COPD Flashcards by Wendy Pitts

COPD is?

chronic, inflammatory response a/w pollutants

preventable, treatable

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Inflammation in lungs results in? (2)

1) Small airway disease:
airway inflamm and remodeling

2) Parenchymal destrutction:
loss of alveolar attachments and recoil

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Emphysema-caused COPD characteristics?

"Pink Puffer"
Maintains adequate O2 for longer time
Pursed lip breathing,
Pink skin color,
Thin body

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Chronic Bronchitis-caused COPD characteristics?

“Blue Bloater”
Hypoxemia/respiratory acidosis (C)
Cor pulmonale (enlarged R heart from pulm HTN)
Overweight

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Chronic Bronchitis definition?

Chronic, productive cough
Lasting 3 mo during 2 yrs
With no other cause

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Chronic Bronchitis structural Δs? (3)

Mucous gland hyperplasia ->
excess mucus and narrowed bronchioles

Bronchial squamous metaplasia (non-squ replaced w/ squamous cells)

Lost ciliary transport

(Less parenchymal damage than emphysema)

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Chronic Bronchitis structural Δs results from?

Inflamm of submucosa of bronch wall by neutrophils

Chronic bacterial inf/hyper-active reaction

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Chronic Bronchitis causes what type of obstruction?

Results in?

inspiratory and expiratory

hypoxemia and hypercarbia

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Emphysema definition?

Pathological enlargement of air spaces DISTAL to terminal bronchs

Due to destruction of alveolar walls

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Emphysema destructive process?

(P) > elastase or < antitrypsin

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Emphysema structural Δs?

↓ alveolar SA available for gas exchange

↓ recoil -> limits airflow

↓ alveolar support structure -> airway narrowing

Destruction of capillary beds -> ↓ CO2 diffusion capacity

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Emphysema causes what type of obstruction?

Results in?

exhalation

hypercarbia

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Emphysemia vs. Chronic Bronch sxs:

Onset

Dyspnea

Cough

Sputum Production

Sputum Appearance

Onset: E = > 50, B = 30s-40s

Dyspnea:
E = progressive, constant, severe
B = intermitt, mild-mod

Cough:
E = absent -mild
B = persistent, severe

Sputum Production:
E = absent - mild
B = persistent, severe

Sputum Appearance:
E = clear, mucoid
B = mucopurulent

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COPD presentation?

(U) 50s/60s
Dyspnea OE -> DAR
Chronic cough (U) a.m.
Sputum

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Asthma definition?

Chronic inflamm of AIRWAYS
(U) eosinophils

Hyper-reactive airway -> ↑ secretion, mucosal edema, C of bronch sm mm

Reversible

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COPD risk factors?

Smoking (80%)
Pollution
2nd hand smoke
Airway hyper-response
Genetic RF (⍺1 anti-trypsin deficiency)

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Cigarette smoke mechanism of destruction? (2)

stims elastase -> degenerated elastin/alveolar structures

releases cytotoxic oxyrads from WBC

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⍺1 Antitrypsin Deficiency (AATD)?

AAT is protease inhibitor

w/o AAT elastase/proteases destroy lung tissue

smoking accelerates destruction

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COPD physical exam, look for?

Mouth

Neck

Chest

Lungs

Percussion

Heart

Abdomen

Ext

Mouth: tobacco staining

Neck: masses, JVD

Chest: ↑ AP diameter, accessory mm use, breathing rate/effort, central cyanosis

Lungs: ↓ breath sounds, rhonchi, wheeze, crackles; prolonged exhale, purse-lip breathing

Percussion: hyper-resonance

Heart: (P) gallop, RV lift, PMI

Abdomen: (P) hepatomegaly, tender

Ext: cyanosis, clubbing, mm wasting, tobacco stain fingers, peripheral edema

COPD diagnositcs:

CBC

ABG

EKG

Sputum

CBC = (U) normal, (P) late polycythemia

ABG (Arterial blood gases) = hypoxemia, hypercarbia

EKG = sinus tachy, peaked P, R axis deviation, RVH

Sputum = gram stain, culture

CXR findings:

Emphysema

Chronic Bronch

Emphysema = hyperinflation w/ (P) bullae,
flat diaph,
enlarged retrosternal air space

Chronic Bronch = cardiac enlargement,
pulmonary congestion,
↑ lung markings

CXR vs CT for COPD?

