COPD Flashcards
COPD overview
6 th leading cause of death in US
> 10 million dx in us
persistent respiratiory symptoms and airflow limitation
not fully reversible
airflow limitation
small airway disease or emphysema
narrowed airways
mucous and fibrosis
extensive small airway destruction
the hallmark of advanced COPD
airway obstruction
determined by spiromometry
usuall caused by smoking
COPD classification
Emphysema:
lung alveoli destruction and airspace enlargement
chronic bronchitis
chronic cough and phlegm
small airway disease
narrowed small bronchioles and reduced in number
genetic considerations
alpha 1 antitrypsin dediciency
COPD
Emphysema
Four characteristics:
1. chronic exposure to cigarette smoke
2. compromised airway vasculature and gas exchange surfaces
3. structural cell death
4. disordered repair of elastin and other components
Elastin degradation and disorder repair;
primary mechanisms
Autoimmune mechanisms:
promotes progression
Cigarette smoking:
initiates the disease
continue disease progression
despite smoking cessation
cell death occurs
variety of mechanisms
repair of lost smaller airway microvasculature and damaged alveoli
COPD small airway disease
the major site of increased resistance
small airways < 2mm
characteristics
cellular changes
goblet cell metaplasia
smooth muscle hypertrophy
luminal narrowing
fibrosis, excessive mucus, edema, and cellular infiltration
extensive small airway destruction
the hallmark of advanced COPD
COPD bronchitis
characteristics
mucus gland enlargement
goblet cell hyperplasia
leading to cough and mucous production
bronchi undergo squamous metaplasia
predisposed to carcinogenesis and mucociliary clearance
smooth muscle hypertrophy and bronchial hyperactivity
leads to airflow limitation
neutrophil influx
associated with purulent sputum
COPD manisfestaions
prolonged expiratory phase
expiratory wheezes
barrel chest
accessory muscle use
Tripod position:
facilitates accessory muscle use
cyanosis in the lips and nailbeds
Digital clubbing :
investigate for other causes: development of Lung CA
hyperinflation on the chest x-ray
COPD labs
ABG:
resting or exertional hypoxemia
pCO2 > 45
presence /impending acute exacerbation
: elevated hematocrit and RVH
chronic hypoxemia
COPD radiographic studies
CXR with increased lung volumes and flattened diaphragm
CT: Chest
definitive to establish the presence /absence of emphysema
Determine any coexisting diseases
COPD diagnosis
Pulmonary function testing:
reduction in FEV1 an FEV1/FVC
defines airway obstruction
COPD hallmark
COPD chronic management
two main goals of therapy
symptomatic relief
reduce futue risk
most important
stop smoking
anticholinergic muscarinic antagonist
SAMA atrovent
LAMA spiriva
inhaled beta agonist
SABA albuterol
LABA brovona
inhaled corticosteroids
Pulmicort
Combo therapy:
Advair, Symbicort, trilogy
severe COPD
theophyline and daliresp
COPD acute exacerbation
dual SABA/SAMicort 0.5 mg A duoneb
brovana 15mcg NeB Q 12 and Pulmicort Q12 ( neb)
solumedrol
transition to oral dosing 24 hours before DC
avoid chronic use
long-acting muscarinic antagonist ( selbri neo-inhaler)
Zyrtec and singular
maintain 02 > 90%
home 02 needed for < 88%
Acute respiratory failure:
Bipap or intubation
chronic respiratory failure
arrange for NIV
azithromycin
bacterial infections substantial for exacerbations
suitable for antimicrobial and aniinflammatory
