COPD Flashcards
give the def of COPD
chronic lung diease with persisent rairflow limitation
not fully reversible
what are the types of COPD?
Type A - Emphysema
Tpye B - Bronchitis
what is the def of chronic obstructive bronchitius ?
chronic persistent cough with sputum
at least 3 months a year
for 2 years
what is the def of emphysema ?
irreversible distention of the airways located distal to ther terminal bronchiole
destruction of septa and reduced elastic fiber
what is the classification of emphysema
- centrilobular - which appears in COPD
- panacinar - in alpha 1 antitrypsin defi
explain the subtype of centrilobular emphysema
abnormal dilation of respiraotry bronchiole - central portion of the acinus
assocaited with smoking
explain the subtype panacinar
enlargement and descruction of all parts in acinus
seen in alpha-1 antitrypsin and in smoking
what is the etiology of CODP?
smoking
pollution
genetics
explain what alpha 1 Antitrypsin does in the lungs
it protects against damage
what happens to alpha1 AT in COPD?
it is reduced
where in the lungs is emphysema developed before it spreads?
upper part of the lungs where large bullae are formed
define chronic bronchitis
thickening of the bronchial wall due to inflammation
what happens to the mucus gland in bronchitis ?
hyperplasia and hypertrophy resulting in production of viscous mucus
why is recurrent respiratory tract infections increased in bronchitis ?
due to damage o cilia affecting the defense mechanism
what are the symptoms of COPD?
dyspnea
wheeze
frequent lower tract infections
chronic productive cough
explain the dyspnea seen in COPD
progressive
worsen with exercise
MRC sclae used
explain the MRC dyspnea scale
grade 1 breathless only on strenous exertion
grade 2 when waling up a slight hill
grade 3 when walking on flat ground
grade 4 walking 100 meter
grade 5 dressing/undressign
explain the cough in COPD
may be intermittent and may be unproductive
commonly cough up sputum
what are the signs seen in CODP?
tachypnea
tachycardia
barrel chest
accessory muscles
cyanosis
prolonged expiration
polyphonic expiraotry wheeze
CO2 retenion - confusion, tremor,
cur pulmonale
P HTN
Cachexia
what are the finding when insepction ?
barrel shaped
accessory muscles
prolonged expiration
hoovers sign
tripod position
explain the clinical manifestions
decreased fremitus
hyperresonant
prolongeed expiration
reduced breath sounds
wheezing
crackles - when infection occurs
diminished cardiac/hepatic dullness
how is COPD diagnosed ?
spirometry
ECG
chst x ray
lab
arteiral blood gas
what are measured in COPD in spirometry ?
FEV, FCV, PEF, FEV1, FEV1/FCV, VR, TLV
what are the spirmotry values in COPD?
decreased FCV
decreased FEV1
decreased FEV1/FCV below 0.7
increased VR
increased TLC
how is the diagnosis of COPD confirmed ?
The presence of a post-bronchodilator FEV1/FVC < 0.70 confirms the presence of persistent airflow limitation and thus of COPD
explain the stages of the GOLD scale
GOLD 1 mild = FEV1 > 80%
GOLD 2 moderate = 50-80%
GOLD 3 severe = 30-50 %
GOLD 4 very severe = < 30 %
what can DLCO do ?
establish the presence of emphysema
it is reduced in COPD
how is the X ray in type A?
no apparent abnormality
how is the X ray in Type B?
marked inflation
intercostal space is widen
horizzontal pattern in ribs
long thin heart shadow
decreased marking of lung peripheral vessel
arterial blood gas in COPD?
PaO2 < 8.0 with or without PaCO2 > 6.7
what type of respiraotry failure is seen in COPD type A?
Type 1 - low O2 and increased CO2 in blood
which type of respiraotry failure is seen in COPD Type B?
Type 2 - CO2 > 50 mmHg
what are the clinical manifestations of hypercapnia ?
headache
hypercapnic encephalopathy
what are the symptoms of hypercapnic encephalopathy ?
mental slowness
coma
flapping remor
cerebral edema
papillary edema
when does hypercapnic encephalopathy opccur ?
when PaCO2 is over 70 mmHg
what are the classes of bronchodilators ?
B2 agonists - short and long acting
anticholinergic - short and long
theophylline
what are the complications of COPD?
pneumothorax
cor pulmonale
exacerbation
pneumoniae
respiraotory failure
embolism
arithmia
what are the triggers of excerbation of CODP?
infections
smoking
exposures
how is exacerbation treated ?
oxygen threapy
maintain saturation 89-92 %
short acting beta2 agonists
oral glucocorticoids
antibiotica
anticoagulation in case of embolism
embolsim is increased in COPD
