COPD Flashcards
What is COPD
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)
What is the main cause of COPD
Most common cause is smoking
Smoking leading the the two most common forms
1) chronic bronchitis
2) emphysema
What causes COPD develop
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)
What genetic condition can cause COPD
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
Acute bronchitis
- acute inflammation AND infection!
- sputum yellow/green (pus/dead WBC)
Chronic bronchitis
- 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
How to define chronic bronchitis
Presence of inflammation causing a productive cough that last for 3 months or more, per year for at least 2 years
When is chronic bronchitis the worst
- changing from summer to fall
- changing from winter to spring
- causes COPD exacerbation
- weather dependent
Characteristics of chronic bronchitis
- 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)
Complication From fluid production in chronic bronchitis
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
Where does mucus come from in the lungs
Secreted by the goblet cells found in the surface epithelium as well as seromucous glands found in the connective tissue layers
Treatment for COPD
- 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
How to get Home oxygen therapy
“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
Home oxygen therapy types
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
Preventing exacerbations
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
What is Emphysema
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
Air trapping in emphysema
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)
Characteristics of Pulmonary Emphysema
- 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
Clubbing of fingers and toes
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
Treat COPD with
Bronchodilators and steroids
- short/ long acting bronchodilators
Treat emphysema with
Give bronchodilators
Teach breathing w/ pirced lips
Chronic bronchitis management
- 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
Nutrition for chronic bronchitis and emphysema
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
Oxygen for chronic bronchitis and emphysema
- 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!!
Breathing drive
Trigger by the need to get ride of co2 in normal people
In COPD they have a breathing drive to get o2
Bronchodilators
Relax and open airway for increase airflow in and out with respiration
- dilate before your Medicate !!!
Short acting bronchodilators
Abuterol
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
Long acting bronchodilators
Salmeterol
Take same time everyday
Increase dilate all day or all night
Will not help with acute attack
Corticosteroids inhaler
Beclamethasone
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)
