Chronic Obstructive Pulmonary Disease. Flashcards
Essentials of Diagnosis:
- is a common respiratory condition characterized by airflow limitation that is not reversible.
- The term refers to a clinical syndrome of chronic respiratory symptoms. Subtypes include emphysema, chronic bronchitis, and chronic obstructive asthma.
- Appropriate management can decrease symptoms (especially dyspnea), reduce the frequency and severity of exacerbations, improve health status, improve exercise capacity, and prolong survival.
Chronic Obstructive Pulmonary Disease.
General Considerations:
- The chronic airflow limitation that characterizes is caused by a mixture of small airways disease and parenchymal destruction.
- Chronic inflammation causes structural changes, small airways narrowing, and destruction of lung parenchyma.
- Loss of small airways may contribute to airflow limitation and mucociliary dysfunction, a characteristic feature of the disease.
- A hallmark is the acute exacerbation of symptoms beyond day to day variation including increased dyspnea, increased frequency or severity of cough, increased sputum volume or character.
- Cigarette smoking is by far the most important cause of this disease in North America
Chronic Obstructive Pulmonary Disease.
Physical examination: Dx
Emphysema
* “Pink Puffer” Emphysema predominant
* Major complaint is dyspnea
* Usually presents after age 50
* Cough is rare, may have scant thin clear sputum
* Patients are thin
* Uncomfortable appearing with accessory muscle use
* Chest is quiet without adventitious lung sounds
* Severe emphysema will have decreased intensity of breath and heart sounds
* Barrel Chest or flattened diaphram
Emphysema
Physical examination:
Chronic bronchitis - “Blue Bloater” Bronchitis predominant. Defined as a chronic productive cough for three months in each of two successive years in a patient in whom other causes of chronic cough (e.g., bronchiectasis) have been excluded.
* Major complaint is productive chronic cough with mucopurulent sputum
* Frequent exacerbations due to chest infections
* Often present in their 30’s and 40’s
* Mild dyspnea
* Rhonchi invariably present, wheezes are common
Chronic bronchitis
Physical examination:
All physical findings are generally present only with severe chest disease.
Emphysema
* “Pink Puffer” Emphysema predominant
* Major complaint is dyspnea
* Usually presents after age 50
* Cough is rare, may have scant thin clear sputum
* Patients are thin
* Uncomfortable appearing with accessory muscle use
* Chest is quiet without adventitious lung sounds
* Severe emphysema will have decreased intensity of breath and heart sounds
Chronic bronchitis - “Blue Bloater” Bronchitis predominant. Defined as a chronic productive cough for three months in each of two successive years in a patient in whom other causes of chronic cough (e.g., bronchiectasis) have been excluded.
* Major complaint is productive chronic cough with mucopurulent sputum
* Frequent exacerbations due to chest infections
* Often present in their 30’s and 40’s
* Mild dyspnea
* Rhonchi invariably present, wheezes are common
Other:
* Unusual positions to relieve dyspnea at rest
* Digital clubbing is NOT typical
Chronic Obstructive Pulmonary Disease.
Labs/Imaging:
PFT’s (airflow obstruction ubiquitous in all PFT’s)
Spirometry
* Spirometry is the essential test to confirm the diagnosis
Peak expiratory flow rate (also know as peak flow, use the peak flow meter to measure)
Chronic Obstructive Pulmonary Disease.
Chronic Obstructive Pulmonary Disease: Consult
- Measured with a peak flow meter
- Used to objectively measure how obstructed the patient is and used to measure improvement after therapy
- Normal values are based on sex, age, and height
- The lower the number the more obstructed they are due to Asthma or COPD exacerbation.
Peak expiratory flow rate (peak flow)
Lab:
Arterial blood gas obtained during acute exacerbations at higher level of care
Chronic Obstructive Pulmonary Disease
Imaging:
Chest radiography (CXR)
* Frequently obtained to exclude other lung diseases
* Chronic Bronchitis shows only nonspecific peribronchial and perivascular markings (dirty lungs)
* May show hyperinflation and flattening of the diaphragm in half the cases of emphysema
CT Scan
* More sensitive and specific than CXR for diagnosis
Chronic Obstructive Pulmonary Disease
Differential Diagnosis:
- Asthma
- Bronchiectasis
- Cystic Fibrosis
- Bronchopulmonary Mycosis
Chronic Obstructive Pulmonary Disease
Treatment:
is guided by the severity of symptoms or the exacerbation of stable symptoms.
Oxygen Therapy- Supplemental O2 for patients with resting hypoxemia (Pa02 <56 mmHg) is the only therapy with evidence of improvement in the natural history of COPD
Lifestyle modifications:
* Stop smoking
* Elimination of exposure to products of combustion.
* Vaccination
* Patient Education: use of inhaler
* Nutrition and Self-Management
Medications:
Inhaled Bronchodilators
* Albuterol: Short Acting Beta Antagonist
* Salmeterol (Serevent) Long Acting Beta Antagonist
Corticosteroids
* Fluticasone (Flovent) Inhaled Glucocorticoids
Adverse Effects: Glucocorticoids
-Cardiovascular: Hypertension, subarachnoid hemorrhage
-Central nervous system: Fatigue, headache, malaise, pain, procedural pain, voice disorder
-Dermatologic: Pruritus, skin rash.
- Prednisone - is an oral systemic corticosteroid
Chronic Obstructive Pulmonary Disease
Dx:
Prognosis
* Outlook is poor for patients with significant disease.\
Disposition
* If patient is stable, not in any acute distress, with normal vital signs and you suspect COPD in a patient with no previous COPD diagnosis then this patient will need consult with MO, referral for PFT’s, and pulmonology referral.
* If patient is unstable, experiencing an acute exacerbation, has any acute distress or has any concerning abnormal vital signs, discuss with MO and MEDEVAC.
* Your next step in treatment of an exacerbation is if there is SOB, dyspnea or a lot of wheezing will be adding Oral Steroids to the Albuterol (such as prednisone).
Chronic Obstructive Pulmonary Disease
