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31 Cards in this Set
- Front
- Back
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What is the cause of airway problems in COPD?
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A chronic inflammatory airway response secondary to smoking
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What is the main cause of COPD?
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Smoking
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What two conditions comprise COPD?
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Emphysema: destruction of the alveoli
Chronic bronchitis: inflammation of the bronchi that causes increased mucus production |
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If a person's COPD is comprised mostly of emphysema, what do we call them?
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A pink puffer
Normal blood levels of CO2 Hyperinflation Low diffusion capacity Wasting |
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If a person's COPD is comprised of chronic bronchitis, what do we call them?
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Blue bloater
CO2 retainer Overweight RHF |
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What are some of the airway changes in COPD?
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Smooth muscle contraction
Hypersecretion of mucus Loss of elastic recoil Narrowing |
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What are some of the inflammatory changes in COPD in cell types present? Protein levels?
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Increased neutrophils, macs, CD8 cells
Protease/antiprotease inmbalance |
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What are some of the structural changes that happen in COPD?
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Alveolar destruction
Collagen deposition Glandular hypertrophy Airway fibrosis |
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What is the mechanism by which chronic bronchitis occurs?
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1. Damage to mucuciliary clearance
2. Pooling of secretions 3. Bacterial growth 4. Epithelial changes 5. Further worse clearance |
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What mutation is common in people who are genetically susceptible to COPD?
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Alpha-1 antitrypsin
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What abnormalities are present in the urine of people with COPD?
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Increased elastin levels
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Where are the problems manifest in people with smoking induced COPD? Genetically susceptible/
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Upper lung problems
Lower lung problems |
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Why are we seeing such an increase in COPD?
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People aren't dying of other things.
Baby boomers are coming to the age where they start to show it. |
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What are the established risk factors to COPD?
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Cigarette smoking
Occupational exposure Alpha1-Antitrypsin deficiency Air pollution |
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What are the symptoms of COPD?
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Cough: +/- sputum
Dyspnea, worsening with exertion Wheezing |
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What are the features of COPD on exam?
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Prolonged expiration
+/- wheezing Increased AP diameter Decreased breath sounds Late stage: Labored breathing Cyanosis Cor pulmonale |
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What is cor pulmonale?
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RHF due to pulmonary HTN
Such a severe degree of hypoxia and alveolar destruction that pulmonary vasoconstriction is induced |
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What doees COPD look like on plainfilms?
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Flattened diaphragm
"Blacker appearance' to chest film Increased retrosternal clearspace Hyperinflation |
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On HRCT, what do you see in emphysema dominant COPD? Airway disease predominant COPD?
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Emphysema: lack of septa
Airway: white opacifications of bronchi due to buildup of mucus |
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What PFT indicates a high probability of obstructive disease?
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FEV1/FVC
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What is the difference in spirometry between COPD and normal respiration?
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Other than an abnormal FEV1/FVC, what other abnormalities are present in PFTs for COPD?
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Increased lung volume: TLC > 120%
RV > 120% Decreased DLCO in emphysema |
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What is the objective of treatment in COPD? Is it curative?
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Relieve dyspena and decrease exacerbations
No. The damage to the lung has already been done. |
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What is predictive of mortality in COPD?
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BODE:
BMI Obstruction Dyspnea Exercise tolerance |
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What is the GOLD index?
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A classification system for COPD.
It classifies the degree of airflow limitation |
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What are the pharmacotherapies for COPD?
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Anticholinergics: bronchodilation
Beta agonists Inhaled corticosteroids PDE4 inhibitor |
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When prescribing inhaled corticostorids for COPD, how should you prescribe them?
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Always with a bronchodilator
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What are the side effects of inhaled corticosteroids in COPD?
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Thrush
Pneumonia |
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What is the treatment for COPD exacerbations?
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short-acting bronchodilators
Systemic corticosteroids Antibiotics: if bacteria are present |
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Should people with COPD be on oxygen?
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Yes.
Improves mortality |
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What is the most important thing you can do for your patients in relation to COPD?
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GET THEM TO STOP SMOKING!
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