COPD (Chronic Obstructive Pulmonary Disease) Sputum: Colorless; clear Thick; yellow; creamyPinkish fruityGreenishRustyLayeredMalodorBlood streak-

viral infection staphylococcus infection pulmonary edema pseudomonas infection pneumonia Bronchiectasis lung abscess or depression of the lungs PTB, Ca Lung Asthma Allergens (dust, chalk, pollens, chicken, seafoods) Abnormal antigen-antibody reaction (a A-A reaction) Stimulates mast cells with presence of inflammation response)

Release of mediators *histamine- (prolonged inside the body but slow) constriction/ narrowing of the airway *SRS-A slow reacting substance of anaphylaxis Potent than histamine *ECF-A Eusinophils chemotactic factor of anaphylaxis

Bronchial wall Asthma cough

hyper secretion Spasm/ of bronchial mucus constriction of the bronchi/ dyspnea bronchioles Wheezing

Narrowing the airway of the patient CHRONIC BRONCHITIS Cough will last for more than 3 months for 2 consecutive years ACUTE for pedia patient pathologic/ microorganism

Pathophysiology same with asthma Cardinal sign: bronchial edema; hypersecretion; spasm Airway obstruction Airway resistance Impaired gas exchange Impaired ventilation Hypoxia Cyanosis (Called BLUE BLOATERS) Predisposing factors: cigarette/ tabacco smoking

EMPHYSEMA Over inflation of alveoli/ distended alveoli No elastic recoil Problem during exhalation Predisposing factor: smoking, hereditary, and age. Smoking Presence of Nicotine old age wear and tear Destruction of Alveolar epithelium hereditary enzyme inhibitor deficiency of alpha antityrpsin

Stimulate release of Alveolar macrophages Release of protease/elastase *protease theory*elastase theoryconnective tissues: collagen and elastin Lung compliance and elastic recoil (expand) (go back to resting state)

Loss elastic recoil Over inflation/ distention of the alveoli Compression of the diaphragm RR Reddish skin pink puffer surfactant (phospholipid) closure of alveoli pulmonary Hypertension (HPN) stiffening Right ventricular hypertrophy Right ventricular failure Coronary pulmonale Arrest due to failure due to HPN constriction of pulmonary casculatures pulmonary vascular resistance Poor ventilation

atelectasis

hypercarbia ( CO2) hypoxia/ hypoxemia

respiratory acidoses

Surfactant decreases the tension of the surface of your alveoli Status Asthmaticus lock of the bronchioles spasm of larynx ER (1:1000 subcutaneous Epinephrine, adrenaline)

Management: 1. Avoid allergens 2. Desensitization- gradually introduce of allergens 3. Steroids- decrease bronchial edema and decrease bronchospasm Inhalation- decrease toxicity Fluticasone Budesonide Dont abrupt stop of hydrocortisone (IV) Tapper into prednisone (oral) 4. Bronchodilators Relaxes the smooth muscles of bronchus/bronchioles Salbutamol Ventolin Terbutalin- Bricanyl (oral) Salmeterol- Seravet Albuterol _Volmax 5. Mucolytics- decrease stixkiness of the mucus Ambroxol- Mucosolvan Carbocistene- Loviscol, Solmux Aciitylcysteine- Fluilucil 6. Inhalation USLOG 7. Chest tapping- loosen the secretion (after inhalation) 8. Postural drainage drainage of secretion through gravity 9. Pursed lip breathing- prevent air trapping 10. Diet low CHO (carbohydrates) presence of CO2 .. ( hypercarbia patient) 11. Small frequent feeding avoid abdominal distention 12. Regular exercise (modified) tolerable of the patient Prevent hypoxia

13.

14.

15.

Secretions move to be easy to cough out Environment Smoke free Wear mask Avoid perfume, powder Provide well ventilated room Too hot increase energy expenditure (needs more oxygen - May develop hypoxia Too cold- constrict - SOB because of spasm Psychologically prepare Counsel, talk, provide more information Psychologically prepare from : stress, fear . These may cause bronchospasm that may lead to SOB O2 therapy 2L/ min - average