COPD Flashcards
a permanent abnormal enlargement of the__________ , associated with destructive changes of the________
Emphysema, air spaces distal to the terminal bronchioles, alveolar walls
What are the two major types of emphysema
Panlobular (panacinar), Centrilobular (centriacinar)
Type of emphysema wherein the entire acinus is involved.
(3) There is a significant loss of lung parenchyma.
(4) Alveoli are destroyed.
(5) Bullae are present.
(6) Usually is associated with emphysema resulting from a1-antitrypsin deficiency
Panlobular emphysema
Lesion is in the center of the lobules, which results in enlargement and destruction of the respiratory bronchioles.
Centrilobular
Usually involves the upper lung fields and is most commonly associated with chronic bronchitis.
Centrilobublar
Emphysematous changes are isolated and accompanied by the development of , which are weak air spaces and susceptible to rupture.
Bullous emphysema, bullae
are defined as air spaces adjacent to the pleura, usually less than 1 cm in diameter
in their distended state.
Blebs
are defined as air spaces in their distended state, more than 1 cm in diameter
Bullae
_______ of the lung is diminished, which results in premature airway closure.
__________flow rates are normal, while__________ flow rates are reduced. Air-trapping leads to chronic hyperinflation of the lungs and an_______ FRC.
Elastic recoil, Inspiratory, expiratory, increased
Lung compliance (CL) is\_\_\_\_\_\_\_\_\_\_\_ as a result of the destruction of elastic lung tissue. Emphysema diminishes the area over which gas exchange occurs and is accompanied by regional differences in ventilation and perfusion. This accounts for increased\_\_\_\_\_\_\_ and the abnormal ABG results observed in patients with emphysema
increased, physiologic dead space
Clinical signs and symptoms of emphysema
D,I-Ap, ACM, HG,ABG,DCY,COR
a. Dyspnea: initially occurs on exertion, then progressively worsens.
b. Digital clubbing: results from chronic hypoxemia.
c. Increased anteroposterior (AP) chest diameter
(barrel chest).
d. The use of accessory muscles during normal
breathing.
e. Elevated hemoglobin (Hg) level, hematocrit
(Hct), and red blood cell (RBC) count.
f. ABG levels reveal chronic CO2 retention and
hypoxemia (advanced stages of the disease).
g. Diminished breath sounds and hyper resonance
to percussion.
h. Cyanosis.
i. Right-sided heart failure (cor pulmonale) in
advanced stages.
Cor pulmonale results from an increased________ as it attempts to deliver blood through constricted pulmonary blood vessels. These vessels are constricted (causing pulmonary hypertension) as a result of _______. Chronic pulmonary hypertension results in right ventricular hypertrophy and, eventually, cor pulmonale. Cor pulmonale results in ___________
workload on the right ventricle, arterial hypoxemia and hypercapnia, peripheral edema, such as pedal (ankle) edema, distended neck (jugular) veins, and an enlarged liver.
Characteristics of Chest X-ray of emphysema
F,H,R,B
a. Flattened diaphragm
b. Hyperinflation
c. Reduced vascular markings
d. Bullous lesions
Treatment for emphysema
a. Smoking cessation program
b. Adequate hydration
c. Bronchial hygiene therapy
d. Bronchodilators
(1) Inhaled short-acting beta-adrenergic (SABAs) such as albuterol or levalbuterol
(Xopenex) that are referred to as rescue drugs and are recommended for symptomatic management of all COPD patients
(2) Short-acting anticholinergics such as ipratropium (Atrovent)
(3) Long-acting beta-adrenergic (LABAs) such as salmeterol (Serevent) or long-acting anticholinergics such as tiotropium bromide.
e. Methylxanthines such as theophylline
f. Prevention of infections by immunizations
g. Pulmonary rehab
h. Breathing exercise training
(1) Diaphragmatic breathing exercises
(2) Pursed-lip breathing: prevents premature airway closure by producing a back pressure into the airways on exhalation
chronic excessive mucus production, resulting from an increase in the number and size of mucus glands and goblet cells. Symptoms are cough and increased mucus production for at least__________ years. Males are most commonly affected.
