Obstructive Lung Diseases

Spirometry

The most used pulmonary function test. It measures volume and speed of exhalation and inspiration.
Total lung capacity (TLC)
- The volume of the lungs at maximal inflation
Tidal volume
- The volume of air moved into and out of the lungs during normal resting respirations
Vital Capacity
- The volume of air exhaled slowly after the deepest possible inspiration.
Forced vital capacity (FVC)
- The volume of air forcefully exhaled after the deepest possible inspiration
Forced expiratory volume in 1 second (FEV1)
- The volume of air which has been exhaled after one second of forced expiration.
Peak expiratory flow rate (PEFR)
- The highest airflow rate during forced expiration

Use of accessory muscles for breathing
Tachypnea
Tachycarida
Wheezing
Paradoxical pulse – pulse that is weaker during inhalation and stronger during exhalations
Spirometry
- FEV1
  - Decreased
  - Improves with use of a bronchodilator
- PEFR
  - Decreased
  - Improves with use of a bronchodilator
  - Used for home monitoring
- FVC
  - Normal
  - Histamine or methacholine challenge if spirometry is not effective
Chest X-ray – Typically normal, but hyperinflation of the lung fields is possible

Intermittent
- Two or less episodes per week
- Two or less nighttime episodes per month
Mild persistent
- More than two episodes per week
- Three to four nighttime episodes month
Moderate persistent
- Daily episodes
- One nighttime episodes per week
Severe persistent
- Symptoms are continuous
- Night time episodes almost every night

Preventative care – remove allergens or triggers
- Pet dander, especially cats. Keep pets out of the bedroom!!!
- Dust mites
- Mold
- Cigarette smoke
Chronic Treatment
- Mild intermittent
  - Short acting beta 2 agonist (albuterol)
- Mild persistent
  - Short acting beta 2 agonist
  - Daily use of low dose inhaled steroid (beclomethasone)
Moderate persistent
- Short acting beta 2 agonist
- Daily use of medium dose inhaled steroid
- Daily use of long acting beta2 agonist (salmeterol)
Severe persistent
- Short acting beta2 agonist
- Daily use of high dose inhaled steroid
- Daily use of long acting beta2 agonist
- Systemic steroids
Acute exacerbation
- Short acting beta 2 agonist
- Consider upping steroid by either adding an inhaled steroid or adding an oral steroid
- Oxygen if necessary
- Consider an anticholinergic (ipratropium bromide)
Other medications
- Mast cell stabilizer (cromolyn sodium)
- Leukotriene antagonist (montelukast)

The number one cause of COPD is smoking
Chronic bronchitis is an inflammation of the bronchi with a productive cough for at least three consecutive months per year in two consecutive years. These are the “blue bloaters.”
Emphysema is the destruction of the alveoli. They lose their shape and also collapse trapping air inside. These are the “pink puffers.”

Chronic cough
- Chronic bronchitis – productive cough
- Emphysema – dry cough
Dyspnea
Wheezing
Fever
Chest pain
Pink puffers
- Puffer = hyperventilation
- Pink = they are less hypoxic than blue bloaters. They are also using more accessory muscles which may make them look more pink
Blue bloaters
- Blue = More hypoxic
- Bloater = more trapped air, therefore larger air volume and barrel chest

Breath sounds
- Chronic bronchitis – rhonchi may be heard
- Emphysema – usually diminished breath sounds
Wheezing
Sputum gram stain and culture
Pulmonary function test
FEV1 is decreased
FEV1/FVC is reduced
Lung volumes go up do to air trapping
Chest X-ray
- Hyperinflation
- Flat diaphragm
- Emphysema – Parenchymal bullae, subpleural blebs
CT