CARDIO-PULMONARY

ACTIVITY FOR PULMONARY CONDITIONS

Name: _______________________________________

I. Tabulate the differences between Obstructive versus Restrictive lung disease.

PULMONARY CONDITIONS

RESTRICTIVE OBSTRUCTIVE

Pathophysiology Air flows to and from Chronic obstructive

the alveoli as lungs pulmonary disease is a
inflate and deflate group of disorders that have
during each respiratory in common abnormal airway
cycle. Lung inflation is structure that results in
accomplished by a obstruction to airflow. In
contraction of emphysema, obstruction is
respiratory, thought to be due to the loss
diaphragmatic, and of normal elastic tension in
external intercostal the lung parenchyma.
muscles, whereas Cigarette smoke is the most
deflation is passive at important cause of
rest. Functional emphysema. Injurious
reserve capacity (FRC) agents, either in the gas or
is the volume of air in particulate phase, incite a
the lungs when the proteolytic reaction in the
respiratory muscles are lung. The type of
fully relaxed and no emphysema and its
airflow is present. The topographic distribution in
volume of FRC is the lung stem from normal
determined by the physiologic processes that
balance of the inward concentrate the cigarette
elastic recoil of the puff both within the lung
lungs and the outward and within the secondary
elastic recoil of the pulmonary lobule.
chest wall. Restrictive
lung diseases are
characterized by a
reduction in FRC and
other lung volumes
because of pathology
in the lungs, pleura, or
structures of the
thoracic cage.

The distensibility of
the respiratory system
is called compliance.
Compliance is the
volume change
produced by a change
in the distending
pressure
Clinical Manifestations § Dyspnea on § Dyspnea on exertion
exertion
§ Cough
§ Reduced exercise
tolerance § Reduced exercise
tolerance
§ Cough (dry)
§ Pursed-lip breathing
§ Tachypnea
§ Prolonged expiration
§ Weight loss
§ Abnormal pulmonary
§ Hypoxemia function

§ Abnormal PFTs § Wheezing

(w/ decreased VC,
IC, and TLC and § Swelling of the
possible impaired extremities
diffusing capacity)
§
§ Abnormal breath
sounds

§ Abnormal chest x-
ray findings

§ Ventilatory muscle
fatigue

§ PH, RVH, or cor

pulmonale

Treatment/Management § Specific § Health education

therapeutic or
corrective measures § Medications (i.e.
Bronchodilators, anti-
§ Supportive inflammatory agents, and
measure mucolytic agents)

o Supplemental oxygen

o Nutritional support

o Ventilatory support

§ Physical therapy
interventions
 § Pulmonary
rehabilitaion

Examples - Atelectasis - Asthma

- Pneumonia - Chronic Bronchitis

- Pneumothorax - Emphysema

- Pulmonary - Bronchiectasis
fibrosis
- Cystic Fibrosis

II. Write the differences of the each clinical entity.

OBSTRUCTIVE LUNG DISEASES

Clinical Etiology Pathophysiology Diagnosis Treatment

Entity

Emphysema Cigarette Repeated High- Medications:

smoking and inflammation of resolution CT
occupational the airways scan is the gold o Anticholinergic
exposure, produces an standard for bronchodilators
which imbalance between diagnosis. versus long-acting
typically endogenous b-agonists
produce proteinases and
centriacinar antiproteinases, o Inhaled
destruction which causes When a patient corticosteroids
progressive lung younger than
destruction. o Supplemental
50 years oxygen
presents with
signs and
Loss of elastic symptoms of
recoil due to tissue emphysema Surgical
destruction leads to
 expiratory collapse or asthma with interventions
of distal, poorly impairment
supported airways, more excessive o Bullectomy
resulting in air than expected,
trapping and o Lung volume
alveolar blood testing reduction
overdistension. should be
conducted to o Lung
test the serum transplantation,
A1-AT particularly for a1-
PI deficiency
level