Chronic Bronchitis, 3 months of the year for more than 2 consecutive
Pathophysiology
a. Increase in the______
b. Increase in the ______
c. Inflammation of _______
d. Mucus plugs in _____
e. Loss of cilia
f. ______ changes in advanced stages of the disease
g. Narrowing airways, leading to airflow limitation
size of mucus glands, number of goblet cells, bronchial walls, peripheral airways, Emphysematous
Clinical signs and symptoms a. Cough with\_\_\_\_\_\_ b. Dyspnea on\_\_\_\_\_ progresses to dyspnea with less effort.\_\_\_\_\_\_\_\_ in advanced stages d. Increased \_\_\_\_\_\_\_ (PVR) in advanced stages e. Increased \_\_\_\_\_\_ count in advanced stages f. Cor pulmonale in advanced stages g. Breath sounds: \_\_\_\_\_\_
sputum production, exertion, CO2 retention and hypoxemia, pulmonary vascular resistance, Hb level, Hct, and RBC, coarse crackles and wheeze
Characteristics of Chest x-ray of CB
A. Not significant in early disease
b. Hyperinflation (in advanced stages)
Abnormal, irreversible dilation of the bronchi caused by destructive and inflammatory changes in the walls of the airway
Bronchiectasis
Causes of Bronchiectasis
- Chronic respiratory infections
- TB lesion
- Secondary to cystic fibrosis
- Bronchial obstruction
- It is not clear whether the chronic dilation is a result of destructive changes in the bronchial walls caused by inflammation and infection or, possibly, a congenital defect of the airways.
- Bronchial obstruction may render the__________ ineffective, which may lead to an accumulation of thick secretions.
- The bronchial wall is destroyed, which results in atrophy of the _______
- Because of the decreased values in both flows and volumes, this disease may be either obstructive or restrictive in nature
the mucociliary transport system, mucosal layer
Clinical Signs and Symptoms
1. Productive cough with large amounts of _________. Often, a layering of the sputum occurs.
thick, purulent secretions that may be foul-smelling
2. Tachypnea and tachycardia.
3. Hemoptysis.
4. Recurrent pulmonary infections.
5. Digital clubbing.
6. Cyanosis.
7. Respiratory alkalosis with hypoxemia (in the early stage).
8. Chronic respiratory acidosis with hypoxemia (in
the late stage).
9. Barrel chest
Characteristics of Chest X-ray of bronchiectasis
- Increased lung markings
- Flattened diaphragm
- Segmental atelectasis
treatment for bronchiectasis
- Bronchial hygiene therapy
- Aerosol therapy
- Bronchodilator therapy
- Mucolytics (e.g., acetylcysteine [Mucomyst],
dornase alfa [Pulmozyme]) - Antibiotics: inhaled, oral, and/or IV
- O2 therapy
- Expectorant: such as guaifenesin (Humibid)
_______disease that characterized by persistent respiratory symptoms and airflow limitations that is due to airway and/ alveolar abnormalities usually caused by significant exposure to noxious particle or gases.
COPD, Common, preventable and treatable
It is made in the liver and one of its functions is to protect the lungs from_____, an enzyme that can breakdown connective tissue.
Alpha-1 antitrypsin, neutrophil elastase
What are the risk for developing COPD
Genes, Age, Exposure to particles
Common cause of COPD
cigarette smoking, alpha-1 antitrypsin deficiency, outdoor air pollution, long-standing asthma, biomass, and occupational exposure
It is the most commonly encountered risk factor for COPD
Cigarette smoking
Type of exposure that involves organic and inorganic dust and chemical agents and fumes
occupational exposure
Type of exposure wherein air pollution from biomass cooking and eating in poorly ventilated areas
Indoor air pollution
Disease that weakens the connective tissue of the body, especially the tendons and ligaments
Ehlers- Danlos syndrome
Inherited disorders that support anchor organs and other structures in the body. Affects the eyes, blood vessels and skeleton
Marfan syndrome
is a disorder of connective tissue, which is the tissue that provides structure and strength to the muscles, joints, organs, and skin.
Cutis laxa
is a disorder that affects copper levels in the body. It is characterized by sparse, kinky hair; failure to gain weight and grow at the expected rate (failure to thrive); and deterioration of the nervous system
Menkes syndrome
Signs and symptoms of what disease include intellectual disability and developmental delay, seizures, problems with movement and balance (ataxia), abnormal tensing of the muscles (spasticity), and involuntary slow, sinuous movements of the limbs (athetosis).
