COPD Flashcards
COPD
chronic obstructive pulmonary disease >limitation of airflow through lungs *preventable and treatable *not fully reversible >progressive >pulmonary inflammatory response to noxious particles or gases >eventually systemic symptoms develop
COPD II
chronic bronchitis *upper airway problem emphysema *lower alveolar destruction These conditions co-exist *goal: maintain oxygenation and tissue perfusion
Incidence and prevalence of COPD:
> 12.1 million americans have COPD >18ys old
4th leading cause mortality in U.S. more common in men
women with COPD on rise
highest incidence in white amercians
more than 50% die within 10 years of diagnosis
predicted to become 3rd leading cause of death worldwide by 2020
primary cause-cigarette smoking
Pathophysiology of COPD:
> primary disease process is chronic inflammation
*airways, pulmonary blood vessels, lung parenchyma
inhalation of noxious particles (how disease starts): releases inflammatory cells, increased mucus production, damage and repeated healing, and remodeling and fibrosis
Most common characteristics of COPD:
inability to expire air (hyper airflow of the lungs), airway obstruction leads to progressive air trapping, and residual air+loss of elastic recoil = hyperinflation (barrel chest)*
other common characteristics of COPD:
> gas exchange abnormalities
*alveolar destruction (blebs and bullae), hypoxemia, hypercapnia
mucus hypersecretion and cilia dysfunction
loss of elastic recoil
pulmonary vascular changes
*pulmonary hypertension
*cor pulmonale
Cor pulmonale:
enlargement of the right side of the heart
Pathophysiology: Vascular changes
> pulmonary vascular changes
*blood vessels thicken
*surface area for diffusion of O2 decreases
*hypoxemia at rest=late stage
*may need supplemental O2 earlier with exercise
Cor pulmonale - right sided hypertrophy of pulmonary artery>leads to right sided heart failure
COPD: Chronic bronchitis
> presence of chronic productive cough for 3 or more months in each of 2 successive years when other causes of chronic cough are excluded
bronchi and bronchioles affected
irritants cause:
*inflammation, congestion, bronchospasm, mucosal edema
smaller airways affected first
Chronic bronchitis: Pathophysiology
> inflammation and scarring of bronchiole lining
*decreased airflow, excessive mucous accumulation, cough develops, and ciliary function decreases
bacteria multiply causing infection
COPD: Emphysema
> abnormal permanent enlargement of the air space distal to the terminal bronchioles (alveoli)
10 % of pts with COPD have pure emphysema
*most have mix of chromic bronchitis and emphysema
COPD vs Asthma
High level of proteases
alveoli destroyed: bullae formed
*loss of elastic recoil
*alveoli overstretching
*bronchioles collapse
loss of lung elasticity with lung hyperinflation
results: increased work of breathing, decreased area for gas exchange, air trapping in lungs
Risk factors: COPD
cigarette smoking, occupational risks, air pollution, infection, genetics, and aging
Cigarette smoking:
>smoking causes destruction of alveolar walls *smoke causes hyperplasia of cells *increased mucus production *reduces airway diameter >smoke reduces ciliary action >smoke releases proteases in lungs: *breaks down elastin in found in alveoli
COPD: Cigarette smoking
> clinically significant airway obstruction develops in about 15% of smokers
passive smoking also contributes to respiratory problems (SHS)
COPD: occupation and environment:
> COPD can develop with intense or prolonged exposure to:
- environmental tobacco smoke
- occupational dusts, vapors, irritants, or fumes
- high levels of air pollution
- fumes from indoor heating or cooking with fossil fuel
