COPD Flashcards
What are some obstructive airway diseases ?
- asthma
- cystic fibrosis
- COPD
What is COPD ?
progressive lung disease characterized by persistent airflow limitation
- associated with chronic inflammatory response in lungs and airway
What can cause COPD ?
- primarily caused by cigarette smoking and other particles and gas
- may have genetic deficiency of alpha-1 antitrypsin (A1AD)
What is chronic bronchitis ?
the presence of cough and sputum production for at least 3 months in each of two consecutive years
What is emphysema ?
loss of lung elasticity and hyperinflation of lung tissue
- causes the destruction of alveoli
What other conditions are included within a COPD diagnosis ?
chronic bronchitis & emphysema
What is the pathophysiology of COPD ?
chronic inflammation of airways, lung parenchyma and pulmonary blood vessels which leads to increased mucus production and a structural change in the lungs leading to airway constriction
What is the defining feature of COPD
airflow limitation during forced exhalation
- inability to expire air
- the air becomes trapped so the pt’s is having to inhale when the lungs are already in a “over-inflated” state
What is bullae and blebs ?
- Bullae: large air spaces
- Blebs: air spaces next to pleurae
What does having COPD lead to ?
- airflow limitations
- air trapping
- poor gas exchange
- wall of alveoli destroyed
- formation or bullae and blebs
- will eventually lead to hypoxia and retained CO2
What are some clinical manifestations of COPD ?
- chronic intermittent cough
- wheezing on auscultation, in late stages may be more diminished
- barrel chested and purse lipped
- clubbing and polycythemia vera
- fatigue and decrease activity tolerance
- use of accessory muscles to breathe
- prolonged expiratory phase
- thin in appearance
- cor pulmonale
- hypercapnia
What are some diagnostic studies ?
- history and physical: smoking history and functional ability
- chest x-ray
- O2 sats: with COPD normal is usually 88-92%
- 6-minute walk index
- COPD assessment test (CAT)
- pulmonary function test
- ABGs
What does a pulmonary function test measure ?
tests FEV1 (forced expiratory volumes) calculates the amount of air that a person can force out of their lungs in 1 sec
What is the primary cause of COPD exacerbations ?
bacterial and viral infections
What are some S&S of a COPD exacerbation ?
- increased wheezing
- acute change in usual patterns of dyspnea, cough, or sputum
- malaise, fatigue, confusion, depression, anxiety
- severe: accessory muscle use, central cyanosis, altered LOC, edema in lower extremities/signs of rt sided HF, unstable BP
What can happen if someone has a severe COPD exacerbation ?
- acute respiratory failure
- need to be intubated
What is the first complications of COPD ?
pulmonary hypertension
What causes pulmonary hypertension ?
- alveolar hypoxia causes constriction of pulmonary vessels
- chronic hypoxia stimulates RBC production which causes polycythemia which increases the viscosity of blood
- this leads to increased pulmonary vascular resistance which causes the pulmonary hypertension
What causes Cor Pulmonae ?
pulmonary hypertension pressure increases within the lungs
- the pressures on the Rt side of the heart must increase to push blood into the lungs
- leads to S&S of Rt sided HF
- late manifestation, worse prognosis, may need to be on palliative care
How do bronchodilators help with COPD ?
opens up the airways
How do anticholinergic bronchodilators help with COPD ?
relax muscles around bronchi to bronchodilate
How do steroids help with COPD ?
reduce inflammation
- prednisone/prednisolone
How do antibiotics help with COPD ?
will treat the bacterial infection if there is one
- test sputum to find the bacteria
What is a bullectomy ?
removal of large air spaces to improve lung function
- thru a thorascope
What is a lung volume reduction surgery ?
removed diseased lung to improve performance of remaining tissue
- thru thorocotomy/bronch
What are some surgical treatments for COPD ?
- bullectomy
- lung transplant
- lung volume reduction
What do we want the O2 sat for a COPD pt to be like ?
88-92%
- higher can cause O2 toxicity and CO2 narcosis
How does oxygen therapy help with COPD ?
