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Pathophysiology > Chap 12- COPD > Flashcards

Chap 12- COPD Flashcards

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1
Q

ATS

A

American Thoracic Society

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2
Q

American Thoracic Society definition of COPD

A

Preventable and treatable disease state that characterized by airflow limitation that is not fully reversible. The airflow is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cig smoking. Produces systemic consequences

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3
Q

Chronic bronchitis is defined what

A

clinically-sputum production, shortness of breath

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4
Q

Chronic Bronchitis

A

Chronic PRODUCTIVE COUGH for 3 months in each of 2 successive years in a pt whom other causes of production chronic cough have been excluded

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5
Q

Emphysema is defined what

A

pathologically- destruction of the last 3 divisions- where gas exchange occurs (decrease in gas diffusion)- lose stability

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6
Q

Emphysema

A

The presence of permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of the walls and without obvious fibrosis

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7
Q

GOLD

A

Global initiative for COPD

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8
Q

Gold definition of COPD

A

preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual pts. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with anabnormal inflammatory response of the lung to noxious particles or gases

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9
Q

Even though chronic bronchitis and emphysema can develop alone, but what and called what?

A

they often occur together as one disease complex. When this happens, the disease entity is called COPD

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10
Q

Anatomic Alternations of the lung associated with chronic bronchitis

A

Chronic inflammation and swelling of the wall of the peripheral airways,
Excessive mucous production and accumulation,
Partial or total mucous plugging of the airways,
Smooth muscle constriction of bronchial airway (bronchospasm),
Air trapping and hyperinflation of alveoli

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11
Q

Submucosal bronchial glands enlarge and the number of goblet cells increase, resulting in

A

excessive mucous production and the number and function of cilia diminishes

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12
Q

Systemic Consequences of COPD

A

heart

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13
Q

Anatomic Alternations of the lung associated with Emphysema

A

Permanent enlargement and destruction of the air spaces distal to the terminal bronchioles,
Destruction of pulmonary capillaries,
Weakening of the distal airways-primarily the resp bronchioles,
Air trapping and hyperinflation

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14
Q

2 kinds of emphysema

A

Panacinar (panlobular) emphysema, Centriacinar (centrilobular) emphysema

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15
Q

Panacinar (panlobular) emphysema

A

Younger patients. Often associated with ALPHA 1- ANTITYPSIN deficiency= dp alpha 1 antitypsin therapy

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16
Q

Most severe type of emphysema?

A

Panacinar (panlobular) emphysema

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17
Q

Centriacinar (centrilobular) emphysema

A

Strongly associated cig smoking, associated with chronic bronchitis

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18
Q

Risk factors

A

Tobacco smoking,
Occupational dusts and chemicals,
Indoor air pollutions (biomass fuels),
Outdoor air pollution,
Conditions that affect normal lung growth (during gestation or early childhood),
Genetic Predispositions (alpha 1 antitypsin deficiency)

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19
Q

Genetic predispositions (alpha 1 antitypsin deficiency)

A

-Alpha 1 antitypsin inactivates the enzyme Elastase
-MM phenotype (normal level of alpha 1 antitypsin)
-ZZ phenotype (alpha 1 deficient)
MZ phenotype (intermediate deficiency)

