COPD

Question 1

What is COPD

Answer 1

Chronic obstructive pulmonary disorder is a group of conditions causing chronic or recurrent obstruction of airways

1) chronic bronchitis
2) emphysema
3) asthma (child) / restrictive airway disease (adult)

Question 2

What is the main cause of COPD

Answer 2

Most common cause is smoking

Smoking leading the the two most common forms

1) chronic bronchitis
2) emphysema

Question 3

What causes COPD develop

Answer 3

Result from long term exposure to lung irritants that damage the lungs and airways

This can include jobs that deal with:

• silica
• fabric fibers
• sawdust
• cigarettes
• and other irritants (mines, farming)

Question 4

What genetic condition can cause COPD

Answer 4

Alpha 1 antitrypsin deficiency

• is a protein that protects the lungs, in this cause it can’t reach or doesn’t fit the receptors

Can cause COPD in people who don’t smoke

Question 5

Acute bronchitis

Answer 5

• acute inflammation AND infection!

- sputum yellow/green (pus/dead WBC)

Question 6

Chronic bronchitis

Answer 6

• chronically inflamed and irritated lung tissue
• is NOT a infection
• pleura tissue swelling
• bronchi restriction
• mass cells secrete fluid to “soothe” tissue that is inflamed but it turns into sputum (white/ clear and thick!!)
• damage to the lungs does not go away, last forever

Question 7

How to define chronic bronchitis

Answer 7

Presence of inflammation causing a productive cough that last for 3 months or more, per year for at least 2 years

Question 8

When is chronic bronchitis the worst

Answer 8

• changing from summer to fall
• changing from winter to spring
• causes COPD exacerbation
• weather dependent

Question 9

Characteristics of chronic bronchitis

Answer 9

• Smoking history
• Age of onset 30-40
• Shortness of breathe (can’t take on as much air, this is a early symptom)
• Rhonchi (deep/low pitched)
• Sputum early manifestation ( White/Clear)
• Cyanosis
• Hypercapnia (CO2)
• Hypoxemia may be present ( ⬇️ O2 in blood)
• Frequent cor pulmonale (Lungs harden/ don’t breathe in and out)

Question 10

Complication From fluid production in chronic bronchitis

Answer 10

Patient is more likely to develop infection in airway due to it being warm and moist ( Respiratory Infection)

• the bacteria grow in the fluid not the lung tissue so use inhaled drugs to treat

Question 11

Where does mucus come from in the lungs

Answer 11

Secreted by the goblet cells found in the surface epithelium as well as seromucous glands found in the connective tissue layers

Question 12

Treatment for COPD

Answer 12

• Has no cure but can be managed
• Smoking cessation is most important step an individual can take
• Other non pharmacological treatment may include pulmonary rehabilitation and home oxygen therapy

Question 13

How to get Home oxygen therapy

Answer 13

“Oxygen Challenge”

1) Take O2 status w/o O2
2) Take O2 off, walk in hall til O2 drops below 88%

They will then qualify for home oxygen and insurance will cover

Question 14

Home oxygen therapy types

Answer 14

1) Regular green oxygen- compressed oxygen, only hold so much air
2) Oxygen concentrator- takes air from environment, need one for home and travel, needs battery or electrical source to work

Question 15

Preventing exacerbations

Answer 15

1) Avoid lung irritants
- cleaning supplies
- pollen/ dust
- smoke

2) Avoid extreme changes in weather
- cold constrict airway and can’t dilate
* wear scarf or something over face to warm air before it goes in/ run to warm car
- heat stay dilated and can’t constrict

3) follow up with MD regularly & report symptoms of inflammation/ infection early
4) Manage the disease by taking medications as prescribed

Question 16

What is Emphysema

Answer 16

Permanent enlargement of the alveoli that result in entrapment of air in the lungs

• not as much informations as chronic bronchitis
• alveoli lose elasticity— should force air out but w/o elasticity it had hard time forcing all the air out (retain/trapped air) alveoli enlarge causing barrel chest

Question 17

Air trapping in emphysema

Answer 17

Because air is trapped in the lungs they become hyper inflated
This leads to poor oxygen exchanges as well as structural changes in the chest (Barrel Chest)

Question 18

Characteristics of Pulmonary Emphysema

Answer 18

• Smoking History
• 40-50
• Barrel Chest
• Weight loss
  • Metabolism sky rocket due to using so much energy to breathe
  • can’t tolerate being off o2 long enough to eat
• Decreased breathe sounds
• Normal blood gases until late in disease
  • bc they compensate til late in disease
• Cor pulmonale only in advance cases (right sided heart failure)
• slowly debilitating disease

Question 19

Clubbing of fingers and toes

Answer 19

Caused by any oxygen problems but most emphysema

Lack of oxygen so perfusion can’t oxygenate tissues

Irreversible

Years of low o2– end stage of disease

Question 20

Treat COPD with

Answer 20

Bronchodilators and steroids

• short/ long acting bronchodilators

Question 21

Treat emphysema with

Answer 21

Give bronchodilators

Teach breathing w/ pirced lips

Question 22

Chronic bronchitis management

Answer 22

• Symptoms slowly worsen over time and may exacerbate at any time
• Respiratory infections such as the flu, pneumonia may cause symptoms to exacerbate
  • get flu and pneumonia vaccine !!
  • can’t afford to get these if they have bronchitis or emphysema
• Prescription antibiotics are used to treat infections while bronchodilators and inhaled steroid are used to decrease inflammation and open airway for better gas exchange

Question 23

Nutrition for chronic bronchitis and emphysema

Answer 23

Most people with severe COPD are too short of breathe to eat
• weight loss
• Cachexia - “wasting” need feeding tube

• Eat small, frequent meal with nutrient dense foods
  • add stuff to food to increase calories
• Rest before meals
• Eat food that don’t require a lot of chewing
  • takes too much energy
  • shakes are good
• Avoid use of straws
  • save energy
• Take daily multivitamin
• Narrational supplement
  • Boost/ Ensure
  • May develop iatrogenic diabetes due to steroids and boost has a lot of sugar

Question 24

Oxygen for chronic bronchitis and emphysema

Answer 24

• Many have low partial pressure if oxygen in blood
• treatment w/ oxygen may improve oxygen for some patients while in others I can lead to adverse effects of elevating the carbon dioxide content in the blood
• Recommend that oxygen not exceed 2L/min to prevent Hypercapnia (retaining co2 bc they can’t breathe it out)
  • may experience drowsiness, respiratory acidosis and death
  • when co2 increase, decrease brain response to breath as much! They have to breathe out the co2!!

Question 25

Breathing drive

Answer 25

Trigger by the need to get ride of co2 in normal people

In COPD they have a breathing drive to get o2

Question 26

Bronchodilators

Answer 26

Relax and open airway for increase airflow in and out with respiration

• dilate before your Medicate !!!

Question 27

Short acting bronchodilators

Abuterol

Answer 27

Open airway before treating with other inhaled medications

This makes other medications more effective bc they distribute to lung tissue better once bronchodilation happens

• rescue - teach to use for relief it acute breathing problems or prior to prevent compromised of respiration

Question 28

Long acting bronchodilators

Salmeterol

Answer 28

Take same time everyday

Increase dilate all day or all night

Will not help with acute attack

Question 29

Corticosteroids inhaler

Beclamethasone

Answer 29

Used to decrease local inflammation in the airway

Must perform mouth care to prevent fungal infections

Oral steroids may also be used however these will cause more systemic side effects ( iatrogenic diabetes, weight gain, sleep wake cycle distribution)