Module 3 EB COPD Flashcards
essentials of dx for COPD (4)
- hx of cigarette smoking
- chronic cough, dyspnea, sputum production
- rhonchi, decreased intensity of breath sounds and prolonged expiration on physical exam
- airflow limitation on PFT that is not fully reversible and most often progressive
COPD and asthma are the ________ (#) leading cause of death in the US
4th
how to prevent COPD?
elimination of exposure to tobacco
what is COPD associated with?
-significant concomitant chronic disease –> increases MORTALITY AND MORBIDITY (cardiovascular dx, skeletal muscle dysfunction, metabolic syndrome, osteoporosis, depression, anxiety, lung CA)
-actively tx appropriately to decrease mortality/hospital admits
COPD
-definition (characterized by)
-presence of airflow obstruction due to chronic bronchitis or emphysema, may be accompanied by airway hyper-reactivity and may be partially reversible
COPD
-predisposing factors
***cigarette smoking is the most important cause of COPD - nearly all smokers suffer an accelerated decline in lung fx that is dose and duration dependent
-80% caused by smokers
-20% caused by combinations of tobacco environmental smoke, occupational dusts, and chemicals, indoor air pollution from biomass fuel, cooking oil, outdoor infection, alpha 1, allergy and atopy
late-stage COPD complications
-pulmonary HTN
-cor pulmonale
-chronic respiratory railure
how to gauge sx severity/how to guide tx choices for COPD
mMRC = breathlessness
CAT = health status of patient
S/S COPD
-what patients should we consider dx COPD
-goals of assessment
-excessive cough, sputum production and chronic/progressive dyspnea (sx often present for 10 yrs) and/or hx of exposure to risk factors for disease (smoking)
-determine level of airflow limitation, impact of disease on patient’s health status, and risk of future events (exacerbations, hospital admits, or death) –> helps guide therapy
when is dyspnea usually noted during a COPD exam?
noted on heavy exertion but progresses to mild exertion
dyspnea at rest = SEVERE DISEASE
what two patterns emerge with COPD progression?
pink puffers-emphysema predominant” or blue bloaters-chronic bronchitis predominant
Pink puffers-emphysema
-type of COPD
-major complaint
-abnormal lab values
-pulmonary fx tests
-Type A of COPD; emphysema predominant
-dysnpea, often severe, usually presenting after age 50; cough is rare, with scant clear, mucoid sputum. pts are thin, with recent wt loss common; appear uncomfortable with evident use of accessory muscles of respiration. chest is very quiet w/o adventitious sounds; no peripheral edema
-chest radiograph shows hyperinflation with flattened diaphragms; vascular markings are diminished, particularly at apices
-airflow obstruction ubiquitous. total lung capacity increased, sometimes markedly so; DLCO (single-breath diffusing capacity for CO) reduced. static lung compliance increased
blue bloaters-chronic bronchitis predominant
-type of COPD
-hx and physical examination
-abnormal laboratory studies
-pulmonary fx tests
-type B (bronchitis predominant)
-chronic cough, productive of mucopurulent sputum, with frequent exacerbations due to chest infections; often presents in late 30s and 40s. dyspnea is usually mild, though patients may not limitations to exercise. pts frequently overweight and cyanotic but seem comfortable at rest. peripheral edema is common. chest is noisy, with rhonchi invariably present; wheezes common
-Chest radiograph shows increased interstitial markings (“dirty lungs”), especially at bases. diaphragms are not flattened
-airflow obstruction ubiquitous. Total lung capacity generally normal but slightly increased. Single-breath diffusing capacity for CO (DLCO) normal; static lung compliance normal
hallmark of COPD
periodic exacerbations of sx beyond normal day variation often including:
increased dyspnea
increased frequency or severity of cough
increased sputum volume
change in sputum character
***exacerbations commonly precipitated by infection
chronic bronchitis
-def
-clinical dx definite as excessive secretions of bronchial mucus with a daily cough for 3 months or more for at least 2 consecutive years
-excessive bronchial secretions and daily productive cough for >3 months
-Blue bloater (chronic bronchitis): overweight due to activity intolerance, elevated hemoglobin, peripheral edema due to R heart failure, rhonchi and wheezing, chronic and productive cough, PaCO2 is elevated