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20
Q

Alpha 1 antitypsin inactivates

A

the enzyme Elastase

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21
Q

ZZ phenotype

A

alpha 1 deficient

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22
Q

MZ phenotype

A

intermediate deficiency

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23
Q

MM phenotype

A

normal level of alpha 1 antitypsin

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24
Q

Diagnosis of COPD, key indicators

A 
over 40 years of age,
Dyspnea with excursion,
Chronic cough- bronchitis,
Chronic sputum production- bronchitis
History of exposure of risk factors (SMOKING)
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25
1st key indicator of COPD
DYSPNEA with excursion
26
PFT in diagnosis of COPD
FVC, FEV1, and FEV1/FVC ratio
27
FVC
Total amount of air in (forced vital capacity)
28
FEV1
1st second, should be 80% of FEV
29
FEV1/ FVC
Restrictive or obstructive? staging how bad they are. 70% and up = norm, 70% and under= obstructive disease (asthma,ect)
30
Stages of COPD per PFT results as recognized by GOLD
Stage 1, Stage 2, Stage 3, Stage 4
31
Stage 1 mild
FEV1/FVC < 70%, FEV1> 80% of predicted, Symptoms mild to absent
32
Stage 2 moderate
FEV1/FVC <70%, FEV1 50-80% of predicted, SOB with exertion, Usually seek medical attention at this point
33
Stage 3 severe
FEV1/FVC <70%, FEV1 30-50% of predicted | Symptoms may impact patients quality of life -pulmonary rehab time
34
Stage 4 very severe
FEV1/FVC < 70%, FEV1 <30% of predicted, Chronic Ventilator failure (Abnormal ABGs), Quality of life severely impaired, Exacerbations may be life threatening
35
Stage 4 ABGs reading
Chronic resp acidosis (fully compensated). drive switches from CO2 to O2. CO2= <60 (55-60)
36
What stage is seen in the hospital?
Stage 4
37
Additional COPD diagnostics
Bronchodilator reversibility testing, CXR (seldom diagnostic), ABG's (ventilatory failure if PaO2 <60mmHg, with/without PaCO2 >50mmHg), Alpha 1- antitypsin deficiency screening
38
Pink Puffer (Type A COPD)
EMPHYSEMA Increased V/Q ratio due to loss of pulmonary capillaries, Hyperventilates to compensate increased V/Q ratio, Increase RR, Thin (muscle wasting due to increased WOB), Barrel Chest (due to over inflation of lungs from air trapping), Accessory muscle usage for inspiration, Pursed lip breathing on exhalation (increased anatomical PEEP)
39
Hyperventilates in Emphysema
Marked SOB, airway resistance increases= RR increases= burning calories= thin
40
DLCO and DLCO/V2 what in Emphysema
decreases
41
Auscultation in emphysema
Decrease breath sounds, decreased heart sounds, prolonged expiration
42
Percussion on emphysema
hyperresonance
43
Chest XR on emphysema
hyperinflation, narrow mediastinum, flat diaphragm, blebs (holes)
44
Digital clubbing in emphysema?
late stages
45
Blue Bloater (Type B COPD)
``` CHRONIC BRONCHITIS Digital clubbing (CF), Decreased V/Q ratio (decreased vent and increased perfusion), Depressed RR, Chronic hypOventilation and increased cardiac output, Decreased PaO2, Increased PaCO2, Compensated pH, Polycethemia, Cyanosis, Cor Pulmonale (Rt sided heart failure), Peripheral edema (gravity dependent, Extended neck veins ```
46
CXR in chronic bronchitis
Congested lung fields, densities, enlarged horizontal (turned) heart (rt)
47
Ausculation in chronic bronchitis
wheezes, crackles, rhonchi, depends on severity
48
Cor Pulmonale
In chronic bronchitis- Pulmonary hypertension=resistance of blood= right sided heart failure
49
Cough in chronic bronchitis?
yes, classic sign, copious amounts of purulent sputum
50
Types of sputum
Mucoid= Thick- asthma, Purulent= yellow- infection, Hemoptysis=blood
51
Chronic bronchitis, things on the rt side of heart increases
CVP, RAP, PA, RVSWI, PVR
52
Hypoventilation- hypoxia and hypercapnia, leading to
polycethemia, increase in RBC, Hgb, Hmt
53
General Management of COPD, Gold program
``` Assessing and monitoring the disease, Reduce risk factors (Na+), Manage stable COPD, Manage exacerbation- imp Exercise, Prevent disease progression, Treat complications (cor pulmonale) ```
54
Step 1 of general management
Assessment and monitoring - Exposure to risk factors, - Past medical history, - Family history of COPD, - Pattern of symptom development, - History of exacerbations, - Presence of comorbidities, - Appropriateness of current medical treatment, - Impact of disease on pts life, - Possibilities of reducing risk factors
55
Step 2 of general management
REDUCING RISK FACTORS - smoking cessation - Other risk factors
56
Step 3 of general management
MANAGE STABLE COPD - Determine severity of disease, - Address cultural and national preference, - Address educational/cognitive issues of pt, - Pharmaceutical management to control or prevent symptoms, - Reduce exacerbations, - Improve exercise tolerance
57
Step 4 of general management
MANAGEMENT OF EXACERBATION - Most common cause is airway infection, - Assess severity of exacerbation, CXR, ABG's, EKG, Sputum sample,ect.. - Adjust med management - consider need for hospitalization
58
Considering need for hospitalization
- marked increase in intensity of signs and symptoms (dyspnea at rest) - hx of severe COPD - Onset of new physical signs - significant co-morbidities - new occuring cardiac arrhythmias - older age - insufficient home support
59
Respiratory care treatment protocols
Oxygen Therapy, Bronchopulmonary Hygiene therapy, Mechanical ventilation(bad news), Expectorants, antiobiotics
60
Oxygen Therapy
Caution do NOT over oxygenate patient, assess PaO2
61
Bronchopulmonary Hygiene Therapy
CPT (Chest Physiotherapy), Hydration (be careful)

Pathophysiology (9 decks)

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