My Dirty Lung

1
My Dirty Lung

• Katie
• Schumacher
• Lauren
• Belleville
• Jeany
• Johnson
• Brandt
• Finney
• Yun Park

2
Earl Edward Crop Duster

• 67 year old male
• Increasing shortness of breath for past 3 months
• Chronic cough with 1-2 tablespoons of sputum
  production daily
• Smoker for 50 years
• Crop duster/farmer

• Pulse 110 beats/min
• Respirations 22 breaths/min
• B.P. 140/90 mmHg
• Temp Normal (98.7o)
• Decreased Breath Sounds w/ crackles in bases
  bilateral
• Pitting edema (lower extremities)

3
Earls Lab Results

• Hemoglobin 17.2 g/dL
• High side of normal
• Hematocrit 53.5
• High
• pH 7.33
• Low
• Plasma CO2 48 mmHg
• High
• Plasma O2 64 mmHg
• Low
• HCO3- - 29 mEq/L
• High

• Pulmonary Function tests
• Severe airflow obstruction
• Hyperinflation
• Severe air trapping
• Low exercise tolerance
• Low O2 saturation and dropping on 2 L oxygen
• ABGs show
• Hypoxia on room air
• Respiratory acidosis

4
Airway Breakdown
5
Normal Lung Function

• Two Lungs Composed of Two Zones
• Conducting Zone
• Trachea, Bronchi, Bronchioles, Terminal
  Bronchioles
• Transports air/O2 into respiratory zone and CO2
  out
• No gas exchange occurs here
• Respiratory Zone
• Respiratory Bronchioles, Alveolar Ducts, Alveolar
  Sacs
• Region where gas exchange occurs

6
Respiration

• Result of varying pressure within the
  lungs/thorax
• Inspiration PinltPatm
• Expiration PingtPatm

7
Inspiration

• Diaphragm and inspiratory intercostals contracts
  enlarging the Thorax
• Pressure within the cavity drops and lungs expand
• Pressure within the lungs drops to below the
  atmospheric pressure
• Air flows into lungs/alveoli and gas exchange
  occurs

8
Expiration

• Expiration
• Diaphragm and inspiratory intercostals quit
  contracting and chest wall recoils
• Pressure within the cavity moves towards
  preinspiration value
• Lungs recoil to original size
• Pressure in the lungs exceeds the atmospheric
  pressure
• Air flows out of lungs

9
Functional Compromises during COPD

• Airway becomes blocked or obstructed
• Emphysema
• Destruction of alveolar walls
• Atrophy and collapse of lower airways
• Chronic Bronchitis
• Excessive mucous production in bronchi
• Chronic inflammatory changes in small airways
• Combination of two causes obstruction

10
Healthy Lung
Smokers Lung
11
Arterial Values
12
Earl Edward Crop Duster

• 67 year old male
• Increasing shortness of breath for past 3 months
• Chronic cough with 1-2 tablespoons of clear
  sputum production daily
• Smoker for 50 years

• Pulse 110 beats/min
• Respirations 22 breaths/min
• B.P. 140/90 mmHg
• Temp Normal (98.7o)
• Decreased Breath Sounds w/ crackles in bases
  bilateral
• Pitting edema (lower extremities)

13
Interpretation

• Chronic Obstructive Pulmonary Disease
• Asbestosis inflammatory condition caused by
  mining occupation
• Pulmonary Neoplasm
• Tumor
• Bronchitis
• Emphysema

14
Bronchitis

• Acute Caused by Virus or Bacteria
• Chronic not necessarily by infection

15
Emphysema

• Def. loss of elasticity of lung tissue
• Cause - Long-term tobacco smoking or exposure to
  toxic chemicals
• Severe Case Cyanosis

16
Diagnostic Tools

• Alpha-1 antitrypsin - Helps diagnose early onset
  of emphysema, especially when the patient does
  not have risk factors such as smoking and
  exposure to lung irritants.
• Chest X-ray Helps to diagnose hyperinflated
  lungs. This doesnt necessarily indicate
  emphysema.
• Spirometer a noninvasive test that measures
  irregularity in breathing.

17
COPD

• Blood gases test - Blood gas measurements are
  used to evaluate your oxygenation and acid/base
  status. Blood gas tests are ordered when you
  have symptoms of an O2/CO2 or pH imbalance, such
  as difficulty breathing or shortness of breath.
• Abnormal results of any of the blood gas
  components may mean that your body is not getting
  enough oxygen, is not getting rid of enough
  carbon dioxide, or that there is a problem with
  kidney function.
• Bronchoscopy - Your physician will then insert a
  bronchoscope, which is a flexible lighted tube
  through your nose or mouth and into your
  windpipe. A small channel in the instrument
  allows tissue and fluid samples to be collected
  when appropriate.
• Exercise Tolerance Testing - Evaluates the
  ability of your heart and lungs to provide oxygen
  and remove carbon dioxide from the bloodstream
  before, during and after you exercise.

