Chronic Obstructive Pulmonary Disease Flashcards
T or F:
COPD is largely preventable.
T
Description of COPD:
5
- Serious and prevalent
- Life threatening with complications
- Progressive
- Chronic, widespread
- Acute, recurrent
What conditions are included in COPD?
- Chronic bronchitis
- Emphysema
Can COPD co-exist with asthma?
Yerp
What are the Et/risks for COPD?
- Smoking (80-90%)
- Aging
- recurrent respiratory infcts
- Genetic deficiency of alpha 1 anti-trypsin
Why is smoking a risk actor for COPD?
5
The irritants in cigarette smoke have several damaging effects:
- They increase mucus secretion -> too much can
obstruct
- Damages cilia
- Causes coughing, damaging if persistent
- Inflm -> tissue damage
- Damage to the walls of capillaries and alveoli
Why is aging a risk factor for COPD?
Because as the elastic tissue in the lungs degenerates with age, their ability to recoil is impeded
What is compliance? How does this relate to COPD?
This refers to the ease with which the lungs are filled and emptied. In COPD, the compliance of the lungs is decreased.
What is chronic bronchitis?
Chronic inflm and obstruction of an airway.
For bronchitis to be considered chronic, how long must the productive cough be present?
For >3 consecutive months in 2 consecutive years
Where does chronic bronchitis generally take place?
In large airways
- eg trachea, bronchi
What causes obstruction in the airways during chronic bronchitis?
- Hypersecretion of mucus
- Hypertrophy of submucosal glands
- Protective at first but will result in obstruction
Eventually, bronchitis will reach the small airways. What will happen here?
(4)
There will be an increase in goblet cells and mucus, causing obstruction. There will also be inflm and fibrosis.
T or F:
Chronic bronchitis is not an infct.
T
Overview of the patho of chronic bronchitis:
Increased mucus secretion -> compromised mucociliary defenses -> infct -> airways become inflmed -> obstruction and airway collapse -> air gets trapped in parts of the lung -> decreased alveolar ventilation
What is the average L/min for ventilation in the lungs?
~4.2 L/min
What is the average L/min for perfusion in the lungs?
~5.5 L/min
What is the ventilation:perfusion ration?
~0.8
If your ventilation:perfusion ratio is less than 0.8, are you at risk for?
Hypoxemia, which will lead to hypoxia
What is the major problem happening in emphysema?
The walls of the alveoli and capillaries are damaged
- loss of compliance
- Stretched out airways
What is the Et of emphysema?
- Smoking
- Genetic deficiency of alpha 1 anti-trypsin (~1%)
What is the role of a1 anti-trypsin? How does this relate to emphysema?
To regulate proteases. This opposes the action of trypsin, which is to breakdown proteins. If there is a deficiency of a1 anti-trypsin, the levels of trypsin increase and can cause major damage to functional cells.
How does smoking contribute to emphysema?
- Inhibits a1 anti-trypsin = unregulated enzymes
- Attracts inflm cells = increased amount of trypsin =
more structural damage
Patho of emphysema:
Proteases destroy alveolar walls -> alveoli merge -> decreased surface area -> less area for diffusion/gas exchange
What happens as a result of air becoming trapped between alveoli?
This increases dead space -> more effort is required to breathe (accessory muscle must be used)
Perfusion is impeded by:
The destruction of the capillaries by trypsin
What are “blebs”?
Small pockets of dead space filled with air, pushes against the pleura.
What are “bullae”?
A large pocket of dead space filled with air, pushes against the pleura.
Initially, the mnfts for COPD are_______.
Insidious
Mnfts of COPD:
- Dyspnea
- Initially only on exertion
- As COPD progresses, with rest as well
- Cough
- Activity intolerance
- Impeded gas exchange, decreases ATP production
- Extremely increased amount of sputum
- Wheezing and crackles
- Impaired respiratory Fx
- Hypoxemia and hypercapnia
- Barrel chest (emphysema)
Upon viewing your pneumonia patient’s chest xray, what abnormal results will you see?
- Buildup of fluid
- Consolidation
What is an example of a pulmonary fx test that might be run to Dx a COPD patient?
A spirometry test.
What changes must be made to limit the progression of COPD?
- Overall healthy lifestyle (diet, activity, etc.)
- Absolutely NO smoking
- Avoid respiratory irritants
COPD Tx:
What is a short acting beta adrenergic agonist?
- A med that will bind to the receptors that adrenaline normally would
- Causes bronchodilation by relaxing smooth muscle
COPD Tx:
What is an anticholinergic?
- Opposes the normal action of adrenaline at receptors
- Causes bronchodilation
COPD Tx:
After treating COPD with short acting drugs, what are 3 other drugs you would consider giving?
- Inhaled steroids, O2
- Inhaled long acting beta agonists
- Theophylline
What is theophylline?
- 2 forms: short and long acting
- Potent bronchodilator
- Anti-inflm
Which vaccines should be given to patients with a Hx of COPD?
Trick question: all of them!
But in this situation: flu and pneumococcal vaccine