Salla
What are the common symptoms of COPD
Cough phlegm production Wheezing SOB, typically on exertion Dyspnea
Goals in managing patients with COPD
Establish the diagnosis of COPD
Optimize lung infection
Maximize the patient’s ability to perform daily activities
Simplify the medical treatment program ASAP
Avoid exacerbation of COPD
Prolong survival
Other term for “blue bloaters”
CB or Type B chronic obstructive pulmonary disease
Unlike emphysema, the pulmonary capillaries in the patient with CB respond to the increase in airway obstruction by decreasing __________ and increasing _______
ventilation, cardiac output
The chronic hypoventilation and increase in cardiac output lead to decreased _______, an increased _______, and _________.
arterial oxygen level, arterial CO2 level, compensated pH level or chronic ventilatory failure arterial blood gas values
The persistent low v/q ratio and depressed respiratory drive both continue to a _______ level and ________ that in turn causes cyanosis.
chronically reduced arterial oxygenation, polycythemia
the normal amount of alpha-1 antitrypsin is
150-350 mg/dl or 1.5-3.5g/l
What method determines a good range of alpha-1 antitrypsin
radial immunodiffusion
Inflammation of blood vessels and low complement protein
hypocomplementemic urticarial vasculitis
Bloater means what
overweight because of edema
Disease characterized by high level of RBC
polycythemia
Major pathologic or structural change that are associated with CB
- Chronic inflammation and thickening of the walls of the peripheral airways
- Excessive mucus production and accumulation
- Partial/ total mucus plugging of the airways
- Smooth muscle constriction of bronchial airways
- Air trapping and hyperinflation of alveoli may occur in late stages
Chest findings in CB
- low tactile vocal fremitus
- hyper resonance
- diminish breath sounds
- crackles, rhonchi, wheezes and use of accessory muscles
It is an abnormal weakening and enlargement of all the alveoli distal to the terminal bronchioles, including the respiratory bronchioles, alveolar ducts, alveolar sacs, and entire alveoli. It is also the most severe type of emphysema.
panacinar/panlobular emphysema
What is the main cause of panlobular emphysema
alpha-1 antitrypsin deficiency
The pathology involves the respiratory bronchioles in the proximal portion of the acinus. The respiratory bronchial walls enlarge, and become confluent and then destroyed.
Centriacinar/centrilobular emphysema
It is the most common form of emphysema
Centriacinar emphysema
What are the two causes of centriacinar
Cigarette smoking and CB
Other term for “pink Puffers”
Emphysema, type A COPD
Other term for “pink Puffers”
Emphysema, type A COPD
meaning of puffing
purse-lip breathing
The term pink puffers is derived from the
reddish complexion
Structures affected in centriacinar emphysema
respiratory bronchioles and upper lobes
Structure affected in panacinar emphysema
respiratory bronchioles, alveolar ducts and sacs and entire alveoli
what type of emphysema often appears anxious, experienced dyspnea and rapid weight loss
Bullous emphysema
Major pathologic or structural changes (emphysema)
- permanent enlargement and destruction of the air spaces distal to terminal bronchioles
- Destruction of the alveolar-capillary membrane
- Weakening of distal airways primarily the respiratory bronchioles
- Air trapping and hyperinflation
4 main organisms (isolated)
Haemophilus influenza
Streptococcus pneumoniae
Staphylococcus aureus
Pseudomonas aeroginosa
CT scan of bronchiectasis
Increase bronchial opacity or end on signet ring opacity
an abnormal large branch of bronchi (alpha-1 chuchu)
Lower left lung scarring or damage (post-tuberculosis)
Three major anatomic patterns of bronchiectasis
Cylindrical (tubular)
Varicose (Fusiform)
Cystic (saccular)
The bronchi are dilated and rigid and have regular outlines similar to a tube.
Cylindrical (tubular)
The bronchi are dilated and constricted in an irregular fashion similar to ________ resulting in distended bulbous chape
Varicose (fusiform)
The bronchi progressively increase in diameter until the end in large cystic-like sacs in the lung parenchyma.
Cystic (saccular)
Major pathologic or structural changes associated with bronchiectasis
- Chronic dilation and distortion of bronchial airways
- Excessive production of often foul-smelling sputum
- Bronchospasm
- hyperinflation of alveoli
- Atelectasis
- Consolidation and parenchymal fibrosis
- Hemoptysis secondary to bronchial arterial erosion
Additional causes of bronchiectasis
Acquired bronchial obstruction congenital anatomic defect Immunodeficiency state Abnormal secretion clearance Miscellaneous disorders
They are the mainstays of bronchiectasis management.
Antibiotic and bronchial hygiene