18
Which Treatment is Appropriate?

• Brochodilators - drugs that work on airways
  either by relaxing airway smooth muscle or by
  blocking the actions of bronchoconstrictors.
• Flu shots
• The flu can cause serious problems to those who
  have COPD. Flu shots can reduce the chance of
  getting the flu.

19
Which Treatment is Appropriate?

• Pulmonary Rehabilitation
• This is a coordinated program of exercise,
  disease management training, and counseling.
• Oxygen Treatment
• The patient has COPD and low levels of oxygen in
  blood, meaning he is not getting enough oxygen
  for himself. Using extra oxygen for more than 15
  hours a day can help him
• Do tasks or activities with less shortness of
  breath
• Protect the heart and other organs
• Sleep more during the night
• Live longer

20
Which Treatment is Appropriate?

• Surgery
• Surgery recommended to those with severe COPD and
  not had any improvement from taking medicines
• Bullectomy- remove one or more very large bullae
  from the lungs (Bullae are areas of out-pouching
  of the end of the breathing tubes, sometimes
  related to obstructive airways disease)

21
Quality of Life

• Quality of Life
• Morbidity
• Number of noninstitutionalized adults who have
  ever been diagnosed with emphysema 3.8 million
• Percent of noninstitutionalized adults who have
  ever been diagnosed with emphysema 1.7
• Mortality
• Number of deaths 13,913
• Deaths per 100,000 population 4.7
• COPD is usually a progressive disease that
  develops slowly, often over the course of
  decades. In a typical case, a cigarette smoker
  would experience declining lung function for many
  years before being diagnosed with COPD and
  receiving therapy. COPD cannot be cured, in part
  because it usually is the result of years of
  development.
• Among the most important steps for smokers is to
  quit smoking immediately. Studies have shown that
  if smoking is ceased early in the disease, the
  rate of lung decline might be slowed to that of a
  normal nonsmoker (Kasper DL et al 2005).

22
Pulmonary Rehab

• The main goals of pulmonary rehabilitation are to
  help patients improve their day-to-day lives and
  restore their ability to function independently.
  If your illness has affected your daily living,
  pulmonary rehabilitation can help you
• Reduce and control breathing difficulties and
  other symptoms.
• Learn more about your disease, treatment options,
  and coping strategies.
• Learn to manage your disease and reduce your
  dependence on health professionals and costly
  medical resources.
• Maintain healthy behaviors such as smoking
  cessation, good nutrition, and exercise.
• In addition, pulmonary rehabilitation can help
  reduce the number and length of hospital stays
  and increase your chances of living longer.

23
Hypersensitivity Pneumonitis (Farmers Lung)

• What is farmers lung and what causes it?
• Possible alternative disease
• Inflammation of the lungs due to breathing in a
  foreign substance dust, fungus, or mold
• Repeated or intense exposure to dust from moldy
  hay, straw, and grain can lead to lung
  inflammation and acute lung disease
• Over time, this acute condition may turn into
  long-lasting (chronic) lung disease
• chronic form of this disease may lead to
  pulmonary fibrosis(scarring of the lung tissue)

24
Pulmonary fibrosis

• Signs and symptoms
• shortness of breath (dyspnea), especially during
  or after physical activity
• dry cough
• Fatigue
• Unexplained weight loss
• Aching muscles and joints
• Symptoms range from moderate to severe. Some
  become ill very quickly, whereas others grow
  worse over a period of months or years.
• No cure

25
Pulmonary fibrosis

• Risk factors
• Age
• Middle-aged to older
• Sex
• Men more likely
• Occupational and environmental toxins
• Exposure to airborne pollutants
• Radiation and chemotherapy
• Smoking (idiopathic p.f.)
• Reason unknown, studies show more smokers than not

26
Pulmonary fibrosis

• Review
• Air travels to lungs through bronchi
• million smaller airways (bronchioles)
• Clusters of tiny airsacs (alveoli)
• Small blood vessels (capillaries)

• What happens?
• damage to the alveoli causes scarring of the
  paper-thin tissue (interstitium) that lines and
  separates the air sacs.
• Normally, the air sacs are highly elastic
• scarring makes the interstitial tissue stiff and
  thick and the air sacs less flexible

27
Pulmonary fibrosis

• Alveoli shrink
• Texture of a dry, stiff sponge, making breathing
  much more difficult
• More difficult to add O2 to blood and remove CO2

28
Sources

• Widmaier, Raff, Strang. (2006)
• Vanders Human Physiology
• http//www.thoracic.org/sections/copd/for-patients
  /anatomy-and-function-of-the-normal-lung.html
• http//www.cfww.org/pub/edition_4/images/05_Living
  _donor_lobar_02.jpg
• http//academic.evergreen.edu/h/huyvin17/images/ch
  ronic.jpg
• http//www.nhlbi.nih.gov/health/dci/Diseases/Copd/
  Copd_WhatIs.html
• http//www.mayoclinic.com/health/pulmonary-fibrosi
  s/DS00927/DSECTION5
• http//www.nlm.nih.gov/medlineplus/ency/article/00
  0109.htm
• http//www.medicinenet.com/hypersensitivity_pneumo
  nitis/article.htmtocf