COPD very brief

Question 1

Definition: COPD

Answer 1

COPD is an umbrella term, which is mainly associated with Emphysema and Chronic bronchitis. It is chronic progressive and irreversible characterised by blocked airflow and breathing difficulty.

Question 2

Definition: Chronic bronchitis

Answer 2

is an inflammation of the lining of the bronchial tubes (trachea, bronchi, terminal bronchioles)

Question 3

Definition: Emphysema

Answer 3

a destruction of the alveolar walls (creating bullae) and loss of lung elasticity resulting in a permanent enlargement of the alveoli

Question 4

Damage to the lungs from COPD can’t be reversed, but treatment can help

Answer 4

control symptoms and minimize further damage

Question 5

Assessment techniques: COPD

Answer 5

• Percussion
• Auscultation
• Sputum
• X-ray
• Spirometry

Question 6

PN (percission note): COPD

Answer 6

hyperresonant

[if atelectasis (consolidation) = dull]

Question 7

Breath sounds: COPD

Answer 7

decreased … due to decreased air entry; excess aei in the lung filters sound

Question 8

Added sounds: COPD

Answer 8

Crackles +/- Wheezes

Question 9

Vocal resonance: COPD

Answer 9

normal or decreased

Question 10

Sputum: COPD

Answer 10

white

Question 11

X-ray: COPD

Answer 11

• Hyperinflation (horizontal ribs)
• Black (air)
• Low flat diaphragm
• Narrow heart … air compresses
• ring shadows (= air filled bullae)

Question 12

Spirometry: COPD

Answer 12

- FEV1/FVC ratio < 70% & FEV1 as below
>80% mild COPD
50-79% moderate, 
30-49% severe
<30% very severe
(GOLD COPD)

Question 13

Treatment: COPD

Answer 13

SOB => Breathing control, Positioning (forward leaning)

Sputum => ACBT

Question 14

why forward leaning position?

Answer 14

facilitates the abdominal contents to raise the anterior part of the diaphragm

Question 15

TEE (thoracic expantion exercise)

Answer 15

• Collateral ventilation

- Interdependence

Question 16

Colateral ventilation

Answer 16

assists removal of secretions … air gets behind the secretions

Question 17

Interdependence

Answer 17

increase lung volume … adjacent alveoli may assist in re-expansion of the lung tissues

Question 18

BC (breathing control)

Answer 18

“diaphragmatic breathing” … shifting the WOB away from the rib cage and accessory muscles (relaxation of shoulder girdle and upper chest)

Question 19

In the obstructed lung, respiration ends prematurely, thus increasing ___ and ___.

Answer 19

RV (Residual Volume), FRC (Functional Residual Capacity)

Question 20

In the restricted lung, volumes are small because inspiration is limited due to ______ compliance.

Answer 20

reduced

Question 21

In the restricted lung, the FVC is ____than normal, but the FEV1 is relatively _____ in comparison.

Answer 21

smaller , large
It is easy to breathe out quickly, because of the high elastic recoil of the stiff lungs (reduced compliance). (e.g fibrosis)
As a result, the FEV1/FVC ratio can be higher than normal, for example 90% (FEV1/FVC ratio >80% = Restrictive)
http://www.medicine.mcgill.ca/physio/vlab/resp/lungdiseases_n.htm

Question 22

In the obstructed lung, the FVC is _____ than normal, but also that FEV1 is much ______ than normal.

Answer 22

smaller, smaller
It is very difficult to exhale quickly due to the increase in airway resistance. (eg. asthma, COPD)
As a result, the FEV1/FVC ratio will be much lower than normal, for example 40% (FEV1/FVC ratio < 70% = Obstructive)
http://www.medicine.mcgill.ca/physio/vlab/resp/lungdiseases_n.htm

Question 23

During quiet breathing, expiration is passively driven by the elastic recoil of the lungs in healthy individuals, so in px with Emphysema (elastic recoil lost), forced or active expiration occurs as well as occurring during exercise. which muscle are used for that?

Answer 23

-abdominal muscles
-internal and innermost intercostal muscles “Back pocket” [pulls the rib cage down]
help expel air.
(External intercostal = “Front pocket” elevate the ribs, assist in deep inspiration by increasing the anterioposterior diameter of the chest)
(Accessory muscles are typically used during inspiration when the body needs to process energy quickly; when a breathing pattern disorder exists.)

Question 24

Definition: Bronchiectasis

Answer 24

an abnormal irreversible destruction and dilation of one or more bronchi, which has vicious cycle of infection and inflammation
(conducting zone: trachea, bronchi, terminal bronchioles), (damage to the bronchial wall = damage/ destroyed cilia => secretions accumulates => bacteria colonise)

Question 25

Progression of Bronchiectasis

Answer 25

- Hypoxaemia (in severe cases) - Recurrent Pneumonia - Cor pulmonale (is enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance or high blood pressure in the lungs)

Question 26

Pathophysiology: Bronchiecctasis

Answer 26

Due to the damaged airway walls, mucociliary escalator becomes damaged or destroyed, leading to pool mucus in pockets of dilated airways (bronchioles) [Inflammation also increases secretions (mucus)]. As a result, bacteria begins to colonise, and resulting in repeated infection and inflammation (daily risk of infection).

Question 27

Definition: Cystic fibrosis

Answer 27

an inherited autosomal recessive single gene defect, which is chronic progressive and irreversible. (defect for CF lies on chromosome 7 - the CFTR gene) (an extra copy of chromosome 21 = Down syndrome)

Question 28

In NZ, approximately __ in __ Caucasians will be a abnormal CFTR gene "carrier". More than ____ children and adults in NZ with CF. If both parents carry the gene, each children born has a ___ in ___ chance of inheriting the condition.

