1. Chronic Bronchitis
    Is defined clinically as chronic productive cough for 3 months in each of 2 successive years in a patient in whom other causes of productive chronic cough have been excluded.
  2. Emphysema
    Is defined pathologically as the presence of permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
  3. The ATS’s definition for Chronic bronchitis is based on...
    The major "clinical manifestations" associated with the disease.
  4. The ATS’s definition for Emphysema is based on...
    The pathology, or the "anatomic alterations of the lung," associated with the disorder.
  5. Chronic Obstructive Pulmonary Disease
    • Is a preventable and treatable disease state characterized by airflow limitation that is not fully reversible.
    • The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking. Although COPD affects the lungs, it also produces significant systemic consequences
  6. Anatomic Alterations of the LungsAssociated with Chronic Bronchitis!
    • Chronic inflammation and swelling of the peripheral airways
    • Excessive mucus production and accumulation
    • Partial or total mucus plugging of the airways
    • Smooth muscle constriction of bronchial airways (bronchospasm)
    • Air trapping and hyperinflation of alveoli—occasionally in the late stages
  7. Anatomic Alterations of the Lungs Associated with Emphysema
    • Permanent enlargement and deterioration of the air spaces distal to the terminal bronchioles
    • Destruction of pulmonary capillaries
    • Weakening of the distal airways, primarily the respiratory bronchioles
    • Air trapping and hyperinflation of alveoli (air-trapping)
  8. Types of Emphysema
    • Panlobular or Panacinar
    • Centrilobular or Centriacinar
  9. Panlobular or Panacinar emphysema
    • Abnormal weakening & enlargement of all alveoli distal to the terminal bronchioles
    • Most severe type
    • More serious clinical manifestations
    • Effects lower parts of lungs
    • Associated with alpha 1 antitrypsin deficiency
  10. Centrilobular or Centriacinar emphysema
    • Proximal part of acinus
    • Most common form
    • Strongly associated with smoking & chronic bronchitis
  11. Risk Factors for COPD!
    • Tobacco smoke
    • Occupational dusts and chemicals
    • Indoor air pollution
    • Outdoor air pollution
    • Conditions that affect normal lung growth
    • Genetic predisposition
    • Alpha 1-antitrypsin deficiency
    • Airway remodeling with asthma
  12. Key Indicators for Considering a COPD diagnosis:
    • Dysypnea
    • Chronic cough
    • Chronic sputum production
    • History of exposure to risk factors
  13. The three main spirometry tests for COPD are...
    • FVC
    • FEV1
    • FEV1/FVC ratio
  14. The presence of COPD is confirmed when...
    Both the FEV1 and FEV1/FVC ratio are decreased
  15. Clinical manifestations of Emphysema!
    (Type A:  Pink Puffer)
    • Thin
    • Barrel Chest
    • Hyperventilation & marked dyspnea; often occurs at rest
    • Late stage:  diminished respiratory drive & hypoventilation
    • Pursed-lip breathing
    • Hoover’s Sign
    • Reddish skin
    • Use od acessory muscles
  16. Clinical manifestations of Chronic Bronchitis!
    (Type B:  Blue Bloater)
    • Stocky, overweight
    • Diminished respiratory drive
    • Hypoventilation common, with resultant hypoxia and hypercapnia
    • Productive cought with copious amounts, purulent sputum
    • Cyanosis
    • Perpherial edema
    • Neck vein distention 
    • Cor pulmonale
    • Polycythemia
    • Digital Clubbing
    • Pulmonary hypertension
    • Infections
  17. Auscultation of Emphysema!
    • Decreased breath sounds
    • Decreased heart sounds
    • Prolonged expiration
    • Hyperresonance
    • Decreased diaphragmatic excursion
  18. Auscultation of chronic bronchitis!
    • Wheezes
    • Crackles
    • Rhonchi
  19. Chest radiograph of emphysema!
    • Hyperinflation
    • Narrow mediastinum
    • Normal or small vertical heart
    • Translucent
    • Depressed or flattened  diaphragms
    • Presence of blebs or bullae
  20. Chest radiograph of chronic brochitis!
    • Congested lung fields
    • Densities
    • Increased bronchial vascular markings
    • Enlarged horizontal heart
    • Bronchogram Small spikelike protrusions
  21. Pulmonary Function Study for Emphysema!
    Decreased DLCO and DLCO/VA
  22. Cardiopulmonary Clinical Manifestations Associated with Chronic Bronchitis and Emphysema! (COPD)
    • Excessive Bronchial Secretions
    • Bronchospasm
    • Distal Airway and Alveolar Weakening
  23. Hoover’s Sign!
    The inward movement of the lower lateral chest wall during each inspiration—indicates severe hyperinflation
