COPD Flashcards
(39 cards)
What is COPD? Is it reversible? What two disease processes do most patients overlap? What other disease may COPD exist with?
- progressive airway limitation or obstruction
- not fully reversible
- most patients overlap emphysema and chronic bronchitis
- COPD may exist with asthma
COPD Pathophysiology
- lungs abnormal inflammatory response to particles/gases
- Chronic inflammation + body’s repair attempt: airways change with scar tissue and narrowing —> mucus hypersecretion, thickening of peripheral airway, fibrosis, exudate; scare tissue formation: narrowing airway lumen; alveolar wall destruction: decreased gas exchange; thickening of pulmonary vessels: pulmonary hypertension
How is Chronic bronchitis diagnosed?
Cough and sputum for at least 3 months in each of two consecutive years
Chronic bronchitis issues
- inflammation: increased mucus production, thicker bronchial walls
- mucus plugging: reduced ciliary function
- damaged/fibrosis adjacent alveoli
- increased susceptibility to respiratory infection
What is emphysema?
Slow progression of wall destruction of overextended alveoli
Emphysema issues
- decreased surface contact with pulmonary capillaries: hypoxemia
- impaired CO2 elimination: hypercapnea and respiratory acidosis
- decreased size capillary bed, increased resistance to pulmonary airflow (less flexible air sacs)
- Chronic pulmonary hypertension: right-sided HF= cor pulmonale
Emphysema —> ventilation/perfusion mismatch leading to….(6)
- chronic hypoxemia
- hypercapnia
- polycythemia (increased RBCs)
- right sided HF: episodic to chronic
- peripheral edema
- central cyanosis and respiratory failure
COPD Risk factors
- smoking and second hand smoke
- e-cig smoking for those who never smoked regular cig —> 75% increased risk
- occupational exposure
- air pollution: indoor or outdoor
- increased age
- alpha1-antitrypsin deficiency leading to lung destruction
COPD S/S (15)
- easily fatigued
- frequent respiratory infections
- use of accessory muscles to breathe
- orthopneic
- cor pulmonale (late in disease)
- thin in appearance
- wheezing
- pursed-lip breathing
- chronic cough
- barrel chest
- dyspnea
- prolonged exploratory time
- bronchitis- increased sputum
- digital clubbing (late sign)
Primary symptoms of emphysema (3)
- wheezing
- barrel chest
- accessory muscle use
Chronic bronchitis primary symptoms
- sputum
- productive cough
Right sided heart failure (cor pulmonale) S/S (9)
- fatigue
- increased peripheral venous pressure
- ascites
- enlarged spleen and liver
- may be secondary to chronic pulmonary problems
- distended jugular veins
- anorexia and complaints of GI distress
- weight gain
- dependent edema
How does cor pulmonale cause edema?
-chronic low O2 —> chronic pulmonary resistance —> pulmonary HTN —> increased right-side cardiac work load —> resulting peripheral edema
COPD ASSESSMENT
- history and physical
- spirometry
- ABGs
- chest x-ray
- alpha1-antitrypsin if the patient is below 45 or has a family hx
What do you withhold from a patient 6-12 hours before pulmonary function tests?
Bronchodilators —> if a pt has taken these it may not give an accurate result due to lungs being more open
What percentage of FEV1/FVC means that someone has COPD?
<70%
Main complications of COPD (2)
- respiratory insufficiency and failure: Chronic or acute
- PNA, chronic atelectasis
COPD symptom reduction for stable disease
- relief of dyspnea
- increased respiratory flow rate
- decreased sputum
- normal ABGs
- improved chest X-ray
Smoking cessation
- set quit date
- refer to program
- frequent follow up
- individualized reinforcement
- nicotine replacement therapy ‘
- antidepressants —> buproprion SR, nortyptiline
- nicotine acetylcholine receptor partial agonist: Vareniciline
What is the COPD collaborative management goal?
Improve oxygenation: ventilation and diffusion
Bronchodilators (what they do, improvement in prognosis? pt education)
- reduce airway obstruction, improve ventilation
- no improvement in prognosis
- patient ed on deliver method
3 examples of bronchodilators
- beta2-adrenergic —> salmeterol, terbutaline
- anticholinergic/ antimuscarinic agents —> ipatropium
- combination short-acting beta2-adrenergic agonist and anticholinergic agent —>__ol/__opium
Corticosteroids (what they do, do they change prognosis? how long does the treatment last?)
- reduce inflammation, improve ventilation
- no change in prognosis; may reduce exacerbation
- short term treatment for symptom improvement
Example of corticosteroids
-inhaled form (combination): advair (salmeterol/fluticasone), symbicort (for otero/budenoside)
