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28 Cards in this Set
- Front
- Back
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what is the pathogenesis of chronic bronchitis?
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incr mucous production (productive cough)
inflamm/scarring of airways mucous gland enlargement smooth muscle hyperplasia |
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what is the pathogenesis of emphysema?
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incr elastase (PMN/macrophage)
decr alpha1-antitrypsin |
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how does tobacco smoke contribute to emphysema pathogenesis?
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incr activated PMNs/macrophages
inhib alpha1-antitrypsin free radical production |
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what is "prolonged" forced expiratory time?
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timed full exhalation of vital capacity >6 seconds
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what is FEV1?
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amount of air that can be forced out of the lungs in 1 second
(the lower the harder it is to breath) |
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what is the definitive diagnostic test for COPD?
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pulmonary function testing (spirometry): the measurement of the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled
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what are the (5) signs of obstruction seen on spirometry?
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decr FEV1 (decr FEV1/FVC)
decr vital capacity (VC) incr total lung capacity (TLC) incr residual volume (RV) incr functional reserve capacity (FRC) |
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what is Functional Residual Capacity (FRC) ?
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the volume of air present in the lungs at the end of passive expiration
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what (2) signs on spirometry are required to diagnose airway obstruction?
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nl/incr TLC
and decr FEV1 |
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what do patients with emphysema look like clinically? (6)
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"pink puffers"
- thin (incr energy use for breathing) - leaning forward - incr AP chest diameter ("barrel chest") - tachypnic w/ prolonged expiration - pursed lips - accessory muscle use |
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what do pts with bronchitis look like clinically?
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"blue bloaters"
- overweight - cyanotic - signs of cor pulmonale - chronic cough - nl/incr respiratory rate - no use of accessory muscles |
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what is vital capacity?
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the volume of air expelled from the lungs during a maximum expiration
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what is the difference in vital capacity (VC) between obstructive and restrictive lung disease?
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none, they are both low
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what should you measure in a pt with a family hx of premature emphysema (<50 yo)?
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alpha1-antitrypsin
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how should you screen for obstruction?
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peak flow meter
(if <350 L/min, then order spirometry) |
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what class of drugs are contraindicated in COPD or asthma exacerbations?
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beta-blockers
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how is mild/severe COPD defined?
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mild:
FEV1 (70%) of predicted severe: FEV1 (<50%) of predicted |
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how does oxygen therapy reduce mortality in patients with COPD?
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controls pulmonary HTN
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what are the criteria for oxygen therapy in COPD?
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one of the following:
- PaO2 (<55) - O2sat (<88%) - PaO2 (55-59) + polycythemia/evidence of cor pulmonale |
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what vaccinations are important in COPD, and how often?
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influenza (annually)
streptococcus pneumoniae (5 yrs) |
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what does theophylline (oral) do to help COPD pts?
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it "may"
- improve mucociliary clearance - improve central respiratory drive |
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what are first line agents for mild/moderate COPD?
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anticholinergic (ipratropium bromide)
and/or beta-agonists (albuterol) |
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what is the MOA of ipratropium bromide (atrovent)?
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blocks muscarinic-r's in the lung, inhibiting bronchoconstriction and mucus secretion.
- non-selective muscarinic antagonist - does not diffuse into the blood (prevents SE's) |
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what are the mcc (organisms) of pulmonary infection in COPD pts?
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s.pneumoniae
h.influenzae mycoplasma pneumoniae m.catarrhalis (cause COPD exacerbations) |
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what is the definition of an acute COPD exacerbation?
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persistent increase in dyspnea
(not relieved by bronchodilators) |
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what are the (6) steps to treat an acute COPD exacerbation?
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CXR
b-agonist + anticholinergic (inhaled) corticosteroids (systemic) antibiotics O2 noninvasvie positive-pressure ventilation (NPPV) |
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what antibiotics are used in an acute COPD exacerbation?
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azithromycin or levofloxacin
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what is secondary polycythemia in COPD?
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Hct:
>55% in men >47% in women (compensatory response to chronic hypoxemia) |
