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