Chronic Obstructive Pulmonary Disease Flashcards
Definition of Chronic Obstructive Pulmonary Disease (COPD)?
“A common, *preventable and treatable disease 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 Emphysema?
enlargement of air spaces & destruction of lung tissue
what is Chronic Bronchitis?
obstruction of small airways
What is the Pathophysiology of COPD?
- Inflammation & fibrosis of the bronchial wall
- Hypertrophy of the submucosal glands
- Hypersecretion of mucus
- Loss of elastic lung fibers & alveolar tissue
- Results in airway obstruction, decreased surface area for gas exchange & mismatching of ventilation & perfusion
- Loss of elastic fibers impairs expiratory flow, leads to air trapping, predisposes to alveolar collapse.
What are the Risk Factors for COPD?
- Cigarette smoking – (80%) dose response, measured in pack-years (not everyone who smokes develops COPD and some who don’t smoke develop COPD)
- Airway hyperresponsiveness (bronchial constriction in reaction to exposures)
- Biomass fuel exposure (developing world)
- Second-hand smoke
- Ambient air pollution
- Genetics; alpha-1-anti-trypsin deficiency (1% of all cases) –think of this in young patients (<45)
What is Proximal acinar (centrilobular) emphysema?
- Abnormal dilation or destruction of the respiratory bronchiole
- Commonly associated with cigarette smoking
- Can be seen in coal workers’ pneumoconiosis
What is Panacinar emphysema?
- Enlargement or destruction of all parts of the acinus
- Most commonly associated with alpha-1 antitrypsin deficiency
- Also sometimes found in smokers
What are the Symptoms of COPD?
- Chronic cough
- Sputum production (worse in the morning)
- Exertional dyspnea (fatigue)
- Wheezing
- Chest tightness
- Weight gain (due to limitation of activity)
- Weight loss in advanced disease
What are the Physical Exam Findings of COPD?
- Prolonged expiratory phase
- Expiratory wheezing (during acute exacerbations)
- Barrel chest
- Enlarged lung volumes (poor diaphragmatic excursion)
- Respiratory distress in severe exacerbation; use of accessory muscles, “tripod” position, pursed lips
- Cyanosis
- Systemic wasting/significant weight loss (advanced disease)
- Signs of right heart failure (advanced disease)
How does the COPD get diagnosed?
- History (shortness of breath, cough, wheeze, cig smoking)
- Physical Exam
- Labs (bicarb)
- Chest X-ray (CXR) – rule out other causes of symptoms
- Pulmonary Function Tests (PFTs)
What are the Laboratory tests for COPD?
-Serum bicarbonate (CO2) – identifies chronic hypercapnia in chronic disease
-Alpha-1-antitrypsin (AAT) deficiency (esp ≤ 45 years)
rule out other causes of dyspnea
-Hemoglobin (Hgb)
-Brain Natriuretic Peptide (BNP)
What is the Pulmonary Function Testing (PFTs) for COPD?
- Spirometry
- Measurement of lung volumes
- Quantitation of diffusing capacity
- Measurements forced inspiratory and expiratory flow rates
What is Spirometry testing for COPD?
- Measures forced expiratory volume in one second (FEV1)
- Measures forced vital capacity (FVC)
- Patient takes as deep breath as possible
- Patient is prompted to blast out air into spirometer
- Patient is encouraged to continue exhaling for at least six seconds
What are the Treatments of Acute COPD Exacerbation?
-Oxygen (keep SaO2 >90% but <96%)
-Systemic glucocorticoids
(Prednisone (oral),
Methylprednisolone (Solu-medrol) (intravenous))
-Short acting bronchodilator
(Ipratropium & Albuterol nebulizer (Duoneb))
Albuterol nebulizer
-Antibiotics (if requires hospitalization or infection)
Cover atypical organisms (Levofloxacin,
Azithromycin)
What is the First line treatment for newly diagnosed COPD?
-Short acting bronchodilator (rescue inhaler)
-Short acting beta-agonists (SABA) (Albuterol (ProAir),
Levalbuterol (Xopenex))
-Short acting anticholinergic
(Ipratropium (Atrovent))
-Combination SABA + Ipratropium (Combivent)**most commonly prescribed
