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28 Cards in this Set

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What are the two classic types of COPD?
Chronic bronchitis and emphysema
What is the clinical diagnosis of chronic bronchitis?
Chronic productive cough for at least 3 months for at least 2 consecutive years
What characterizes emphysema?
Permanent enlargement of air spaces due to destruction of the alveolar walls
What are risk factors for COPD?
The #1 risk factor is tobacco smoke, then alpha-1-antitrypsin deficiency, second-hand smoke and chronic asthma
What are the different types of emphysema? How are they different?
*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
What is the pathogenesis of chronic bronchitis?
Excess mucous production narrows the airways; patients with productive cough, enlargement of mucous glands causing obstruction
What is the pathogenesis of emphysema?
Destruction of alveolar walls due to excessive protease (elastase) or deficiency of alpha-1-antitrypsin
How is tobacco smoke related to emphysema?
Tobacco smoke increases the number of PMNs and macrophages which release elastase and inhibit A1A
How will a patient with COPD present clinically?
Cough, sputum production, dyspnea
Can patients have both chronic bronchitis and emphysema?
Yes, they can have features of both
What are the common signs of COPD?
Prolonged forced expiratory volume, wheezes, tachypnea, cyanosis, use of accessory respiratory muscles, hyperresonance on percussion, and signs of cor pulmonale
How can you definitively diagnose COPD?
Pulmonary function tests, decreased FEV1/FVC ratio < .75-.80
What changes occur to other lung volumes in COPD?
Increased TLC, residual volume, and FRC, decreased vital capacity
How will a patient with emphysema present?
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
How will a patient with chronic bronchitis present?
Blue bloaterss, patients tend to be overweight, cyanotic, chronic cough and sputum production, signs of cor pulmonale, no acute respiratory distress
How useful is a CXR for diagnosing COPD?
Only good for severe advanced emphysema, shows hyperinflation of the lungs and a flattened diaphragm
What is the most important intervention in patients with COPD? Why?
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
Can you reverse COPD?
No, the damage is permanent
What are other treatment modalities of COPD?
Beta-2-agonists (bronchidilators), inhaled anticholinergic agents (ipratropium), and inhaled corticosteroids
What is the significance of oxygen therapy?
Shown to improve survival and quality of life in patients with COPD
What is the criteria for continuous or intermittent long-term oxygen therapy in COPD?
PaO2 55 mmHg or O2 sat < 88%
What vaccinations should patients with COPD receive?
Influenza vaccine annually and vaccine against Streptococcus pneumoniae every 5-6 years
What kinds of surgeries may be of help for patients with COPD?
Lung resection or transplantation
How do you treat patients with mild to moderate COPD?
Bronchodilator and anticholinergic drugs are 1st line agents; inhaled glucocorticoids can be used as well, or theophylline
How do you treat patients with severe COPD?
Same medications but with continuous oxygen therapy
What is an acute COPD exacerbation?
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
If a patient presents with COPD exacerbation, what is the treatment order?
1) CXR
2) beta-2-agonist and anticholinergic inhaler
3) systemic corticosteroids
4) antibiotics
5) supplemental oxygen
What are the most common causes of acute exacerbations?
Infection, noncompliance with therapy, and cardiac disease