COPD Flashcards
COPD definition
airflow limitation that is not fully reversible. usually progressive and associated with abnormal inflammatory response to noxious stimuli
General COPD pathogenesis
smoking or another irritant in the presence of host susceptibility factors leads to lung inflammation. lung inflammation leads to fewer anti-proteinaseas and fewer anti-oxidants. Increased proteinases, repair processes, increased reactive oxidative species, and lung inflammation work together to cause COPD.
How does inflmmation contribute to airway obstruction in small and large airways?
small airways undergo remodeling, increased inflammatory exudate, thickened walls, more macrophages, CD8 cells, and fibroblasts.
large airways: also have mucus gland hyperplasia, neutrophils in sputum, and squamous cell metaplasia (cancer precursor).
So, together: small airways are remodeled and small with CD8 cells and macrophages
Large airways also have extra mucus and squamous cell metaplasia.
What is dynamic hyperinflation
when a COPD person exercises, they don’t have the extra time they need to let air out of their lungs. so, instead, the functional residual capacity (expiratory reserve vol and residual vol) gets bigger and bigger. hard to breathe in when lungs are already very big–> dyspnea
What does COPD look like on pulmonary function tests?
decreased peak expiratory flow, FEV1/FVC <70% and scooping during expriation on flow vol curve
How does COPD change the diffusing capacity?
decreases it.
because of decreased alveolar SA and decreased capillary numbers
Main differences btw COPD and asthma
COPD is irreversible and involves CD8 cells, macrophages. Alveolar destruction.
asthma is reversible (sort of) and involves mast cells, Th2 CD4 cells, and eosinophils. No alveolar destruction.
Overlap exists
Cor pulmonale
Complication of COPD.
enlargement of right heart due to high BP in pulmonary veins. chronic hypoxia leads to pulmonary vasoconstriction which leads to pulmonary HTN which leads to right heart hypertrophy. may lead to edema, more dyspnea, and death.
Bullae
thin walled air space within the lung at least 1 cm big. inovles pleura, septa, and compressed lung tissue (not a cyst). may enlarge progressively. Complications of bullae include infection and pneumothorax if popped. with pneumothorax, patients may have lung collapse as air is continually trapped in that space. very bad for COPDers who already have reduced reserves, dyspnea. Can lead to acute resp failure.
Extrapulmonary features of COPD (8)
- hypercoaguability (strokes, DVTs, emboli),
- CV (arrhythmias, MI, CHF, aortic aneurysm),
- weight loss,
4.osteoprosis,
5.anemia - coronary artery disease,
- lung cancer
- diabetes
depression
What are some PE findings for COPD
expiratory wheez, hyperinflation, decreased breath sounds, crackles, distant heart sounds, depressed diaphragm.
at the late stages, see tripod, accessory muscle use, pursed lips in expiration, paradoxical retraction (bottom goes out on inspiration because diphraghm is no longer flat- Hoover’s sign), clubbing, cyanosis, big JVD, big liver asterixis (tremo when hand is extended)
(wheeze, hoover, clubbing, tripod, pursed lips, asterixis is enough)
Test results for COPD, including X ray and CT
X ray shows blebbs. see barrel chest
CT like swiss cheese
see obstruction, decreased diffusion capacity, air traping, and bigger lung capacity.
Survival prediction in COPD
BODE scores: FEV1, distance walked in 6 minutes, BMI (over 21 better than under 21), dyspnea
Management of COPD
assessment and monitoring of symptoms, risk factor reduction, management of stable COPD, and treatment of exacerbations
Assessment and monitoring of COPD symptoms and reduction of risk factors
assess and monitor SOB, cough, and sputum levels. look at spirometry. assess risk factors.
Smoking cessation is the single most effective (and cost effective) intervetion to decrease development and progression of COPD.
Flu vaccine also increases life span.
