COPD Flashcards
COPD is?
chronic, inflammatory response a/w pollutants
preventable, treatable
Inflammation in lungs results in? (2)
1) Small airway disease:
airway inflamm and remodeling
2) Parenchymal destrutction:
loss of alveolar attachments and recoil
Emphysema-caused COPD characteristics?
"Pink Puffer" Maintains adequate O2 for longer time Pursed lip breathing, Pink skin color, Thin body
Chronic Bronchitis-caused COPD characteristics?
“Blue Bloater”
Hypoxemia/respiratory acidosis (C)
Cor pulmonale (enlarged R heart from pulm HTN)
Overweight
Chronic Bronchitis definition?
Chronic, productive cough
Lasting 3 mo during 2 yrs
With no other cause
Chronic Bronchitis structural Δs? (3)
Mucous gland hyperplasia ->
excess mucus and narrowed bronchioles
Bronchial squamous metaplasia (non-squ replaced w/ squamous cells)
Lost ciliary transport
(Less parenchymal damage than emphysema)
Chronic Bronchitis structural Δs results from?
Inflamm of submucosa of bronch wall by neutrophils
Chronic bacterial inf/hyper-active reaction
Chronic Bronchitis causes what type of obstruction?
Results in?
inspiratory and expiratory
hypoxemia and hypercarbia
Emphysema definition?
Pathological enlargement of air spaces DISTAL to terminal bronchs
Due to destruction of alveolar walls
Emphysema destructive process?
(P) > elastase or < antitrypsin
Emphysema structural Δs?
↓ alveolar SA available for gas exchange
↓ recoil -> limits airflow
↓ alveolar support structure -> airway narrowing
Destruction of capillary beds -> ↓ CO2 diffusion capacity
Emphysema causes what type of obstruction?
Results in?
exhalation
hypercarbia
Emphysemia vs. Chronic Bronch sxs:
Onset
Dyspnea
Cough
Sputum Production
Sputum Appearance
Onset: E = > 50, B = 30s-40s
Dyspnea:
E = progressive, constant, severe
B = intermitt, mild-mod
Cough:
E = absent -mild
B = persistent, severe
Sputum Production:
E = absent - mild
B = persistent, severe
Sputum Appearance:
E = clear, mucoid
B = mucopurulent
COPD presentation?
(U) 50s/60s
Dyspnea OE -> DAR
Chronic cough (U) a.m.
Sputum
Asthma definition?
Chronic inflamm of AIRWAYS
(U) eosinophils
Hyper-reactive airway -> ↑ secretion, mucosal edema, C of bronch sm mm
Reversible
COPD risk factors?
Smoking (80%) Pollution 2nd hand smoke Airway hyper-response Genetic RF (⍺1 anti-trypsin deficiency)
Cigarette smoke mechanism of destruction? (2)
stims elastase -> degenerated elastin/alveolar structures
releases cytotoxic oxyrads from WBC
⍺1 Antitrypsin Deficiency (AATD)?
AAT is protease inhibitor
w/o AAT elastase/proteases destroy lung tissue
smoking accelerates destruction
COPD physical exam, look for?
Mouth
Neck
Chest
Lungs
Percussion
Heart
Abdomen
Ext
Mouth: tobacco staining
Neck: masses, JVD
Chest: ↑ AP diameter, accessory mm use, breathing rate/effort, central cyanosis
Lungs: ↓ breath sounds, rhonchi, wheeze, crackles; prolonged exhale, purse-lip breathing
Percussion: hyper-resonance
Heart: (P) gallop, RV lift, PMI
Abdomen: (P) hepatomegaly, tender
Ext: cyanosis, clubbing, mm wasting, tobacco stain fingers, peripheral edema
COPD diagnositcs:
CBC
ABG
EKG
Sputum
CBC = (U) normal, (P) late polycythemia
ABG (Arterial blood gases) = hypoxemia, hypercarbia
EKG = sinus tachy, peaked P, R axis deviation, RVH
Sputum = gram stain, culture
CXR findings:
Emphysema
Chronic Bronch
Emphysema = hyperinflation w/ (P) bullae,
flat diaph,
enlarged retrosternal air space
Chronic Bronch = cardiac enlargement,
pulmonary congestion,
↑ lung markings
CXR vs CT for COPD?
