NSG 6420 final

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NSG 6420 MIDTERM
COPD Stage I
MILD
FEV1/FVC <70%
FEV1</80%
*Chronic cough/sputum production
*Pt unaware lung function is abnormal COPD Stage II
MODERATE
FEV1/FVC <70%
FEV1 50-80%
SOB with exertion
Cough and sputum production present COPD Stage III
SEVERE
FEV1/FVC < 70%
FEV1 30-50%
Greater SOB
Reduced exercise capacity
Fatigue
Repeated exacerbations with impact on QOL COPD Stage IV
VERY SEVERE
FEV1/FVC<70%
FEV1<30%
Resp. Failure
Cor Pulmonale (elevation of JVP and pitting ankle edema)
QOL very impaired
Exacerbations may be life threatening

How does FEV1 decrease?
Inflammation
Narrowing of peripheral airways
Airway collapse in severe emphysema COPD diagnosis?
SPIROMETRY is key Primarily Inflammatory with superimposed bronchospasm
Asthma
Most common chronic respiratory disorder among all age groups
Asthma Atophy
exaggerated IgE mediated immune response; all atophic disorders are type I hypersensitivity
disorders Type I hypersensitivity reaction
Immediate hypersensitivity
IgE-mediated
Antigen binds to IgE that is bound to tissue mast cells and blood basophils, triggering release of
preformed mediators (histamine, proteases, chemotactic factors) and synthesis of other mediators
(prostaglandins, leukotrienes, platelet-activating factor, cytokines)
-causes vasodilation, increased cap. permeability, mucus hypersecretion
**atopic disorders (allergic asthma, rhinitis, conjunctivitis), anaphylaxis, some cases of
angioedema, urticarial, and latex and some food allergies
**Develop <1h after exposure to antigen Allergic triad of symptoms
allergies, eczema, and asthma Samter's Triad
Nasal polyps, asthma, and ASA allergy Most common symptom of asthma
wheezing Common only symptom of asthma?
Cough
-can often delay dx of asthma
AKA cough variant asthma Best way to confirm asthma dx?
bronchial provocation Intermittent asthma
sx </2days/week
PM awakenings </2/month
SABA use </2 days/week
No interference with norm. activity
0-1 exacerbations requiring oral steroids / yr Tx for intermittent asthma
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