Approaching Patients W/ Obstructive Respiratory Diseases Flashcards
Types of COPD
Emphysema
Chronic bronchitis
sometimes asthma and bronchietasis, but these are more acute
What labs/tests do you want to get for acute cases of pulmonary dysfunction
ABG test
Portable imaging (x-ray/UA)
CBC, CMP
Spirometery
Emphysema
“Pink puffers”
Prolonged damage to the alveolar walls and interstitum
Often older and thinner (but not always)
Causes decreased radial traction of parenchyma
- Airways tend to collapse
- more hypercapneic (more CO2) rather than hypoxemia (low O2)
Signs/symptoms
1) air-trapping
- barrel chested and usually has prolonged expiration times w/ breathing
2) dyspnea
- acute/mild = exertional only
- chronic/severe = at rest and exertional
* is prolonged in supine position and Usually takes time to show up*
3) coughing
- may or may NOT be present
4) flattened of the diaphragm w/ increased lung fields on imagining
5) increased TLC and decreased DLCO (decreased perfusion)
Physical exam findings of emphysema
Wheezing
- almost always present
Diminished or distant breath sounds
Prolonged Expiratory phase
- (1:2 inspiratory/Expiratory phase time)
Coarse crackles in lungs
- may or may not be bilateral and usually in upper areas of lungs
- sign of infection most often
Tripod positioning
- arms are forward when breathing with body leaning over
Possible weight loss
Pursed-lip positioning
decreased fremitus (when saying 99, less resonance felt upon palpation of back)
2 types of emphysema
1) centriacinar (centrilobular)
- most common form
- associated with heavy smoking
- upper lung zones have most destruction
- “blebs” are often present in upper lungs (imaging)
2) Panacinar (panlobular)
- associated with alpha-1 antitrypsin deficiency
- lower lung zones have most destruction
- “blebs” are often present in lower lungs (imaging)
Chronic bronchitis
“Blue bloaters”
more hypoxemia (low O2) rather than hypercapneic (high CO2)
Often overweight (but not always)
Signs/symptoms
1) chronic persistent cough
- often present w/ mucus/phlegm especially in the morning
- if persistent coughing is lasting at least 3 months/year for 2 years, then chronic bronchitis is diagnostically 100%
2) hypoxia/cyanosis is more prevalent
- especially prevent in appendages
3) elevated hemoglobin
- due to increased hematopoiesis and erythropoietin due to hypoxemia
4) ronchi and wheezing are present
5) increased or normal TLC w/out decreases in DLCO (normal)
Diagnosis and severity of COPD is determined by what PFT values?
Diagnosis = FEV1/FVC
- if it is <70%, COPD is clinically diagnostic
Severity = FEV1
- based on % (less than 80%)
Gold stage and severity specific values
Both are used to categorize how bad COPD is currently
GOLD 1/mild = FEV1/FVC <0.7 and FEV1 >80%
GOLD 2/moderate = FEV1/FVC <0.7 and FEV1 50%-80%
GOLD 3/severe = FEV1/FVE <0.7 and FEV1 30%-50%
GOLD 4 /Very severe = FEV1/FVE <0.7 and FEV1 <30%
Pharmacological Treatments for COPD
1) usually start with SABA (short acting beta agonist)
- usually albuterol
2) then go to LAMA (long acting muscarinic antagonist)
3) inhaled corticosteroids are next if 1/2 dont work
* note none of these affect mortality! Only oxygen affects this(increases long-term mortality) *
Non-pharm treatment of COPD
Smoking cessation
Oxygen treatments
Flu vaccinations
Pulmonary rehabilitations
Non-invasive positive pressure ventilation (NPPV)
- end stage only
Surgery
- end stage only