5C: OLD Flashcards
What does the obstruction of air flow result in?
Impairments of mechanical function (primarily reduce FEV1) and gas exchange
According to GOLD, what should the FEV1/FVC ratio be?
> .75
What is GOLD Stage 1?
Mild - FEV1 is 80% or greater than predicted
What is GOLD Stage 2?
Moderate - FEV1 between 50-80% of predicted
What is GOLD Stage 3?
Severe - FEV1 between 30-50% of predicted
What is GOLD Stage 4?
Very severe - FEV1 < 30% of predicted
What are the two types of COPD?
Emphysema and bronchitis
What is a pack year?
pack year = ppd x yrs
What does smoking inhibit with Emphysema that leads to destruction of alveolar walls?
Alpha 1-antitrypsin
Why are WBC’s released with emphysema COPD and what is the effect?
To try and get rid of smoking vapor particles, but they end up destroying the alveolar walls because of the lack of alpha 1-antitrypsin
What is the result of early airways closure with COPD?
Overinflation of the alveoli that causes air to get trapped and ventilation/perfusion mismatch
What are permanent effects of COPD?
Enlargement of alveoli, loss of elastic recoil of alveoli, lungs, and thoracic cage
What is the result of overinflation of the alveoli?
Increased RV and increased compliance of the lungs and increased resting size
What happens to rib orientation over time with COPD?
Barrel chested - Increased A-P diameter, and diaphragm flattens
What can happen if hypoxemia persists in a COPD patient?
Pulmonary HTN
In advanced cases, what can the change in diaphragm position result in?
Paradoxial breathing
What are some common symptoms of COPD?
SOB, DOE, orthopnea, wheezing, decreased breath sounds, increased RR, chronic cough, malaise, weight loss
What are observable signs of COPD?
Digital clubbing, peripheral cyanosis, barrel chest, elbow roughness from UE support
What happens to accessory muscles with COPD?
Hypertrophy
What happens to FEV1 with COPD?
Decreases
What is bronchitis?
Productive cough for 3+ more months for at least 2 years
Why is there excess mucous secretions with bronchitis?
Hyperplasia at goblet cells and mucous glands
What happens at the lungs secondary to decreased ventilation?
Vasoconstriction
What can cause a patient with Bronchitis to appear bloated?
Vasoconstriction leads to increased pulmonary pressures and ultimately R sided CHF
What are the four key symptoms of bronchitis?
- Productive cough
- Bloated
- Peripheral cyanosis
- SOB
What is CF and the four effects?
Genetic condition that causes
1. Increased mucous production
2. Thick secretions that block airways
3. Chronic inflammation
4. High susceptibility to infection
What does hyperinflation with CF result in?
Decreased gas exchange and hypoxemia
What are the 5 signs of CF?
- Hyperinflation on x-ray
- Increased RR
- Rales and wheezes
- Productive cough and thick secretions
- Decreased endurance
What is the definition of Asthma?
Reversible OLD characterized by inflammation and increased reactivity of smooth airway muscles to stimuli
What is the response to stimuli with asthma?
Chronic inflammation and then bronchospasm and bronchoconstriction related to the stimuli
What are the four types of asthma?
- Extrinsic
- Intrinsic
- Exercise induced
- Occupational
What is extrinsic asthma?
Reaction to allergens
What is intrinsic asthma?
Unknown, but triggered by pulmonary infections
What is exercise induced asthma?
Related to increased RR demand, airway temp and humidity
What is occupational asthma?
Similar to extrinsic, but directly items at place of work
What is Bronchiectasis?
Progressive with permanent airway damage that is similar to emphysema
What is the specific cause of Bronchiectasis?
Chronic inflammation after pulmonary infection
What conditions can then lead to Bronchiectasis?
- CF - half of all cases
- RA
- Sinusitis
What is the Stage 1 of Bronchiectasis?
Chronic infection
What is Stage 2 of Bronchiectasis?
Chronic inflammatory response to infection
What is Stage 3 of Bronchiectasis?
Impaired immune defense and decreased mucociliary ability
What is Stage 4 of Bronchiectasis?
Permanent dilation of airways
What are 4 signs of Bronchiectasis?
- Persistent cough with large amounts of sputum
- Dyspnea
- Some chest pain
- Fatigue, weight loss, decreased endurance
