28- COPD Flashcards
orthopnea
Dyspnea which occurs when lying flat, forcing the person to have to sleep propped up in bed or sitting in a chair. It is commonly measured according to the number of pillows needed to prop the patient up to enable breathing
Paroxysmal nocturnal dyspnea (PND)
Sudden, severe shortness of breath at night that awakens a person from sleep, often with coughing and wheezing
associated with CHF- after several hours of sleep
acute vs chronic bronchitis timing
acute: 1-3 weeks
chronic: productive cough for at least three months for the past two years
most likely Differential of Shortness of Breath in Middle-Aged Man Who Smokes
acute bronchitis
asthma
COPD
lung cancer
Classic Findings on Physical Exam for COPD
Increased anteroposterior (AP) diameter of the chest
Decreased diaphragmatic excursion
Wheezing (often end-expiratory)
Prolonged expiratory phase
laryngeal height with COPD
decreased- less than 4 cm
gold standard for diagnosing COPD
Pulmonary function testing (PFT)
FEV1/FVC ratio less than the 5th percentile, or less than 70%
stress echocardiogram (C) can confirm
cardiac ischemia
tests to confirm PE
pulmonary angiogram and chest CT
percentages of severity of COPD
mild >80%
moderate: 50-79
severe 30-49
very severe <30%
COPD vs asthma
COPD: irreversible (rather than reversible)
mid life (rather than early life onset)
slowly progress (rather than vary)
during exertion (as opposed to night, or early morn)
smoking influence
not related to allergies, rhinits, eczema
immuno cells with asthma
Mast cells, T helper cells, and eosinophils
immuno cells with COPD
Macrophages, T killer cells, and neutrophils
is FVC increased, decreased, or same in asthma and COPD
same or decreased in COPD
decreased in asthma
when do COPD symptoms begin?
moderate COPD
Therapy for Mild Symptomatic COPD
albuterol prn, or other bronchodilators (LABAs, SABAs, inahled anticholintergics, oral methylxanthines)
when is prednisone given in COPD?
acute exacerbation
will lung function improve after 1 year of smoking cessation?
yes!
how is reversibility defined in spirometry
defined as an increase in FEV1 ≥ 12% after bronchodilator treatment,
therapy for moderate COPD
inhaled anticholinergics (ipratroprium or tiotroprium) alone or in combination with short-acting beta agonists may be utilized.
therapy for severe COPD
inhaled glucocorticosteroids be added to bronchodilator treatment (LABA)
COPD exacerbation presentation
Difficulty catching his or her breath Chest tightness Fever Increased coughing or A change in the cough (more productive, more mucus expelled)
A patient should seek emergency medical care if the usual medications are not working and he or she find
It is unusually hard to walk or talk (such as difficulty completing a sentence)
The heart is beating very fast or irregularly
Lips or fingernails are gray or blue, or
Breathing is fast and hard, even when medication is being used
Antibiotics should be given to:
Patients with exacerbations of COPD with the following three cardinal symptoms: increased dyspnea, increased sputum volume, and increased sputum purulence
Patients with exacerbations of COPD with two of the cardinal symptoms, if increased purulence of sputum is one of the two symptoms
Patients with a severe exacerbation of COPD that requires mechanical ventilation (invasive or noninvasive).
how does COPD cause heart failure
- chronic hypoxia
- pulmonary vasoconstriction
- increases blood pressure in the pulmonary vessels.
- permanent damage to the vessel walls and leads to irreversible hypertension
- Right HF -pump cant resist pressure
- leads to an increase in preload: peripheral edema and increased jugular venous distention.
management of resp acidosis
mechanical ventilation
