COPD Flashcards
What are the 5 types of COPD?
- Asthma
- Bronchitis
- Emphysema
- Bronchiectasis
- Bronchiolitis
Bronchitis is inflammation of the ______ airways.
Large airways
Causes of bronchitis
Smoking
Air pollution
Allergies
Certain occupations: Coal Miners, Textile Workers, Grain Handling
Symptoms of Bronchitis
- Cough
- mucus production; can be caused by bacterial infection - cyclical infections
- Shortness of breath
- Wheezing
- May be cyanotic in severe cases
Wheezing in Bronchitis patients caused by
Increased secrections and inflammation
(different than asthmatic patients)
Normal bronchi vs. Bronchitis
(picture, at same airway generation)
On the following CXR, which image is of a patient with Bronchitis?
Left - Bronchitis, note: darker is more air
Right - normal
Treatment of Bronchitis:
Minimize inflammation with ______ ______ therapy.
short-term steroid therapy
Treatment of Bronchitis:
What kind of bronchodilators can be used?
Albuterol inhalation
Treatment of Bronchitis:
What does hydration do to help the treatment of bronchitis?
Dehydration causes dry secretions which are very difficult to clear in the lower airway spaces.
Treatment of Bronchitis:
Use _______ if a bacterial infection is present.
Antibiotics
Which type of COPD causes lung desruction of the terminal bronchioles down to the alveoli?
Emphysema
(one of the most common lung dieseases)
Which type of COPD slowly and irreversibly destroys the elastic fibers that hold open the small airways?
Emphysema
Emphysema is caused by: (2)
Smoking (most common cause)
Some causes of bronchitis may also lead to emphysema
Symptoms of Emphysema: (2)
Shortness of breath
Impaired ability to exhale
What happens to the alveoli in emphysema?
Septal walls of alveoli breakdown –> large bulla
Which image is of a patient with emphysema?
Discuss the findings of the X-Ray of the patient with emphysema.
The image on the right is the emphysema patient.
Hyperinflation of the lungs (black is air), flattened out diaphragm.
What types of short acting bronchodilators can be used to treat emphysema?
Beta-2 (Albuterol), and
anticolinergic (Atrovent)
What type of long-acting anticholinergic bronchodilators can be used when treating a patient with emphysema?
Spiriva
When treating emphysema, inhaled _______ usually are combined with a long-acting _______ (Advair).
corticosteroids
bronchodilator
End stage emphysema is treated with what?
Oral steroids (Prednisone), and supplimenta oxygen
Which COPD can be treated with lung reduction surgery if the patient has large regions of over distention and poorly functioning lung tissue?
Emphysema
Which COPD is classiifed as swelling and mucus build up in the bronchioles, due to a virus infection?
Bronchiolitis, seen in pts < 2 yo
Which COPD has a seasonal pattern? And which seasons are the worst?
Bronchiolitis; Fall and Spring
Symptoms of Bronchiolitis: (3)
Shortness of breath
Cough
Wheezing
In ________, the airway becomes obstructed from swelling of the bronchiole walls.
Bronchiolitis (in larger airways)
Treatment options for Bronchiolitis (5)
- ABX to treat recurrent infections
- Hydration
- Chest physical therapy (helps with secretions?)
- Steroid therapy
- Bronchodilators
Which COPD causes destruction and widening of large airways that become easily collapsible?
Bronchiectasis, can begin in early childhood
Half of the cases of which COPD is caused by Cystic Fibrosis?
Bronchiectasis
Causes of _______ are recurrent infections and inflamation.
Bronchiectasis
Bronchiectasis can show signs in what other disease?
Tuberculosis
Symptoms of Bronchiectasis (4):
- odor
- Chronic cough with large amounts of foul smelling sputum (yummy)
- Finger clubbing
- Cyanosis
*note* finger clubbing and cyanosis are related
Which COPD presents with the XRay on the right (the one on the left is a normal and for comparison)?
Bronchiectasis
Treatment of Bronchiectasis: (4)
- Hydration (already have limited ability of cilliary action, thick secretions make this worse)
- ABX if secondary infection
- In severe cases, antiviral drugs such as Rebetol
- If hospitalization is needed, humidified oxygen and IV fluids for hydration
Comparative features of
Chronic Bronchitis vs. Pulmonary Emphysema
- Mechanism of airway obstruction
- Dyspnea
- FEV1 (Forced Expiratory Volume in 1 sec)
- PaO2
- PaCO2
- Diffusing capacity
- Hematocrit
- Cor pulmonale
- Prognosis
Levels of the bronchial tree?
Trachea -> Primary bronchi -> Secondary bronchi -> Tertiary bronchi -> Bronchioles -> Terminal bronchioles
Gas exchange picture
Six risk factors that predispose patients to postop pulmonary dysfunction:
- Preexisting pulmonary disease (MOST COMMON risk factor)
- Throacic or upper abdominal surgery
- Smoking - major predisposing factor for the development of COPD. THe risk of death from COPD is 30x higher for heavy smokers (>25 cigarettes/day). Assume any smoker has some degree of pulmonary disfunction.