CT = higher resolution but not necessary for routine

PFT (plumonary fxn tests):

FVC

FEV1

FEV1/FVC

HALLMARK of dz

FVC (forced vital capacity) =
amount forcefully exhaled after max inspiration,
(U) N w/ COPD,
↓ w/ restrictive

FEV1 (forced exp vol in 1 sec) =
(N is >80% of predicted value)
↓ w/ obstructive

FEV1/FVC =
(N is 70-80%)
↓ w/ N FVC is obstructive

Stage I: Mild COPD characteristics?

FEV1/FVC =80% w/ or w/o sxs

Stage II: Mod COPD characteristics?

FEV1/FVC < FEV1 < 80% DOE w/ or w/o cough/sputum

Stage III: Severe COPD characteristics?

FEV1/FVC < FEV1 < 50% ↑ dysp, ↓ exercise capacity, fatigue, repeat exacerbation

Stage IV: Severe COPD characteristics?

FEV1/FVC < 30% | or <50% w/ respiratory failure

Steps to evaluating Obstructive Dz?

1st: Obstructive pattern? (FEV1/FVC < 70%) 2nd: Severity/Stage? (FEV1 post bronchodilator) FEV1 % predicted? FEV1 ↑ >12% (if yes = asthma) 3rd: Sxs/Exacerb? (mMRC or CAT) 0-1 or >2 exacer/ >=1 hospitalization

mMRC Scale?

0 = breathless only w/ strenuous exercise 1 = SOB hurrying on level ground, or walking up slight hill 2 = walk slower on level ground, or stop for breath if walk at regular pace 3 = stop for breath 100 yds or few minutes on level ground 4 = too breathless to leave house or breathless when dressing

Smoking Cess 5-A approach?

``` Ask abt tobacco Advise to quit Assess willingness Assist w/ quitting Arrange support f/u ```

Bronchodilators for COPD?

β2-agonists and anticholingergics Inhaled (site specific vs systemic): hydrofluoroalkane Helps by bronchdil, ↑ ciliary mvmt, ↑ diaph action, ↑ cardiac contract Φ effect on secretions

β2-agonists help COPD how?

Helps by bronchdil, ↑ ciliary mvmt, ↑ diaph action, ↑ cardiac contract Φ effect on secretions

β2-agonists: short acting? β2-agonists: long acting?

albuterol salmeterol formoterol

Anticholinergics help COPD how?

bronchodia ↓ air trapping less cardiac stim

Anticholinergics: short acting? Anticholinergics: long acting?

ipratropium bromide tiotropium bromide

Corticosteriods help COPD how?

Inhaled for maintenance ↓ mucosal edema/inflamm inhibit prostaglandins ↑ response to βs

Theophylline (Methylxanthine) common toxicities?

tachycard, arrhy, seizures don't use anymore

PDE-4 Inhibitor helps COPD how? Indications for use? Drug name?

anti-inflamm - suppresses cytokine release, inhibits neutrophils and WBCs from lungs add-on to bronchodia in refractory cases roflumilast

Methods to mobilize secretions? (4)

1) Moisture: PO and humidify 2) Postural drainage (not effective) 3) Expectorants (not effective) 4) Mucolytic agents (in-pt only)

Antiprotease therapy used for?

for ⍺1-antitryp deficiency | controversial

Pursed lip breathing, why?

causes outflow resistance at lips -> ↑ intrabronch pressure -> keeps bronch open -> ↑ expelled air

Early signs of pulmonary infection? (6)

``` ↑ sputum fever ↑ dysp fatigue chest pain hemoptysis ```

Acute exacerbation of COPD management?

↑ frequency of short-act β2-agonists steroids (↓ recovery and hospit) antibiotics

COPD and low respir infections common why? Etiology?

↓ expectoration causes colonization of bacteria, virals become co-infected H. influ, S. pneumo, M. catarrhalis, Pseudomonasaeruginosa

Antibiotics for low resp infection (outpt)? (4)

Macrolides (azithro, clarithro) Fluoroquinolones (levofloxacin, maxiflozacin) Augmentin Doxy Trimeth-Sulfmeth Cephalosporins (cefdinir)

Hospitalization for COPD when?

``` ↑ intensity of sxs New physical signs (cyanosis, edema, etc) Failure to respond to meds Significant co-morbids Frequent exacerbations ↑ age Insuff home support ```

Supplemental O2 used when? For how long? Concerns w use?

pO2 less than 55 or sat less than 88% At least 12 hrs/day Reduce urge to breathe, result in acidosis