Lungs 2

Front 1

COPD risk factors

Back 1

- smoking!!
- Alpha1-antitrypsin Deficiency
- Hyperresponsive Airways and Occupational Factors will exacerbate

Front 2

chronic obstructive bronchiolitis path

Back 2

- enlargement of mucus secreting glands and ↑ number of goblet cells
– histologically, it will show thickening of the airway wall and infiltration with neutrophils, macrophages, and lymphocytes

Front 3

emphysema path

Back 3

- you get ↓ expiratory flow rate due to loss of elastic recoil
- this creates a lower driving P and the tendency for collapse
– histologially, it will show peribronchiolar destruction of alveolar walls -> loss of alveolar attachments, airway collapse, and enlargement of air spaces distal to the terminal bronchioles

Front 4

Protease, Antiprotease Model for COPD

Back 4

- emphysema results from destruction of the connective tissue matrix of the alveolar walls by proteolyitc enzymes released by inflamm cells in the alveoli
– neutrophil elastase is the big one
– the A1-antiprotease inhibits this

Front 5

cor pulmonae

Back 5

- disease of the RV, 2o to lung disease
– the part of COPD that -> pulmonary hypertension (and eventually this) is hypoxia
– ↓ PO2 -> constriction of pulmonary arterioles

Front 6

dx of chronic bronchitis and emphysema

Back 6

- Chronic bronchitis dx is based on chronic cough and sputum prod
– emphysema dx is based on destruction of lung parenchyma and enlargement of air spaces distal to terminal bronchiole

Front 7

COPD presentation

Back 7

- A viral infection usually the precipitation factor
- Type A (pink puffer) usually assocated w/ emphasema
- Type B (blue bloater) usually assocated w/ bronchitis
– B more hypoxemic and often have hypercapnia & cor pulmonae

Front 8

flow volume loop of COPD

Back 8

- lower peak and slower flow depicted by the concave expiratory limb
– indicates the presence of obstruction, but does not specify the cause
– it’ll suggest hyperinflation, ↑ RV and TLC, and ↓ IC

Front 9

COPD chest rad

Back 9

- low flattened diaphragm and ↑ AP diameter from hyperinflation
– there are also large lung volumes and a reduction of vascular markings
– these changes occur late

Front 10

typical findings in pts w/ COPD

Back 10

- ↓ FVC, FEV1, FEV1/FVC, MMFR – this means obstruction
– there is also air trapping, which causes ↑ RV, FRC, and TLC
– diffusing capacity is normal in bronchitis, ↓ in emphysema

Front 11

O2 for COPD pts

Back 11

- Oxygen – for pts w/ PO2 less than 55 torr
– esp good if pulmonary htx or 2o polycythemia

Front 12

Bronchodilators for COPD pts

Back 12

- can be symp agents, methylxanthines, and anticholinergics
– we have been leaning toward anticholinergics

Front 13

lung Reduction or Lung Transplant for COPD pts

Back 13

– reduction allows the diaphragm to return to normal and it only removes the really diseased parts
– transplant helps but is not practical – best for those who are young w/ A-antitrypsin def

Front 14

FEV1/FVC < 70
FEV1 more than 80
how do you treat?

Back 14

add a short acting bronchodilator when needed

Front 15

FEV1/FVC < 70
FEV1 between 80 and 50
how do you treat?

Back 15

add regular treatment with a long acting bronchodilators and rehab

Front 16

FEV1/FVC < 70
FEV1 between 30 and 50
how do you treat?

Back 16

add inhaled glucocorticosteroids

Front 17

FEV1/FVC < 70
FEV1 < 30 or signs of failure
how do you treat?

Back 17

add long term O2 and consider surgery