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28 Cards in this Set
- Front
- Back
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What are the two classic types of COPD?
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Chronic bronchitis and emphysema
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What is the clinical diagnosis of chronic bronchitis?
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Chronic productive cough for at least 3 months for at least 2 consecutive years
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What characterizes emphysema?
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Permanent enlargement of air spaces due to destruction of the alveolar walls
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What are risk factors for COPD?
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The #1 risk factor is tobacco smoke, then alpha-1-antitrypsin deficiency, second-hand smoke and chronic asthma
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What are the different types of emphysema? How are they different?
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*Centrilobular emphysema most commonly seen in smokers, in upper lung zones and destruction of alveolar walls and little change to distal acini
*Panlobular emphysema seen in patients with alpha-1-antitrypsin, destruction of both proximal and distal acini, in bases of lung |
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What is the pathogenesis of chronic bronchitis?
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Excess mucous production narrows the airways; patients with productive cough, enlargement of mucous glands causing obstruction
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What is the pathogenesis of emphysema?
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Destruction of alveolar walls due to excessive protease (elastase) or deficiency of alpha-1-antitrypsin
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How is tobacco smoke related to emphysema?
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Tobacco smoke increases the number of PMNs and macrophages which release elastase and inhibit A1A
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How will a patient with COPD present clinically?
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Cough, sputum production, dyspnea
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Can patients have both chronic bronchitis and emphysema?
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Yes, they can have features of both
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What are the common signs of COPD?
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Prolonged forced expiratory volume, wheezes, tachypnea, cyanosis, use of accessory respiratory muscles, hyperresonance on percussion, and signs of cor pulmonale
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How can you definitively diagnose COPD?
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Pulmonary function tests, decreased FEV1/FVC ratio < .75-.80
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What changes occur to other lung volumes in COPD?
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Increased TLC, residual volume, and FRC, decreased vital capacity
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How will a patient with emphysema present?
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Pink puffers, patients tend to be thin due to increased energy expenditure during breathing and are barrel chested, pursed lips breathing, use accessory muscles to breathe
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How will a patient with chronic bronchitis present?
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Blue bloaterss, patients tend to be overweight, cyanotic, chronic cough and sputum production, signs of cor pulmonale, no acute respiratory distress
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How useful is a CXR for diagnosing COPD?
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Only good for severe advanced emphysema, shows hyperinflation of the lungs and a flattened diaphragm
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What is the most important intervention in patients with COPD? Why?
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Smoking cessation, FEV1 decreases as we get older, smoking causes a faster rate of decline of FEV1; BUT if a smoker quits, the rate of decline of FEV1 slows to that of someone who has never smoked
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Can you reverse COPD?
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No, the damage is permanent
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What are other treatment modalities of COPD?
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Beta-2-agonists (bronchidilators), inhaled anticholinergic agents (ipratropium), and inhaled corticosteroids
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What is the significance of oxygen therapy?
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Shown to improve survival and quality of life in patients with COPD
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What is the criteria for continuous or intermittent long-term oxygen therapy in COPD?
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PaO2 55 mmHg or O2 sat < 88%
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What vaccinations should patients with COPD receive?
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Influenza vaccine annually and vaccine against Streptococcus pneumoniae every 5-6 years
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What kinds of surgeries may be of help for patients with COPD?
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Lung resection or transplantation
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How do you treat patients with mild to moderate COPD?
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Bronchodilator and anticholinergic drugs are 1st line agents; inhaled glucocorticoids can be used as well, or theophylline
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How do you treat patients with severe COPD?
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Same medications but with continuous oxygen therapy
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What is an acute COPD exacerbation?
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Persistent increase in dyspnea that is not relieved with bronchodilators, increased sputum production and cough; can lead to acute respiratory failure that requires hospitalization and mechanical ventilation
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If a patient presents with COPD exacerbation, what is the treatment order?
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1) CXR
2) beta-2-agonist and anticholinergic inhaler 3) systemic corticosteroids 4) antibiotics 5) supplemental oxygen |
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What are the most common causes of acute exacerbations?
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Infection, noncompliance with therapy, and cardiac disease
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