the Act).

The material in this communication may besubject to copyright under the Act. Any

further reproduction or communication ofthis material by you may be the subjectof copyright protection under the Act.

Do not remove this notice.


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Learning objectives

At the completion of this session it isexpected the student will be ableto:

Describe the pathophysiologicalmechanisms responsible forasthma development and COPD

Explain the role of environmental

factors, exercise and geneticfactors in asthma development

Describe the pathological andphysiological changes associatedwith asthma and COPD

Discuss the impact of asthma andCOPD on the individual and thepopulation

Examine the National Healthpriorities in relation to respiratorydisease


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References

PRYOR, J. & PRASAD, S. A. (2002)

Physiotherapy for respiratory andcardiac problems, Edinburgh,Churchill Livingstone.


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Asthma

Definition

Airways disease characterisedby episodic, reversiblebronchoconstriction resultingfrom hyper-reactivity of the

airways to a variety of stimulior triggers

Obstructive airways disease


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Asthma

Epidemiology

Australias asthma problem

10% of entire population

30% of children & adolescents

Most common illness in children

Most common reason for timeoff school

National Health Priority


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Asthma

Causes

Atopy Pollen

Animal danders

House dust mites

Weather

Exercise

Emotion

Medications

Moulds/Fungi URTIs

Inhaled toxins e.g. cigarettesmoke


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Asthma

Pathology

Inflammation of airway mucosa

Oedema of airway wall

Plasma exudation frombronchial microvessels

Goblet cell hyperplasia

Mucous hypersecretion

Mucous plugging


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Asthma

Pathogenesis

Inhaled proteins captured by dendriticcells which live just under theepithelium

Dendritic cells trigger Helper T cellsbearing the CD4 surface marker

Triggers TH2 immune deviation as a

result of IL-4 signal TH2 secrete IL4/5/6/9/13 and GM-

CSF

Chronically (after a few years ofsensitisation) further antigeninhalation causes TH2 cytokinesecretion. IL-4 and IL-13 induce theadhesion molecule VCAM-1 onmicrovessels used by eosinophils toenter tissues

Marked increase in eosinophilproduction secondary to IL-5


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Asthma

Pathogenesis

IL-4 causes B cells to secrete IgEwhich sensitises mast cells and othercells so they can release massiveamounts of inflamm mediators whenIgE bound to their surface iscrosslinked by antigen.

Tissue damage results from eosinophildegranulation products and theeffects of inflammatory mediators.

Cysteinyl-leukotrines (inflammatorymediators) are also potent smoothmuscle constrictors.


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Asthma


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Asthma

Chronic changes

Caused by cycles of damage andrepair

Hypertrophy and hyperplasia ofairway wall (smooth muscle)

Submembrane deposition ofcollagen causingpseudothickening of basementmembrane

Epithelial fragility Hyperinflation of lungs


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Asthma

S&S

Wheeze (n.b. silent chest)

SOBAR/SOBOE

Cough (tight)

Retractions (intercostal,

supra/substernal)

Use of accessory muscles ofrespiration

Cyanosis

Altered Conscious State

Prolonged expiratory phase

Reduced SpO2


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Asthma

S&S

Diaphoretic

Anxious

Talk test

Tripod Position

Catatonic

Tachycardia (Bradycardia)

Hypotensive

Tracheal tugging

VEs

Tremor


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Asthma History taking

Subjective Assessment Identify trigger

PHx of exacerbations

Medication

Objective Assessment SpO2 Auscultation

Respiratory rate

Heart rate

PEF


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Asthma

Treatment short term

O2 therapy

Fast acting bronchodilators e.g.Salbutamol (relievers vs. preventers)

Corticosteroids e.g.Beclomethasone (mdi),prednisolone (oral)

Anticholinergic bronchodilators

Nebulisation and deposition ofdrugs

Combined therapies e.g.Seretide

Latent response


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Asthma


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Asthma

Treatment long term

1. Assess severity2. Achieve best lung function

Exercise

Breathing control

3. Maintain best lung function Optimise medication

Avoid triggers where possible

4. Asthma management plan

5. Educate and review


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Emphysema

Definition

Derived from Greek and meansto blow into hence aircontaining or air inflated

An abnormal, permanent

enlargement of the air spacesdistal to the terminalbronchioles, accompanied bydestruction of their walls


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Emphysema

Causes

Smoking Genetic

Air Pollution

Mining

Asbestosis

Farming


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Emphysema

Pathology

Thinning and destruction ofalveolar walls

Loss of elastic tissue and radialtraction in airways

Early collapse of airways duringexpiration

Hyperinflation of lungs

Bullae


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Emphysema


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Emphysema


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Emphysema

S&S

Dyspnoea partic. SOBOE Barrel shaped chest

Pale & cyanosed

Wheeze

Cough Body wasting

PLB

Prolonged expiratory phase


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Emphysema

S&S

Tripod position Talk test

Anxious

Indrawing of intercostal m.


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Emphysema

S&S

Pink Puffers Maintain adequate ABGs and SpO2 Dyspnoeic


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Emphysema

S&S

Blue Bloater Chronic bronchitis

Purulent sputum

CO2 retainers

Hypoxic drive


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Emphysema

Treatment

Remove cause (smoking) Optimise medication

Education

Exercise

Breathing exercises

O2 therapy


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Chronic bronchitis

Definition

The presence of a chronic,productive cough for at least 3consecutive months over atleast 2 consecutive years


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Chronic bronchitis

Causes Cigarette smoking

Hypertrophy of submucosalglands

Increase in goblet cells

Infection Smokers have more infections

due to:

a) Inhibition of ciliary action

b) Direct damage to respiratoryepithelium

c) Inhibition of leucocytes inclearance of bacteria


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Chronic bronchitis

Pathology

Mucous gland enlargement Mucous hypersecretion

Airways atrophy

focal squamous metaplasia

ciliary abnormalities

airway smooth muscle hyperplasia

inflammation

bronchial wall thickening

fibrosis and scarring


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Chronic bronchitis


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Chronic bronchitis

S&S

Cough Sputum

SOB

Cyanosed

Over-weight

Wheeze

Abnormal blood gases Hypercapnia & hypoxaemia

Cor pulmonale


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Chronic bronchitis

S&S

Clubbing of fingers Anxious

Talk test


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Chronic bronchitis

Treatment

Pharmacological managementof infections

Bronchodilators

Education

Exercise Breathing exercises

O2 therapy

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