- Obesity
- >60 years old
- Prolonged general anesthesia (>3 hrs)
Compare pulmonary function testing lung volumes of a normal pt and a pt with obstructive pulmonary disease
VC is decreased (the largest amt that can move in 1 breath)
RV is increased (the volume that cannot be tapped into)
FRC is increased (the volume of air at the end of passive expiration)
TLC is normal to increased (lot of gas retention)
What is PEFR?
Peak Expiratory Flow Rate, the highest rate that comes out of the lungs
What is FEF25-75?
Forced Expiratory Flow between 25 - 75% of vital capacity, it’s reproducable because it’s not dependent on patient effort.
Spirogram: Volume vs. Time graph
Spirometric classification of severity of COPD based on postbronchodilator FEV1 measurements
What is stage 0?
- At risk
- Normal spirometry
- Chronic symptoms (cough, sputum production)
Spirometric classification of severity of COPD based on postbronchodilator FEV1 measurements
What is stage 1?
- Mild COPD
- FEV1/FVC < 70%
- FEV1 ≥ 80% predicted
- With or without chronic symptoms (cough, sputum production)
Spirometric classification of severity of COPD based on postbronchodilator FEV1 measurements
What is stage 2?
- Moderate COPD
- FEV1/FVC < 70%
- 50% ≤ FEV1
- < 80% predicted
- With or without chronic symptoms (cough, sputum production)
Spirometric classification of severity of COPD based on postbronchodilator FEV1 measurements
What is stage 3?
- Severe COPD
- FEV1/FVC < 70%
- 30% ≤ FEV1
- < 50% predicted
- With or without chronic syptoms (cough, sputum production)
Spirometric classification of severity of COPD based on postbronchodilator FEV1 measurements
What is stage 4?
- Very severe COPD
- FEV1/FVC < 70%
- FEV1 < 30% predicted or FEV < 50% predicted plus chronic respiratory failure
Survival rates in COP according to % predicted postbronchodilator FEV1 < 65 years of age in patients (table)
What two factors increase the work of breathing in COPD patients?
- Elevated airway resistance
- Air trapping
True or False:
Respiratory gas exchange is impared because of ventialtio/perfusion (V/Q) imbalance.
True
True or false:
The predominance of expiratory airflow resistance results in air trapping: residual volume and total lung capacity (TLC) decrease.
False, RV and TLC increase
Name triggers for COPD exacerbations that cause hospitalizations for these patients.
- Respiratory infections (most common)
- Allergens
- Pungent odors (such as perfumes)
- Dust
- Mold
For how long before surgery should smoking be discontinued?
6-8 weeks
…to decrease secretions and to reduce pulmonary complications
(smoking increases mucus production and decreases clearance)
Acute exacerbations aka bronchospasming are best treated with what?
B2-adrenergic agonists
Other treatments pts will be on are prednisone, ipratropium, Leukotriene inhbitors, or Theophylline
Is regiona anesthesia an option for COPD patients?
No impairment of lung function except with lithotomy and lateral ecubitus. A high spinal or epidural can affect accessory muscles and produce an ineffective cough and the inability to clear secretions.
Why is it preferred to use Sevo or Des on patients with COPD?
Because both are rapidly elimintated from the lungs and would minimize ventilatory depression in the early postop period.
What ventilatory considerations are made for COPD patients during anesthesia?
- Controlled mechanical ventilation will optimize lung function. Patients may not tolerate spontaneous ventilation without assistance.
- Large tidal volumes (10-15ml/kg) combined with a slow inspiratory flow will minimize turbulent flow and help maintain optimal ventilation-to perfusion matching.
- Slow respiratory rates (6-8bpm) provide sufficient time for complete exhalation to occur
True or False:
COPD patients can tolerate residuale NMDB during emergence.
False, make sure patients are fully reversed and have no residuale NMBD on board
Typical blood gases (pH, PCO2, PO2, HCO3-, SpO2) of patients with Bronchitis? WIth Emphysema?
Bronchitis Emphysema
pH 7.35 Ph 7.32
Pco2 45 Pco2 50
Po2 63 Po2 75
Hco3- 30 Hco3- 32
Spo2 90 Spo2 94
Slanting and prolongations of expiratory upstroke is indicative of what on the capnogram?
Obstruction to gas flow caused by a partially obstructed tracheal tube or obstruction in the patient’s airways (COPD or bronchospasm)
Flow volume loops graph
Extubation considerations of a pt with COPD
- Deep extubation may be of benefit in the patient has a reactive airway.
- The down side with deep extubation, you risk respiratory insufficiency that you my not have with an awake patient.
- Patients with COPD will probably require a longer stay in PACU or may require a stay in the ICU to better monitor their ventilatory function.
- They will most certainly require supplemental oxygen in the early postop period.