Answer 28

1 in 25, 500, 1 in 4

Question 29

Pathophysiology: Cystic fibrosis

Answer 29

The defective CFTR protein affects the chloride, sodium and water movement across the epithelium, causing abnormally thick mucus secretion, resulting in impaired mucociliary clearance. It encourages bacteria to colonise leading to infection. These factors increase resistnace to ventilation, resulting in impaired gas exchange; therefore, the body increases RR to increase minute ventilation causing SOB.

Question 30

Definition: Pneumonia

Answer 30

an acute infection of the alveoli due to a viraety of bacteria, virus or fungi, and can occur as a secondary complication of surgery or mechanical ventilation.

Question 31

Pneumonia is usually classified into two types

Answer 31

- Community acquired pneumonia | - Hospital acquired pneumonia ... hospitalised for more than 2 days in the last 90 days

Question 32

Typical pneumonia (there is also Atypical)

Answer 32

acute onset with fever (>38), chills and a productive cough | dry cough, fever, sore throat and headache

Question 33

Categorisation of pneumonia from the "site" - Lobar pneumonia - Bronchopneumonia

Answer 33

- affects one or more lobes of the lung caused by Steptococcus pneumonia (80%); younger adults - acute inflammation of the walls of the bronchioles; infants, young children, elderly

Question 34

Risk factors: Pneumonia

Answer 34

Environment factors: exposure to cigarette smoke, lack immunisation, poor nutrition, poor housing, over-crowding, reduced access to primary health care Underlying conditions: Chronic lung disease (CF, Asthma, Bronchiectasis), Chronic health condition (diabetes, heart failure, cancer), Age (75), HIV, reduced rate of breast feeding

Question 35

Epidemiology: pneumonia is the leading cause of death in children worldwide killing ___ million children a year. Those less than __ yrs or over __ yrs have the highest rates of mortality. NZ has high rates, and ____ times more prevalent in Maori than non-Maori.

Answer 35

1.1 million, 6yrs, 75yrs, 3 times

Question 36

Pathophysiology: Pneumonia

Answer 36

as a consequence of infectious pathogens, an inflammatory response occurs resulting in proliferation of neutrophils which damages lung tissue, and can lead to pulmonary oedema and fibrosis as well as reduced lung expansion. This inflammatory response can lead to pleural effusion, which can result in lobar collapse or emphyma. Therefore px with pneumonia, gas exchange is reduced, resulting in increase of RR and HR , which may lead to hypoxaemia.

Question 37

Progression: Pneumonia Uncomplicated pneumonia usually shows improvement within __ - __ hrs of antibiotic treatment and continue to improve over time. The antibiotics must be continued for the full course of __ days

Answer 37

24 - 48hrs, 7 days

Question 38

PT management: Pneumonia

Answer 38

- Optimise V/Q (to prevent hypoxaemia) - Secretion clearance if present - Mobility assessment

Question 39

Chronic Hypoxaemia leads to

Answer 39

1. Polycythaemia (incr RBC = thick blood => try to give more O2) 2. Pulmonary hypertension 3. Right ventricular hypertrophy 4. Cor pulmonale (right sided heart failure form long term pulmonary hypertension) 5. Systemic congestion

Question 40

Antibiotics: first line antibiotic for Pneumonia

Answer 40

Amoxicillin 500mg - 1g three times daily for 7 days

Question 41

Pathophysiology: Chronic bronchitis

Answer 41

Mainly due to the toxin from Tabaco, the airways are inflamed, and causing hypertrophy and hyperplasia of the mucus gland; hyper secretion of mucus; dysfunctional cilia, resulting in impaired mucociliary clearance. These factors increase resistance to ventilation, which leads to air flow obstruction, and resulting in impaired gas exchange. Therefore the body increases respiratory rate to increase minute ventilation causing SOB. It also causes cough that is productive and chronic, as the body attempts to open and clear the airways of particles and mucus or over reaction to ongoing inflammation (cough assists in sputum clearance).

Question 42

Pathophysiology: Emphysema

Answer 42

Mainly due to the long term exposure to toxin from Tabaco, inflammation becomes chronic and causes thickening and destruction of the alveolar walls, which leads to form bullae, resulting in a reduction in surface area available for gas exchange. Moreover, the alveolar walls lose its elasticity and surfactant, leading to floppy air ways, and air becomes trapped in these spaces of damaged lung tissues. As a result, the lungs slowly enlarge and breathing requires more effort as there is no elastic recoil. Hence, due to hyperinflation body increases respiratory rate to increase minute ventilation causing SOB.

Question 43

Pathophysiology: asthma

Answer 43

Asthma attack can be triggered by multiple factors, such as dust, animal hair, pollen, grass, mold, exercise, cold air, stress, and certain cells lining the airways release multiple inflammatory mediators (histamine, nitric oxide). Then the inflammation in the airways cause bronchospasm, vascular congestion, excessive mucus production, thickening of air way walls, which increase resistance to ventilation, leading to air flow obstruction, resulting in impaired gas exchange. Therefore, on exertion the body increases respiratory rate to increase minute ventilation resulting in SOB.

Question 44

Epidemiology: COPD

Answer 44

- more common in men (who smoke/ exposed to inhaled polution) - 14% of NZers >40yrs have COPD

Question 45

Epidemiology: Bronchiectasis

Answer 45

- 3.7/ 100, 000 children per year in NZ - 1 in 3000 children in NZ gets bronchiectasis - 80% are Maori or Pacific Islanders

Question 46

Epidemiology: CF

Answer 46

- >500 children and adults in NZ | - 1 in 25 caucasians will be a "carrier" in NZ