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16 Cards in this Set
- Front
- Back
COPD
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Preventable and treatable disease characterized by airflow limitation that is NOT FULLY reversible
Progressive and associated with abnormal inflammatory response to noxious particles/gases (e.g., cigarette smoking) Hyperinflation may occur Includes: Chronic Bronchitis, Emphysema, and Bronchietasis but NOT asthma Mixed picture of Emphysema & Chronic Bronchitis Risk Factors: Tobacoo smoke, alpha 1 anti-trypsin deficiency, outdoor pollution, indoor pollution, and occupational dusts PFT: FEV1/FVC < 0.7 Symptoms: Cough, sputum, dyspnea, exercise intolerance, wheeze and then spirometry & imaging |
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Chronic Bronchitis
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Clinical Df: Productive cough for 3 months for 2 consecutive years
Pathology: Increased Reid Index (gland to bronchial wall thickness ratio) >50% Gross: Bronchial wall thickening due to airway remodeling & glandular hypertrophy "Blue Bloater" |
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Emphysema
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Df: Enlargement of airspaces distal to the terminal bronchi with:
a) Destruction of alveolar walls, no fibrosis b) Destruction of pulmonary capillaries c) Increased compliance, loss of elastic recoil, hyperinflation and PEEPi d) V/Q mismatching, reduced diffusion (DLCO) with ultimate hypoxia Histology: a) Centriacinar - Associated with cigarette smokers in upper and posterior lung lobules b) Panacinar - Associated with alpha 1 anti-trypsin deficiency. c) Distal Acinar - Young, tall, skinny persons with bullae and blebs with risk of spontaneous pneumothorax "Pink Puffer" Tx: Anticholinergic bronchodilators (ipratropium bromide) and oxygen, enzyme replacement (rare) |
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Bronchiectasis
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Df. Chronic necrosis of bronchi with recurrent infections (focal pneumonia in America, TB worldwide)
Associated with CF, Kartagener's Syndrome (immotile cilia), HIV, or any immunocompromised state |
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Classification of COPD via GOLD Criteria
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For all stages, FEV1/FVC < 0.7
Stage I: Mild FEV1 >= 80% predicted (no symptoms necessarily) Stage II: Moderate 50% <= FEV1 < 80% predicted Stage III: Severe 30% <= FEV1 <= 50% predicted Stage IV: Very Severe FEV1 < 30% or <50% with chronic respiratory failure |
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COPD Pharmacotherapy
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Short Acting Bronchodilators:
1st option Anticholinergics (Ipratropium bromide, Atrovent) have low side effects Beta-2-agonists (Albuterol, Proventil, Ventolin) Long Acting Bronchodilators (moderate disease): Anticholinergic (Tiotropium Spirvia) Beta-2 agonists (Fomoterol, Foradil, Salmeterol, Seravent) Steroids NOT first line therapy, only severe cases due to side effects (cataracts, muscle weakness, HTN, osteoporosis, diabetes) Methylxanthines (theophylline) high side effect profile (seizures) |
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Infections & COPD Exacerbations
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Mild-moderate: S. pneumonia, H. influenzae, Moraxella catarrhalis, M. pneumoniae, and viruses
Severe: Pseudomonas spp., Gm(-) enteric bacilli |
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Surgery & COPD
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Used in severe COPD (no clear guidelines)
Volume Reduction - decreases hyperinflation Lung Transplantation - Done for CF, Pulmonary HTN, COPD, Emphysema, Interstial lung disease |
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Asthma
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Df. Chronic inflammatory disorder of the airways associated with airway hyperresponsiveness, airflow limitation (reversible), and respiratory symptoms (wheeze, cough, tight chest)
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Risk Factors for Asthma
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Genetics & Environment
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Asthma Epidemiology
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37% 0-19 y, 30% 20-39 y, 21% 40-59 y, and 12% 60+ y
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Asthma pathophysiology
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Narrow bronchi, mucus plugs, curschmann spirals (sloughed epidermal cells due to plugs), charcot-leyden crystals (eosinophil debri), sub-mucosal glandular hyperplasia, hypertrophy of bronchial smooth muscle, eosinophils, mast cells, lymphocytes
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Dutch Hypothesis
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Chronic asthma leading to airways remodeling and eventual COPD if persists for an extended period of time
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Astham dx
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Bronchodilator response or adequate history (cough at night, cough associated with allergens, physical activity, etc.)
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DDx for Wheezing
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Tumor in vocal cord, aspiration of foreign body, asthma, airway obstruction
Differentiate via flow volume loop: "boxy" inspiration (with stridor) for tumor, delayed expiration for obstruction |
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Allergen testing in Asthma
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Generally not done due to the early and late asthmatic response with difficulty in dosing the antigen; so, use methacholine test
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