copd Flashcards
systemic consequences of copd progression
cardiac and skeletal muscle dysfunction, osteoporosis, depression, and anemia.
COPD is a major cause of morbidity and mortality and a significant cause of disability worldwide
copd classifies to:
Chronic bronchitis
characterized by chronic cough for at least 3 months for 2 consecutive years with inflammation and fibrosis of the small airways
Emphysema
characterized by alveolar wall destruction and airspace enlargement resulting in loss of gas-exchange surface area.
genetic factor in development of emphysema
The best documented genetic factor is a rare hereditary deficiency of α1-antitrypsin (Antiproteinase)
Severe deficiency of this enzyme results in premature and accelerated development of emphysema.
Difference in inflammatory reaction
asthma and copd cells and mediators
Asthma
* Eosinophils and mast cells
* IL-1, IL-8, and TNF-α.
COPD
* Neutrophils, macrophages, and CD8+ T lymphocytes
* proteinases such as elastase and proteinase-3.
protinease and antiprotinease imbalance
Increase: proteinase: lung prenchyma –> loss elasticity and remodling –>narrow
Decrease: antiprotinease( inhibit trypsin, elastase enzymes which cause destruction to lungs)
pathalogical changes due to obstruction aiflow
- pulmonary hyperinflation
- pulmonary HTN
- mucus hypersecretion
- ciliary dysfunction
- airflow limitation
- gas exchange abnormal
Emphysema
Permanent enlargement of the airway distal to the terminal bronchiole with destruction of alveolar walls.
Both airway and blood vessels destroyed
PaO2 is low and paCO2 is normal
Pink color, muscle wasting and weight loss, better prognosis
sign and symtpoms of copd
- chronic cough for 3 mnths
- Chronic Sputum Production
3: dyspnea on rest and exertion and othopenea
4: of heaviness in the chest.
5: use of accessory muscles for respiration
Clinical Presentation and Diagnosis
1: pursed lips
2: barrel chest
3: lung auscultation
4: hypoxemia cynosis and tachycardia
5: corpulmonale : second heart sound, jugular venous distention (JVD), lower extremity edema, and hepatomegaly.
d
chronic bronchitis
Productive cough on most days for 3 months, for 2 consecutive years
Mucus hyper-secretion,
Loss of ventilation due to obstruction by mucus
paCO2 is high
Bluish face and lips, obese, poor prognosis
GOLD guidelines for diagnosis of copd
- perform spirometry
- cough
- dyspnea, worsning, persistant
- cough with suptum
- History of exposure to risk factors, especially tobacco smoke.
* Spirometry revealing an FEV1/FVC less than 70% of predicted is the hallmark of COPD.
GOLD grade
Classification
Spirometry Results fev1
- I mild ≥ 80
- II moderate 50-79%
- III severe 30% -49%
- IV very severe <30% predicted or FEV1 <50% predicted plus chronic respiratory failure
difference between asthma and copd
age:Asthma < 40 copd >40
smoking: asthma not cause copd,(>10 pack-years).
sputum: infrequent copd often
allergies: asthma often copd infreqent.
course: asthma stable, copd progressive
spirometery: ashtma normla copd not normalixe
hyperactivity: ashtma
corticosteroid response: asthma
brnchodialtor response: asthma
Smoking Cessation
critical part of any COPD treatment plan because
- it slows the rate of decline in pulmonary function
- It reduces cough & sputum production
- It decreases airways reactivity
Smoking cessation is the only intervention that has been shown to reduce mortality in COPD
5A and 5R
- ask
- advice
- assess
- assist
- arrange
- Relevance
- Risks
- Rewards
- Roadblocks
- Repetition