CT = higher resolution but not necessary for routine
PFT (plumonary fxn tests):
FVC
FEV1
FEV1/FVC
HALLMARK of dz
FVC (forced vital capacity) =
amount forcefully exhaled after max inspiration,
(U) N w/ COPD,
↓ w/ restrictive
FEV1 (forced exp vol in 1 sec) =
(N is >80% of predicted value)
↓ w/ obstructive
FEV1/FVC =
(N is 70-80%)
↓ w/ N FVC is obstructive
Stage I: Mild COPD characteristics?
FEV1/FVC =80% w/ or w/o sxs
Stage II: Mod COPD characteristics?
FEV1/FVC < FEV1 < 80%
DOE w/ or w/o cough/sputum
Stage III: Severe COPD characteristics?
FEV1/FVC < FEV1 < 50%
↑ dysp, ↓ exercise capacity, fatigue, repeat exacerbation
Stage IV: Severe COPD characteristics?
FEV1/FVC < 30%
or <50% w/ respiratory failure
Steps to evaluating Obstructive Dz?
1st: Obstructive pattern? (FEV1/FVC < 70%)
2nd: Severity/Stage? (FEV1 post bronchodilator)
FEV1 % predicted?
FEV1 ↑ >12% (if yes = asthma)
3rd: Sxs/Exacerb? (mMRC or CAT)
0-1 or >2 exacer/ >=1 hospitalization
mMRC Scale?
0 = breathless only w/ strenuous exercise
1 = SOB hurrying on level ground, or walking up slight hill
2 = walk slower on level ground, or stop for breath if walk at regular pace
3 = stop for breath 100 yds or few minutes on level ground
4 = too breathless to leave house or breathless when dressing
Smoking Cess 5-A approach?
Ask abt tobacco Advise to quit Assess willingness Assist w/ quitting Arrange support f/u
Bronchodilators for COPD?
β2-agonists and anticholingergics
Inhaled (site specific vs systemic): hydrofluoroalkane
Helps by bronchdil, ↑ ciliary mvmt, ↑ diaph action, ↑ cardiac contract
Φ effect on secretions
β2-agonists help COPD how?
Helps by bronchdil,
↑ ciliary mvmt,
↑ diaph action,
↑ cardiac contract
Φ effect on secretions
β2-agonists: short acting?
β2-agonists: long acting?
albuterol
salmeterol
formoterol
Anticholinergics help COPD how?
bronchodia
↓ air trapping
less cardiac stim
Anticholinergics: short acting?
Anticholinergics: long acting?
ipratropium bromide
tiotropium bromide
Corticosteriods help COPD how?
Inhaled for maintenance
↓ mucosal edema/inflamm
inhibit prostaglandins
↑ response to βs
Theophylline (Methylxanthine) common toxicities?
tachycard, arrhy, seizures
don’t use anymore
PDE-4 Inhibitor helps COPD how?
Indications for use?
Drug name?
anti-inflamm - suppresses cytokine release,
inhibits neutrophils and WBCs from lungs
add-on to bronchodia in refractory cases
roflumilast
Methods to mobilize secretions? (4)
1) Moisture: PO and humidify
2) Postural drainage (not effective)
3) Expectorants (not effective)
4) Mucolytic agents (in-pt only)
Antiprotease therapy used for?
for ⍺1-antitryp deficiency
controversial
Pursed lip breathing, why?
causes outflow resistance at lips ->
↑ intrabronch pressure ->
keeps bronch open ->
↑ expelled air
Early signs of pulmonary infection? (6)
↑ sputum fever ↑ dysp fatigue chest pain hemoptysis
Acute exacerbation of COPD management?
↑ frequency of short-act β2-agonists
steroids (↓ recovery and hospit)
antibiotics
COPD and low respir infections common why?
Etiology?
↓ expectoration causes colonization of bacteria,
virals become co-infected
H. influ, S. pneumo, M. catarrhalis,
Pseudomonasaeruginosa
Antibiotics for low resp infection (outpt)? (4)
Macrolides (azithro, clarithro)
Fluoroquinolones (levofloxacin, maxiflozacin)
Augmentin
Doxy
Trimeth-Sulfmeth
Cephalosporins (cefdinir)
Hospitalization for COPD when?
↑ intensity of sxs New physical signs (cyanosis, edema, etc) Failure to respond to meds Significant co-morbids Frequent exacerbations ↑ age Insuff home support
Supplemental O2 used when?
For how long?
Concerns w use?
pO2 less than 55 or sat less than 88%
At least 12 hrs/day
Reduce urge to breathe, result in acidosis
