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32 Cards in this Set
- Front
- Back
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what 3 disorders consitute COPD?
which 2 conditions in COPD are usually comorbid? |
1.chronic bronchitis
emphysema asthma 2. emphysema and chronic bronchitis |
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what are som risk factors for COPD?
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smoking
passive smoking ambient air pollution hyperresponsive airways (asthma) white man -alpha-1 anytitrypsin deficiency |
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what is the definition of chronic bronchitis?
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chronic productive cough for 3 mo. in each of 2 successive years
-need a 2 yr hx of cought to dx |
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1.are alveoli efffected in chronic bronchitis?
2. how is mucous production effected by chronic bronchitis? |
-alveoli are spared
-obstrucion to expiration but alveoli not effected -excess mucous and thicked airway |
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what is emphysema and how is it diagnosed?
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abnormal permanent enlargement of air spaces distal to terminal bronchiles w/destruction of their walls w/o obvious fibrosis
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what are teh 4 types of emphysema and which are clinically important?
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clinically important:
centrilobular panacinar nonclincally important: paraseptal irregular |
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what lobe is effected in centrilobar emphysema
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upper lobe dz
decreased protease |
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pan acinar emphysema
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evertyhing destroyed
alpha-1 antitrypsin deficiency |
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paraseptal (distal) emphysema
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leads to spontaneous pneumonthorax
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irregular emphysema
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we all have it
ass with scarring |
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what is the overall mechanism by which cigarett smoking induces lung damage?
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cigarette smoke derived free radicals and oxidants->inflammatory cell recruitment->PMN, serine proteases, cystein proteases, transcription of proinfalmmatory cytokines->injury
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what are the structural changes in COPD?
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1. fibrosis of small airways
2. destruction of aveolar walls 3. vascular changes ---pulmonary HTN: due to hypoxemia ---Cor Pulmanale: right sided heart failure 5. ciliary dysfxn 6. increased mucous secreting cells/mucous cell hyperplasia 7. goblet cell hyperplasia |
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damaging cycle of COPD?
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expiratory flow limitations, air trapping, hyperinflation->dyspnea-> reduced exercise endurance->inactivity->deconditioning->dyspnea
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blue bloater
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good mm mass
cyanotic/nonclubbed increased mucous belt open: abdominal accessory mm being used SCM hypertrophy fairly well majority of year hypoxemic hypercapnic (due to air trapping) increasd dead space |
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comparison of lung volume parameters of COPD
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increased reserve volume
increased expiratory reserve volume --->higher FRC=RV+ERV **breath at higher volumes |
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pink puffer is ass. w/ what dz?
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-emphysema
-mm. wasting -pursed lip breathing -SCM hypertrophy -no peripheral edema -gaunt (increased energy expenditure) |
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clinical features of COPD?
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smokers
in 50's dyspnea with exertion could be misdiagnosed as asthma |
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signs and symptoms of COPD
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1. airflow obstruction
-wheezing auscultation -prolonged expiratory time 2. severe emphysema indicated by: hyperinflation of lungs low diaphragmatic position decreased intensity of heart and breath sounds severe dz suggested by: pursed lip breathing use of accessory respiratory mm -retraction of intercostal spaces **increase RV, decreased FVC, decreased FEV1, decreased FEV1/FVC |
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chronic bronchitis vs emphysema
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emphysema:
older thin cor pulmonale late mild hypoxemia hypercapnia late lung compliance increased DL CO-reduced airway obstruction-severe hematocrit-normal Chronic bronchitis: younger stacky cor pulmoanle early hypoxemia-prominant hypercapnia-early lung compliance-normal airway obstruction-moderate hematocrit-increased |
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treatment strategy for COPD
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stop smoking
bronchodilators++ trial of steroid++ mucolytics oxygen+++ rehab |
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brochodiltors:
anticholingergics: |
LABA
SABA ipratropium newly introduced tiotropium |
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GOLD therapy at each stage of COPD:
stage 0 |
chronic symptoms exposure to risk factors
normal spirometry --avoid risk factors influenza vaccine |
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GOLD therapy at each stage of COPD:
stage 1 |
FEV/FVC <70
FEV1>80 with or w/o symptoms --avoid risk factors flu shot add SABA |
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GOLD therapy at each stage of COPD:
stage 2 |
FEV/FVC<70
50%>FEV1<80% w or w/o symptoms add LABA |
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GOLD therapy at each stage of COPD:
stage 3 |
FEV/FVC<70
30%>FEV1<50 w or w/o symptoms avoid risk factors flue shot SABA LABA ICS |
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stage 4:
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FEV/FVC<70%
FEV<30 or presence of chronic respiratory failure or right heart failure avoid risk factors flu shot SABA LABA ICS O2 |
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exacerbation of COPD
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-increased dyspnea
-increased sputum volume -increased production or change in color |
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indications for chronic O2
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-PaO2<55 while on room temp
-PaO2 55-60 +Pul HTN or COr pulmonale -fall in PaO2<55 during exercise or sleep |
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What is the only thing that has been shown to increase survival in COPD?
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O2
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why has theophylline fallen out of favor bc?
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potential drug interactions
systemic route of administration potential for cardiac stimulation potential for CNS stimulation |
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an elevation in this lung volume is the hallmark of hyperinflation seen in COPD?
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residual volume
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GOLD guidelines for managing COPD basis the classification of COPD depending on
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FEV1
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