Chronic obstructive pulmonary disease Flashcards
definitions of COPD SUBGROup ?
chronic bronchitis - excessive tracheobronchial mucus production
which causes productive cough for 3 months in a year for more than 2 consecutive years
pulmonary emphysema - permanent distention of the alveoli and destruction of the alveolar septal distal to the terminal bronchiole
what is the etiology of copd ?
smoking
air pollution indoor and outdoor - sulphur oxide and nitrous oxide
occupation - organic and inorganic dust and chemical agents = chronic bronchitis
emphysema - alpha 1 antitrypsin deficiny
what is the pathology of COPD ?
CB
over production of mucus
metaplastic goblet cells - in the large bronchi
epithelium in the small bronchi - normal ciliates columnar epithelium transforms into goblet cells
smoking causes squamous metaplasia
emphysema - over extension and destruction of the pulmonary acini
central acinar affecting emphysema
panacinar emphysema (all of the acne affected due to hereditary alpha 1 anttrypsin deficicny)
paraseptal - peripheral ducts involving
irregular emphysema – extensive scarring
difference in inflammation between asthma and copd
asthma - sensitising agent
air way inflammation - CD4 and t lymphocyte mediates
eosinophils
completely reversible
COPD noxious agent - airway inflammation CD8 - t lymphocytes macrophages neutrophils IRREVERSIBLE - once copd developed cannot be cured
clinical symptoms of copd ?
productive cough - wit sputum = chronic bronchitis
emphysema is non cyanotic
progressive dyspnea
wheezing and tightness of chest
systemic features - cachexia = emphysema overweight and eriheral edema = chronic bronchitis depression osteoporosis
physical examinations of copd ?
central cyanosis
barrel shaped chest = emphysema
respiratory rate more than 20 breaths per minutes
paradoxical flattening of hemidapgarm - with inspiration
pursed lip breathing - slow expiratory flow and moreeffieicnt lung emptying
= emphysema
resting muscle activation - use of the scalene , sternocleidomastoid
right sided heart failure signs
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PALPITATION AND PERCUSION
hype resonant chest sound
wheezing with quiet breathing
inspiratory crackles
difficult to locate the heart apex beat and seen at the xiploid area
diastolic gallop and holosystolic murmur with neck vein distention and ankle edema - presence of right sided heart failure
exacerbations in copd caused by ?
bacterial ,- mostly homophiles influenza
strep pneumonia
viral infection
pollutants
diagnosis of copd ?
spirometry in every thing FEV1/FVC <0.7
mild - stage 1
FEV1 percentage of predicted value
80 PERCENT or more
moderate - stage 2
FEV1 of predicted value
< or equal to 50- < 80 percent
stage 3 severe
FEV1 of predicted value
< or equate to 30 percent - <50 percent
stage 4 - very severe
FEV1 of predicted value
FEV1 less than 30 percent
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put into combined copd
patient group A
severity stage 1 / 2
one or less exacerbation with no hopitilisation
symptoms are mild
mMRC dyspnea scale <2
CAT score <10
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B
severity the same as A
exacerbations the same as A
symptoms severe
mercy dyspnea scale 2 or more
CAT score >10
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C
severity stage 3 /4
2 or more exacerbations per year
1 or more leading to hospitalisation
symptoms , MMRC and CAT - similar to A
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D
severity and exacerbations similar to C
symptoms MMRC and CAT similar to that of B
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bronchodilator reversibility test
chest x ray - hyperinflation and hyper lucency , flattening of diaphragm , increase retrosternal space volume horizontal ribs
arterial blood gas measurement
emphysema - pa02 reduced
cb - markedly reduced
pac02 - normal in in emphysema
chronic bronchitis - early hypercapnia
what is the management of copd ?
no treatmnet is successful without cessation of smoking
STEP DOWN used in asthma not applicable in copd
since COPD is stable and often progressive
patient group A - short acting anti cholinergic drugs
or SABA
seance line : long acting anticholinergic drug (LAMA) or LABA
patient group B
long acting anticholingerc drugs (lama)
LABA
patient group C
inhaled corticosteroids and LAMA
or
LABA
seance - LAMA and LABA
patient group D
inhaled corticosteroids + LAMA or LABA
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antibiotics in exacerbations - empiric tetracycline , ampicillin and quinines 7-10 days
anti oxidants - n acetylcystsient
mucolytics - ambroxol
long term oxygen therapy in stage 4
bullectomy - for bullous emphysema
or lung volume reduction surgery - due to hyperinflation
examples of SABA
SAMA
LABA
LAMA
ICS
saba - salbutamol
laba - salmeterol
SAMA - ipratropium bromide
LAMA - tiotropium bromide
ICS - budesonide