Pulmonary
rehabilitation and
other treatment
options for COPD

Asthma When the Hyperreactivity of High- Medications

provocative the airways to resolution CT
stimuli are various stimuli scan is the gold - Short-
immunologi provokes bronchial standard for acting B2-
c in origin, smooth muscle diagnosis. agonist
sensitized contraction and
hypertrophy, - Inhaled
mast cells mucosal edema, corticosteroids
exposed to and overproduction When a patient
specific of viscous mucus younger than Avoidance of asthma
antigens triggers
degranulate 50 years
and presents with
signs and
release symptoms of Aerobic
bronchoactiv emphysema conditioning,
e mediators, relaxation
causing or asthma with techniques, and
extrinsic, or impairment dyspnea
atopic, more excessive
than expected, positions
asthma,
which is blood testing
most should be
commonly conducted to
seen in test the serum
children. A1-AT
 level

When the
cause is not
clearly
related to
allergy, as in
adult onset

asthma,
intrinsic or
nonatopic
asthma is
present;
sometimes

it is due to
sensitivity to
aspirin or
nonsteroidal
antiinflamma
tory

drugs
(NSAIDs),
nasal
polyposis, or
sinusitis

Chronic The most Inflammation of Pulmonary Medications

Bronchitis common airways induces Function
causes of mucosal edema, Testing (PFT) -
emphysema hypersecretion of Anticholinergic
include mucus, and This test Bronchodilators
cigarette destruction of cilia involves a
smoking and -> (+) airway series of - Inhaled
occupational resistance and breathing Corticosteroids
exposure, produce expiratory maneuvers that
which flow limitation measure the Supplemental
typically airflow and Oxygen
produce volume of air
centriacinar in your lungs. Pulmonary
destruction This allows rehabilitation
your doctor to
objectively
assess the
function of
 your lungs.

High
Resolution
Computed
Tomography
(HRCT)

Chest X-rays
can help
confirm a
diagnosis of
chronic
bronchitis and
rule out other
lung
conditions.

Sputum
Examination
Analysis of
cells in your
sputum can
help determine
the cause of
some lung
problems.

Cystic Genetic Is the result of High- Medications:

Fibrosis defect leads variable mutation resonance CT
to excessive of the gene, CF scan is the best Antibiotic and
production of transmembrane tool for antifungal
thick, regulator (CFTR), diagnosis medications have
dehydrated, which is associated because it is become the mainstay
hyperviscous with the failure of very sensitive in managing active
mucus and chloride secretion in detecting infection and
impairment that results in cystic minimizing chronic
of the dehydration of formation and colonization
mucociliary endobronchial honeycombing
blanket. secretions and without "brosis
cripples the and dilatation
 mucociliary of the thoracic
function as well as duct.
Chronic disrupts the
bouts of function of the There may
inflammation pancreas and also be the
and infection reproductive dilatation of the
lead to the system. thoracic duct.
breakdown
of protein in The airway The results of
the lungs. epithelial cells PFTs may
activate show an
proinflammatory obstructive,
mediators and restrictive, or
Obstructions neutrophils that mixed pattern
of small lead to further with typically a
airways cellular reduction in
develop from destruction. FEV
mucus plugs
and This leads to an
destruction increased attraction
of the to bacteria because
cartilaginous of the decreased
support of ability to contain
the airways. and

remove bacteria.
CFTR is also
associated with the
transportation of
bicarbonate and
sodium and has
been linked to the
differentiation of
osteoblastic cells

RESTRICTIVE LUNG DISEASES

Clinical Entity Etiology Pathophysiology Diagnosis Treatment

Respiratory Result of an Development of Chest X-ray will High

Distress infection, ARDS is associated illustrate a ventilationpressur
Syndrome direct injury with damage to the patchy, diffuse es and high
to the lung alveolar epithelial airspace disease. oxygen
tissue as cells and the concentration
with a blunt disruption of need to be avoided
chest trauma
or as a result the pulmonary CT scan is because these
of an vascular consistent with factors can actually
indirect endothelium diffuse damage contribute to
injury that is due to injury and further cellular
associated Barotrauma, edema, which injury.
with volutrauma, and compresses
systemic oxygen toxicity uninvolved tissue Management of
inflammatio caused by the use of that further fluid balance to
n and mechanical impairs the minimize
elevations in ventilator to respiratory pulmonary edema
inflammator compensate for system. and still maintain
y mediators. respiratory cardiac output.
dysfunction or In patients with
Several failure can also lead residual Antibiotics and
factors that to further pulmonary systemic
predispose inflammation and dysfunction, the corticosteroidsare
an cellular damage PFTs will show a used to minimize
individual to restrictive infection and
ARDS, process with a inflammation,
which can decline in lung respectively
include, but volumes.
are not
limited to,
pneumonia,
aspiration,
lung
contusion,
fat emboli,
near
drowning,
inhalation
injury,
sepsis,
severe
trauma, and
blood
product
 transfusion

