Flashcards in Tutorial 2: COPD Deck (32)
What are the subtypes of COPD?
emphysema, chronic bronchitis, and chronic obstructive asthma
How does GOLD define COPD?
characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases
What is chronic bronchitis?
chronic productive cough for three months in each of two successive years
(in a patient in whom other causes of chronic cough (eg, bronchiectasis) have been excluded )
What is emphysema?
abnormal and permanent enlargement of the airspaces distal to the terminal bronchioles
accompanied by destruction of the airspace walls, without obvious fibrosis (ie, there is no fibrosis visible to the naked eye)
What is Asthma?
chronic inflammatory disorder of the airways
associated with airway responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing
If a pt with asthma has airway obstruction that is not completely reversible, what disease do they have?
What is asthma-COPD overlap?
"characterized by persistent airflow limitation with several features usually associated with asthma and several features usually associated with COPD"
(consensus statement from international societies on each)
What changes are seen in pulmonary vasculature in COPD pathology?
- intimal hyperplasia and smooth muscle hypertrophy/hyperplasia thought to be due to chronic hypoxic vasoconstriction of the small pulmonary arteries
- loss of capillaries/distal vasculature due to destruction of alveoli
What categories of emphysema are there (pathology)?
Distal acinar (aka paraseptal)
What is the most common association with proximal acinar emphysema?
commonly associated with cigarette smoking, but can also be seen in coal workers’ pneumoconiosis
What changes are seen in proximal acinar emphysema?
abnormal dilation or destruction of the respiratory bronchiole, the central portion of the acinus
What is the most common association with panacinar emphysema?
alpha-1 antitrypsin deficiency
Can also be seen with proximal emphysema in smokers.
What is the most common association with distal acinar emphysema?
When occurring alone: spontaneous pneumothorax in a young adult
What airway abnormalities are seen on pathology in COPD?
- chronic inflammation
- increased numbers of goblet cells
- mucus gland hyperplasia
- narrowing and reduction in the number of small airways
- and airway collapse due to the loss of tethering caused by alveolar wall destruction in emphysema
What is the most important risk factor for COPD?
Below what pack-year threshold is COPD unlikely?
What % of COPD pt never smoked?
Ask about second hand, occupational
What are the 3 cardinal Sx of COPD?
dyspnea, chronic cough, sputum production
What is the most common early Sx of COPD?
What are the three typical ways pt with COPD present?
- sedentary, with fatigue: Hx elicits exertional dyspnea
- resp sx: dyspnea, cough. Insidious worsening of dsypnea and of sputum
- intermittent episodes of cough, purulent sputum, wheezing, fatigue, dyspnea
What is the typical sputum pattern of someone presenting with COPD with sputum production?
- initially, only in morning; may progress to be present through the day
- volume rarely exceeds 60mL
- usually mucoid, but can be purulent during exacerbations
What does finger clubbing indicate in COPD?
Not typical: suggests comorbidities such as lung cancer, interstitial lung disease, or bronchiectasis
What exam findings present in early COPD?
physical examination may be normal, or may show only prolonged expiration or wheezes on forced exhalation.
What exam findings present in progressed COPD?
- hyperinflation (eg, increased resonance to percussion)
- decreased breath sounds
- crackles at the lung bases
- distant heart sounds
What additional exam findings present in severe COPD?
- increased anteroposterior diameter of the chest ("barrel-shaped" chest)
- depressed diaphragm with limited movement based on chest percussion
What additional exam findings present in end-stage COPD?
- positioning to relieve dyspnea
- use of accessory muscles
- expiration through pursed lips
- Hoover's sign
What is Hoover's sign and why does it happen?
paradoxical retraction of the lower interspaces during inspiration
As diaphragm flattens, pulls horizontally --> pulling in ribs (instead of pulling down lungs)
What is the diagnostic test used to diagnose COPD?
postbronchodilator FEV1/FVC < 0.70)
What is the GOLD classification of COPD?
GOLD 1 (Class I): Mild Sx. FEV1 ≥ 80% predicted
GOLD 2 (Class II): Moderate Sx
50% ≤ FEV1 < 80% (of predicted)
GOLD 3 (Class III):
Severe Sx. 30% ≤ FEV1 < 50%
GOLD 4 (Class IV): Very severe Sx. FEV1 < 30% predicted
Mnemonic: For GOLD categories according to the FEV1 %, remember that 30 + 50 = 80.