  24. Palpation of the Chest in emphysema!
    • Decreased tactile fremitus
    • Decreased chest expansion
    • PMI often shifts to the epigastric area
  25. Sputum culture for Chronic Bronchitis !
    • Streptococcus pneumoniae
    • Haemophilus influsenzae
    • Moraxella catarrhalis
  26. The goals of COPD management!
    • Relieve symptoms
    • Prevent disease progression
    • Improve exercise tolerance
    • Improve health status
    • Prevent and treat complications
    • Prevent and treat exacerbations
    • Reduce mortality
    • Prevent or minimize side effects from treatment
  27. Management of COPD!
    • Glucocorticosteroids
    • Vaccines
    • Antibiotics
    • Mucolytic
    • Antitussives
    • Non-pharmacologic treatment
    • Rehabilitation
    • Oxygen therapy
    • Surgical treatment
  28. Exacerbation of COPD is defined as...
    An event in the natural course of the disease characterized by a change in the patient’s baseline dyspnea, cough, and/or sputum that is beyond normal-day-to-day variations, is acute in onset, and may warrant a change in regular medication in a patient with underlying COPD
  29. Respiratory Care Treatment Protocols for chronic bronchitis and emphysema!
    • Oxygen
    • Bronchopulmonary Hygiene
    • Aerosolized Medication
    • Mechanical Ventilation
    • Other Meds
    • ØExpectorants
    • ØAntibiotics
  30. Anatomic Alterations of the Lungs with asthma!
    • Smooth muscle constriction of bronchial airways (bronchospasm)
    • Bronchial wall inflammation
    • Excessive production of thick, whitish, bronchial secretions
    • Mucus plugging
    • Hyperinflation of alveoli (air-trapping)
    • In severe cases, atelectasis caused by mucus plugging
  31. Extrinsic asthma (Allergic or Atopic asthma
    Asthma episodes linked to the exposure of a specific allergen (antigen):
    • House dust
    • Mites
    • Furred animal dander
    • Cockroach allergen
    • Fungi
    • Molds
    • Yeast
  32. Extrinsic asthma!
    • Extrinsic asthma is an immediate (Type I) anaphylactic hypersensitivity reaction
    • Extrinsic asthma is family related and usually appears in children and adults younger than 30 years old. 
    • It often disappears after puberty
    • Because extrinsic asthma is associated with an antigen-antibody induced bronchospasm, an immunnologic mechanism plays an important role.
  33. Intrinsic asthma (Nonallergic or Nonatopic asthma)
    Occupational sensitizers (Occupational Asthma)
    • Asthma episode cannot be directly linked to a specific antigen or extrinsic factor.
    • Onset usually occurs after the age of 40 years
    • Immunologically mediated
    • Latency period of months to years after exposure
  34. Intrinsic (Non-Allergic) Asthma!
    • Not directly linked to a specific antigin
    • Contributing factors are elusive
    • Normal serum IgE levels
    • Usually occurs > 40 years age
    • Some overlap with atopic asthma
    • Non-specific stimuli
  35. Test Used in the Diagnosis and Monitoring of Asthma!
    • Spriometry
    • Peak expiratory flow
    • Responsiveness to metacholine, histamine, mannitol, or exercise challenge
    • Positive skin tests with allergens or measurement of specific IgE in serum
  36. Cardiopulmonary Clinical Manifestations Associated with Asthma!
    • Bronchospasm
    • Excessive Bronchial Secretions
  37. Vital Signs with asthma!
    • Increased respiratory rate (Tachypnea)
    • Increased heart rate (pulse)
    • Increased blood pressure
  38. Clinical manifestations of asthma!
    • Use of accessory muscles of inspiration
    • Use of accessory muscles of expiration
    • Pursed-lip breathing
    • Substernal intercostal retractions
    • Barrel chest
    • Cyanosis
    • Cough and sputum production
    • Pulsus paradoxus
  39. Chest assessment assicioated with asthma!
    • Expiratory prolongation
    • Decreased tactile and vocal fremitus
    • Hyperresonant percussion note
    • Diminished breath sounds
    • Diminished heart sounds
    • Wheezing and rhonchi
  40. Sputum culture with asthma!
    • Eosinophils
    • Charcot-Leyden crystals
    • Casts of mucus from small airways (Kirschman spirals)
    • IgE level (elevated in extrinsic asthma)
  41. Chest radiograph of asthma!
    • Increased anteroposterior diameter (barrel chest)
    • Translucent (dark) lung fields
    • Depressed or flattened diaphragms
  42. Asthma exacerbation is defined as...
    A progressive increase in shortness of breath, cough, wheezing, or chest tightness, or a combination of these symptoms.
  43. Respiratory Care Treatment Protocols with asthma!
    • Oxygen Therapy Protocol
    • Bronchopulmonary Hygiene Therapy Protocol
    • Aerosolized Medication Protocol
    • Mechanical Ventilation Protocol
  44. Anatomic Alterations of the Lungs with cystic fibrosis!
    • Excessive mucus production and accumulation of thick, tenacious mucus in the tracheobronchial tree
    • Partial or total bronchial obstruction (mucus plugging)
    • Atelectasis
    • Hyperinflation of the alveoli
  45. Cystic fibrosis is an...
    Autosomal recessive gene disorder caused by mutations in a pair of genes located on chromosome 7.