Pulmonary Cause is Characterized by Open lung Medications:

Fibrosis unknown, patchy, nonuniform, biopsy is the
but much and variable most de$nitive growth factor
work has destruction of method for the Band endothielin-
been done to interstitial tissue. diagnosis of IPF 1, which have been
develop a because there are shown to interfere
classificatio There is also a many diseases with the adverse
n system of minimal that have a effects of the
IPF that is inflammatory similar clinical immune response.
based on component to this presentation
pathological disease with
findings and collagen deposition Chest X-ray
clinical that thickens the and high-
presentation alveolar septum resonance CT
scan will
Linked to document
immune bilateral
disorders, interstitial
occupational infiltrates
exposures, typically starting
genetic and in the upper
hormonal lobes.
abnormalitie
s, and a
complication
of lung
injury

Pneumonia Bacterial Infection is caused Chest X-ray Antimicrobial

pneumonia by various therapy
pathogens (e.g. Blood culture
Streptococcu bacteria, viruses, Deep breathing
s mycoplasmas, and Sputum culture exercises
pneumoniae fungi) that produce
damage to specific Pulse oximetry Coughing
Mycoplasma tissue and mobilization
pneumoniae immunologic CT scan
responses to the Bronchial drainage
Haemophilu microbe and release Fluid sample
s influenzae roxic inflammatory Percussion and
Bronchoscopy Vibration
Legionella
pneumophila mediators. Supportive
measure (e.g.
Viral oxygen and
pneumonia replacement fluids)

Influenza

Respiratory
syncytial
virus (RSV)

Rhinoviruse
s

Fungal
pneumonia

Pneumocysti
s jirovecii

Cryptococcu
s species

Histoplasmo
sis species
Bronchogenic Small cell Obstruction or - Chest X- Surgical resection
Carcinoma lung cancer compression of ray for early stage
(SCLC, 20% bronchi results in - CT scan NSCLC and
of all lung atelectasis, - Biopsy occasionally SCLC
cancers), - Sputum
pneumonia, and/or cytology Combination
which lung abscess. chemotherapy
includes
small cell, or • Obstruction or Radiation therapy
oat cell, compression of
carcinoma, blood vessels causes Novel treatment
is highly _ V/_Q using monoclonal
associated antibodies,
abnormalities and inhibitors,
with sometimes a angiogenic
cigarette superior vena cava substances, and
smoking or syndrome. gene transfer and
exposure alteration under
and usually • Direct extension of investigation
presents the tumor to the
chest wall leads to
as a large pain
central
tumor with and resultant
mediastinal hypoventilation.
involvement
. • Involvement of the
pleura produces
It responds pleural effusion.
reasonably
well to • Early spread via
chemotherap the vascular and
y and lymph systems is
radiation. common,

• Non–small leading to metastasis

cell lung to the lymph nodes,
cancer adrenal glands,
(NSCLC, brain,
75% of all
lung bone, and liver.
cancers),
• Paraneoplastic
which syndromes occur in
includes approximately 10%
squamous to 20%
cell
carcinoma, of patients,
adenocarcin particularly those
oma with SCLC, and
may include digital
(the most
Pulmonary Increased Elevated left atrial Chest X-ray Supplemental
Edema pressure, (LA) and left oxygen (assisted
hydrostatic, ventricular (LV) Pulse oximetry ventilation)
or pressures are
cardiogenic Blood tests Morphone
pulmonary reflected back to the
edema. The lungs, which Electrocardiogra Diuretics
most impedes blood flow m (ECG)
common through Nitroglycerin and
causes are Echocardiogram other afterload
Coronary the pulmonary reducers
Artery vasculature, leading Cardiac
Disease, to increased catheterization
Hypertensiv intrapulmonary
e heart
disease, blood volume (i.e.,
aortic or pulmonary
mitral valve congestion) and
disease, and pulmonary
cardiomyopa
thy capillary hydrostatic