COPD Flashcards
Definition and classification
It is a chronic irreversible generalized airways obstruction characterized by chronic obstructive bronchitis, abnormalities in small airways, and emphysema.
Pathogenesis.
Permanent hyperactivity of parasympathetic nervous system with hyperproduction of acetylcholine, bronchial spasm and hypersecretion of mucus
•Insufficiency of adrenal receptors in bronchial walls as the result of deep morphological changes with bronchial hypersecretion, bronchial spasm and cough
•Bronchial hyperreactivity which is characterized by immune inflammation of bronchioles walls
All that lead to:
•1) narrowing of bronchioles;
•2) development of emphysema
CLASSIFICATION
І, mild FEVІ ≥80% , FEVІ/FVC < 70% - As a rule chronic cough with sputum
II, moderate < FEVІ < 80% - FEVІ/FVC < 70% - Symptoms are more significant, presence of dyspnea during physical activity and exacerbation
III, severe FEVІ < 50% FEVІ/FVC < 70% - Symptoms cause worsening of life quality
IV, very severe FEVІ < 30% FEVІ/FVC < 70% and CR
Symptoms, criteria, diagnosis and treatment
Anamnesis and complaints
Severe smoking
•Occupational diseases
•Family anamnesis
•Chronic cough is the earliest sign of COPD and arise earlier then dyspnea
•Sputum – as a rool in small amount, after cough
•Dyspnea – persistent, progressive, becomes worse during physical activity and in severe cases – even if patient is calm
Physical findings
Central cyanosis, emphysematous chest, additional breathing muscles are necessary for breathing
•Increasing of breathing rate, decreasing of its deepness, prolongation of expiration
•Percussion: decreasing of heart dullness
•Auscultation: wheezing, dry rales, heart tones are dull
Lab findings
Bullae are seen occasionally with COPD. Large bullae are generally well seen on ordinary x-rays,
radiographs of a patient with chronic obstructive pulmonary disease
(COPD) reveal pulmonary hyperinflation. In the PA projection above
are at the level of the eleventh posterior ribs and appear flat.
bronchograms may reveal cylindrical dilation of bronchi on inspiration bronchial collapse on forced expiration, and enlarged mucous ducts Prank: saccular bronchiectasis is unusual and generally occurs only in patients who have had a previous severe respiratory infection.
1: DIAGNOSTIC CRITERIA FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE:
1. Complaints of shortness of breath, chronic productive or non-productive cough.
2. Long history of smoking, exposure to smoke or other lung irritants. Genetic predisposition such as alpha-1 antitrypsin deficiency.
3. Chest X-Ray with hyperinflation of lungs, flat hemi-diaphragms, large central pulmonary arteries.
4. Emphysema on CT of chest
5. SPIROMETRY(gold standard for diagnosis):
a. FEV-1 <80% predicted
b. FEV-1/FVC < 70%
C. Post-bronchodilator FEV-1 < 12% increase.
Treatment of copd
1) Inhaled bronchodilators:
Beta-agonists( relax bronchial smooth muscle):
a) Short-acting:- Salbutamol 100 MDI inhaler
b) Long-acting:- Salmeterol 25-50 MDI
Anticholinergics
c) Short-acting: Ipratriopium bromide 20, 40 MDI
d) Long-acting: Tiotropium 18 DPI
Short act. Beta-agonists + anticholinergic in one inhaler
2) Inhaled glucocorticosteroids: Budesonide (100, 200, 400)
3) Long-acting beta-agonists + glucocorticoids
4) Systemic glucocorticoids: Prednisone 5-60mg (pill) 5) O2 therapy
6) Smoking cessation, vaccinations
7) supportive care
