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17 Cards in this Set

  • Front
  • Back
COPD risk factors
- smoking!!
- Alpha1-antitrypsin Deficiency
- Hyperresponsive Airways and Occupational Factors will exacerbate
chronic obstructive bronchiolitis path
- 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
emphysema path
- 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
Protease, Antiprotease Model for COPD
- 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
cor pulmonae
- 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
dx of chronic bronchitis and emphysema
- 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
COPD presentation
- 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
flow volume loop of COPD
- 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
COPD chest rad
- low flattened diaphragm and ↑ AP diameter from hyperinflation
– there are also large lung volumes and a reduction of vascular markings
– these changes occur late
typical findings in pts w/ COPD
- ↓ 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
O2 for COPD pts
- Oxygen – for pts w/ PO2 less than 55 torr
– esp good if pulmonary htx or 2o polycythemia
Bronchodilators for COPD pts
- can be symp agents, methylxanthines, and anticholinergics
– we have been leaning toward anticholinergics
lung Reduction or Lung Transplant for COPD pts
– 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
FEV1/FVC < 70
FEV1 more than 80
how do you treat?
add a short acting bronchodilator when needed
FEV1/FVC < 70
FEV1 between 80 and 50
how do you treat?
add regular treatment with a long acting bronchodilators and rehab
FEV1/FVC < 70
FEV1 between 30 and 50
how do you treat?
add inhaled glucocorticosteroids
FEV1/FVC < 70
FEV1 < 30 or signs of failure
how do you treat?
add long term O2 and consider surgery