- long-term therapy improves prognosis, mental acuity, mental health and exercise intolerance
- helps reduce polycythemia vera, pulmonary HTN, and cor pulmonale
- do not titrate O2 with MD orders
What breathing technique is good for a COPD pt ?
pursed-lip breathing
- prevents bronchial collapse and can decrease dyspnea and anxiety
- slows breathing, makes each breath more effective
- great when exercising
How do you do pursed-lip breathing ?
- inhale through nose 1-2 secs
- exhale through pursed lips 4 secs
What are some airway clearance techniques ?
- chest physiotherapy: postural drainage & percussion
- positive expiratory pressure device: inhale and exhale thru the device and when exhaling a vibration is created when can loosen secretions (acapella or aerobika)
- huff coughing: helps loosen mucus and move it thru the airways before coughing it up (avoids narrowing or collapse)
How does the tripod position help with COPD ?
- helps maximize air exchange
- helps diaphragm move downward to increase volume in chest cavity
- forces the lung to expand
What do we teach about energy conservation for a pt with COPD ?
- encourage exercises like walking and strength training to improve upper muscle function
- balance tolerance with benefit (will be SOB but if it takes more than 5 mins to return to baseline then reduce activity)
- can take bronchodilator before exercise
- pulmonary rehab can build up strength and endurance
What is some nutritional education ?
- eat high calorie, high protein, low carb diets
- smaller more frequent meals (3-5 every day)
- increase fluid intake if tolerated to keep secretions thin (unless in cor pulmonale)
- too many carbs can lead pt to acidemia
What is some psychological therapy for someone with COPD ?
- anxiety from COPD can be taught relaxation techniques
- benzos and opiates shouldn’t be used due to sedative effects
What is some health promotion for someone with COPD ?
- smoking cessation would decrease COPD incidences dramatically
- elimination of exposure to irritants in environment
- early diagnosis and tx of respiratory illnesses
- immunizations for flu, pneumococcal, pneumonia, RSV, COVID
What is hypercapnia ?
build up of CO2 in the blood
What O2 mask should we give to a pt with hypercapnia ?
venturi facemask
- 24 or 28% O2
- we want to maintain the SpO2 >90%
- without hypercapnia we will titrate O2 upwards
What is the arterial blood gas for a COPD patient usually ?
compensated respiratory acidosis
What are some bronchodilators used for COPD ?
- short acting beta adrenergic agonist: albuterol
- inhaled long acting: salmeterol/formoterol
What are some anticholinergic bronchodilators ?
administered via inhalation
- short acting: ipratropium (Atrovent)
- long acting: tiotropium bromide (Spiriva)
- often in hospital use nebulizer tx of iprotromium+albuterol (DuoNeb)
What are some antibiotics that may be given ?
- amoxicillin
- azithromycin
- doxycycline
What are some considerations for use of B2 adrenergic agonist (bronchodilators) ?
- most effective for bronchospasms, promotes bronchodilation, and suppresses the histamine release in the lungs
- S&S: tachycardia, anxiety, jitteriness, tremors
- short acting used for emergencies or acute exacerbations
What are some considerations for use of anticholinergic bronchodilators ?
- cause bronchodilation, and approved to treat COPD
- S&S: dry mouth (suck on hard candies to help), and hoarseness
- tiotropium has longer duration and can be given less often
What are some considerations for use of anti-inflammatory corticosteroids ?
- most effective anti-asthmatic med
- suppresses inflammation & decreases bronchial hyperactivity
- S&S: thrush, increased glucose
- usually inhaled but can be PO or IV (inhaled has less SE)
- PO & IV: increase appetite and mood swings
- rinse out mouth after admin to avoid thrush
What are leukotriene modifiers used for ?
- effective for add on therapy with (not replace) inhaled corticosteroids
- interferes with synthesis or block action of leukotrienes
- Ex.) Montelukast (singulair)
What are some considerations for use of leukotriene modifiers ?
- S&S: HA, dizziness, nausea, fatigue, abd pain, bronchospasms, GI distress
- not for use in acute asthma
- used mainly as maintenance and prophylactic therapy
What are examples of corticosteroids ?
- inhaled: flovent
- PO: prednisone
- IV: solumedrol (methylprednisolone), decadron
What are the classifications for COPD ?
- Gold 1 (mild): FEV1 > 80%
- Gold 2 (moderate): FEV1: 50-80%
- Gold 3 (severe): 30-50%
- Gold 4 (very severe): < 30%
