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Flashcards in COPD Deck (47):
1

What does COPD stand for?

chronic obstructive pulmonary disease

2

T or F: management of COPD and asthma are pretty much the same

false

3

What is the respiratory system?

gas exchange system (lungs) + pump (to ventilate lungs)

4

What is the pump?

chest wall, respiratory muscles (diaphragm), brain areas/neuronal connections that control breathing muscles

5

What is resting breathing rate of a normal healthy human?

12-15 times/ minute

6

About how much air is inspired/expired per breath?

500 mL

7

What is the chest shaped like in most COPD patients?

a barrel
*bc it is full with air that cannot get out

8

In COPD patients - do they have more or less alveoli than normal

way less plus they are swollen, enlarged and/or not working properly

9

What are alveoli involved in?

gas exchange

10

Describe some symptoms associated with COPD

-chronic cough
-increase in mucous production
-inflammed airways
-dyspnea (causes impaired exercise tolerance and contributes to anxiety and depression)

11

Is COPD preventable?

Yes

12

Is COPD treatable?

No - it is simply manageable

13

T or F: COPD only affects your lungs

False - because exercise is harder it affects skin, cardiovascular, liver, kidneys, all in a negative way.

14

What are the two types of COPD?

1. chronic bronchitis
2. emphysema

15

What is chronic bronchitis?

pretty much - lots of mucous being produced, which leads to coughing and people spitting more

*cig smoking most common cause

16

T or F: after we hit emphysema we can still reverse this disease

False

*Before we hit emphysema stage we can partially reverse this disease. After we hit emphysema stage there is no reversing

17

What is emphysema?

**only a description of lung changes

-It is an abnormal enlargement to the terminal bronchioles accompanied by destruction of their walls.
-Alveoli become larger and decrease in number which reduces the amount of oxygen transferred by the lungs to the blood stream.

18

List 4 points about chronic bronchitis

-main issue for pts with COPD
-chronic inflammation of airways
-nagging, persistent cough (smoker's cough)
-lots of mucus

19

List 3 points about emphysema

-damage to alveoli and lung tissue
-air is trapped in "dead space" at terminals
-difficulty exhaling

20

Level 1 of COPD = ?

chronic bronchitis

21

Level 2 of COPD = ?

emphysema

22

COPD is canada's ___ leading cause of death

4th

23

When testing a patient's lung health, what are important questions to ask?

-do you cough regularly?
-do you cough phlegm?
-do simple things cause shortness of breath?
-do you wheeze when you exert yourself or at night?
-do you get frequent colds that persist longer than normal?

24

So smoking is #1 cause of COPD, but when it is genetic, what is the cause of COPD?

-alpha 1 anti-trypsin (AAT) deficiency
-AAT's primary role is to protect lung cells specifically
-if this is deficient, cells are not protected and tissue is destroyed

25

What is the disease hallmark of COPD?

accelerated decline in lung function

26

In one sentence: What is the difference between asthma and COPD?

In asthma there is inflammation resulting in narrowing of the airways with excess mucous, while in COPD we have same inflammatory events along with structural damage to the parenchyma (functional parts of the lung)

27

How does cigarette smoke contribute to COPD?

It increases oxidants such as hydrogen peroxide and nitric oxide which:
-contribute to tissue damage
-promote inflammation
-increase protease activity!

28

What worsens COPD?

-oxidative stress
-proteinases
-lung inflammation

29

What makes COPD a little bit better?

-antioxidants (vit D and E)
-antiproteinases
-other repair mechanisms

30

What are the 5 major physiologic outcomes of COPD?

** ON EXAM KIDS

1. mucus hyper-secretion
2. airflow limitation & hyperinflation (barrel lung)
3. gas exchange abnormalities
4. pulmonary hypertension
5. muscle wasting

31

Explain gas exchange abnormalities.

*Bronchitis and emphysema cause altered gas exchange*

-hypoxemia (low blood oxygen)
-hypercapnia (high blood CO2)

32

Explain pulmonary hypertension

-increased pressure in the pulmonary
-secondary to gas-exchange abnormalities
-can result in right ventricular hypertrophy and ultimate RIGHT-SIDED HEART FAILURE

33

Explain muscle wasting

-also systemic inflammatory processes
-leads to skeletal muscle wasting
-contributes to decreased exercise capacity which reduces overall health status and prognosis

34

What is a COPD exacerbation?

A sustained worsening of dyspnea, cough or sputum, production leading to an increase in the use of maintenance medications and/or supplementation with additional medication

*average patient = 2 exacerbations/year

35

__ % exacerbations caused by infection

50

36

What are other triggers that can cause exacerbations?

congestive heart failure, exposure to allergens/irritants, pulmonary embolism

37

Will a steroid inhaler help with COPD?

No.
Because of emphysema

38

Describe the physical exam for COPD?

-cyanosis of mucosal membranes
-barrel chest
-increased resting respiratory rate
-shallow breathing
-pursed lips during expiration
-use of accessory respiratory muscles

39

What treatment plan do you give to a COPD patient?

Non-Pharms:
-stop smoking!
-pulmonary rehabilitation (exercise training, breathing exercises, shortness of breath strategies)

Pharmacological treatment:
-bronchodilators
-inhaled corticosteroids (ICS)
-ICS and long-acting bronchodilator (LABA) combination therapy
-flu vaccine!!!

40

Give examples of bronchodilators

-anticholinergics
-beta agonists
-theophylline (not often used)

41

What do inhaled corticosteroids do?

decrease inflammation in airways

*not as effective in COPD as in asthma

42

Double therapy would be ??

ICS and beta agonists

43

Triple therapy would be ??

-ICS
-long acting beta agonist bronchodilator
-long acting anti-cholinergic bronchodilator

44

Why is the flu vaccine important for these patients?

Because these people get infections that last longer and are harder to clear due to their breathing problems, it is important to simply avoid the flu by getting the flu shot.

45

Describe the 4 step therapeutic plan for managing acute exacerbation of COPD

1. intensify bronchodilator therapy
2. oral steroids to surpress inflammation
3. antibiotics if purulent, coloured sputum
4. oxygen therapy

46

What are some goals of COPD management?

-prevent disease progression
-relieve symptoms
-improve exercise tolerance and overall health status
-prevent/treat exacerbations/complications
-reduce mortality

47

See slide 60 for some really important stuff that I don't wanna type out.

okay man