  46. Screening and Diagnosis for cystic fibrosis!
    • Sweat Test
    • Immunoreactive Trypsinogen Test
    • Stool Fecal Fat Test
    • Nasal Potential Difference (NPD)
    • Genetic Testing
    • Prenatal Testing
    • Amniocentesis
    • Chorionic villus biopsy
  47. Cardiopulmonary Clinical Manifestations Associated with Cystic Fibrosis!
    • Atelectasis
    • Bronchospasm
    • Excessive Bronchial Secretions
  48. Vital signs with cystic fibrosis!
    • Increased respiratory rate (Tachypnea) Increased heart rate (pulse)
    • Increased blood pressure
  49. Clinical Manifestations of cystic fibrosis!
    • Use of accessory muscles of inspiration
    • Use of accessory muscles of expiration
    • Pursed-lip breathing
    • Barrel chest
    • Cyanosis
    • Digital clubbing
    • Peripheral edema and venous distension
    • Productive cought
    • Hemoptysis
    • Spontaneous Pneumothorax
  50. Chest Assessment Findings with cystic fibrosis!
    • Decreased tactile and vocal fremitus
    • Hyperresonant percussion note
    • Diminished breath sounds
    • Diminished heart sounds
    • Bronchial breath sounds (over atelectasis)
    • Crackles, rhonchi, and wheezing
  51. Hematology with cystic fibrosis!
    • Increased hematocrit and hemoglobin
    • Increased white blood count
  52. Chest Radiograph with cystic fibrosis!
    • Translucent (dark) lung fields
    • Depressed or flattened diaphragms
    • Right ventricular enlargement
    • Areas of atelectasis and fibrosis
    • Bronchiectasis (often a secondary complication)
    • Pneumothorax (spontaneous)
    • Abscess formation (occasionally)
  53. Respiratory care treatment protocols with cystic fibrosis!
    • Oxygen therapy protocol
    • Bronchopulmonary Hygiene Therapy Protocol
    • Lung Expansion Therapy Protocol
    • Aerosolized Medication protocol
    • Mechanical Ventilation Protocol
  54. Medication and special procedures prescribed by the physician 
    for management of cystic fibrosis!
    • Xanthines
    • Expectorants
    • Antibiotics
    • Lung or heart/lung transplantation
    • Future Treatments
    • ØSome advances in gene therapy
  55. Pertussis
    • Seasonal
    • Droplet transmission
    • Contact isolation
  56. Pertussis treatment!
    Oxygen and humidity often done with oxyhood or tent
  57. Anatomical alterations of pertussis
    • Hyperinflation
    • Mucus accumulation
    • Inflammation airways
    • Damaged paralyzed cilia
  58. CVA/Stroke respiratory complications
    • Increased risk of aspiration pneumonia
    • Upper airway is partially paralyzed
    • History of OSA
  59. CVA tratment!
    • Speech therapy
    • Reduce risk of aspiration
  60. Two types of strokes!
    • Ischemic
    • Hemorrhagic
  61. Ischemic
    Due to a sudden interruption of blood flow to the brain
  62. Hemorrhagic
    When a blood vessel in the brain leaks, causin blood to spill in surrounding spaces of the brain tissue!
  63. A person can be HIV positive but...
    Not have AIDs
  64. AIDS
    Acquried immune defficiency syndrome
  65. AIDs/HIV
    • T cells are reduced CD4
    • Kaposi sarcoma
    • TB
    • PCP
    • only assicioated with AIDS
  66. Diagnostic test for HIV/AIDS
    Western BLOT test
  67. Drug regimin for AIDS!
    • HAART
    • Highly active anti retra viral therapy
    • 3 or more drugs
    • Used to supress the progression of the disease
  68. Transmission route for HIV/AIDS
    • During Sex
    • Blood transfusions
    • From mother to child
    • Organ donors
  69. Management of RC protocol!
    • O2 therapy
    • Bronchopulmonary Hygiene therapy
    • Thoracentesis
    • Mechanical ventilation protocol
    • Antibiotics
    • Prophylactics
  70. ALS
    • motor neurons in the spinal cord, brain, and brain stem
    • Upper and lower neurons are affected
  71. Sickle cell disease!
    • Primarily a disease in Africian americans
    • 8 percent of AA have trait
    • .15% have disease
    • 50k USA
    • Mandatory screening
    • Early penicillin profolatic
    • Hyper reactive airways
  72. Clinical manafestations of sickle cell!
    • SOB
    • Pain
    • Dizziness
    • Headache
    • Cold hands/feet
    • Pulmonary emboli
    • Pulmonary hypertension
  73. PFTs with sickle cell disease!
    • Airway obstruction
    • Retructive
    • Hypocemia
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