PANCE Blueprint Pulmonary (10%)

Chronic obstructive pulmonary diseases (PEARLS + Lecture)

The NCCPA™ PANCE Pulmonary Content Blueprint covers two obstructive pulmonary diseases

Chronic bronchitis Defined as a chronic cough that is productive of phlegm occurring on most days for 3 months of the year for 2 or more consecutive years without an otherwise-defined acute cause

  • Chronic Bronchitis = Blue Bloaters (2º to chronic hypoxia)
  • Common in Smokers (80% of COPD patients)

Physical exam: wheezes, rales, and rhonchi

  • PFT's: FEV1/FVC ratio of less than 0.7
  • Chest radiograph: peribronchial and perivascular markings
  • ↑ HGB and HCT are common because of thechronic hypoxic state
  • ↑ pulmonary HTN with RVH, distended neck veins, hepatomegaly


  • Short-acting bronchodilators for mild disease
  • long-acting bronchodilators +/- inhaled corticosteroids for moderate to severe disease
  • Ipratropium bromide is inhaler of choice for COPD
  • Smoking cessation and supplemental O2 (O2 is single most important medication in the long term)
  • Antibiotics for acute exacerbations
  • Flu and pneumococcal vaccines are a must
Apical subpleural blebs

Apical subpleural blebs

Presentation: Consequence of destruction of alveolar septae = Pink puffersThe body's natural response to ↓ lung function is chronic hyperventilation

Physical Exam: Minimal cough, quite lungs, thin, barrel chest.

Chest X-ray will reveal flattened diaphragm, hyperinflation, and small, thin appearing heart

  • parenchymal bullae (subpleural blebs) are pathognomonic

Management is the same as Chronic Bronchitis

  • Ipratropium (also albuterol inhaler)
  • O2
  • Oral steroids
  • Antibiotics (see Chronic bronchitis)

Picmonic Picmonic
IM_MED_ObstructiveLungDisease_v1.3_ Obstructive lung disease is characterized by airway obstruction and associated with inflammation of the airways. Air trapping as a result of airway obstruction causes an increase in the residual volume of the lungs, which means the volume of air left in the lungs after fully exhaling is increased. Forced vital capacity, the volume of air that can be forcibly blown out after one full inspiration, is decreased. FEV1, the forced expiratory volume in 1 second or the volume of air that can be forcibly blown out in 1 second, is also decreased. More importantly, the ratio of FEV1/FVC is decreased because even though FVC is decreased, the FEV1 decreases even greater resulting in an overall decrease in the FEV1/FVC ratio. This can be clearly distinguished from restrictive lung disease which has a ratio greater than 80%. Common obstructive lung diseases include chronic bronchitis, emphysema, asthma, and bronchiectasis.

Obstructive Lung Disease Picmonic

Lesson Intro Video

Pulmonology PANCE and PANRE Content Blueprint Cram Session (Prev Lesson)
(Next Lesson) Brian Wallace PA-C Podcast: Obstructive Pulmonary Diseases
Back to PANCE Blueprint Pulmonary (10%)

NCCPA™ Content Blueprint

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