COPD Flashcards
COPD is defined as a respiratory disorder largely caused by:
smoking, progressive, par’ally reversible airway obstruc’on, lung hyperinfla’on, increasing severity of exacerba’on
Prevalence
COPD affects > 200M people world wide • 65-100M of whom have moderate to severe COPD • COPD increases > 40 yrs. of age • > 700,000 Canadians • 3rd leading cause of death globally • Underdiagnosis and misdiagnosis of COPD common
What are the prime symptoms of COPD
Shortness of breath and exercise limita’on
Pathogenesis
Amplified inflammatory response in COPD pa’ents • Inflammatory cells • Release inflammatory mediators • Inflammatory mediators • Increased in COPD and amplify the inflammatory response • Differences exist in the inflammatory cells and mediators involved in asthma and COPD • COPD – neutrophilic • Asthma – eosinophilic
Pathophysiological changes in COPD lead to:
Airflow limita’on and gas trapping • Gas exchange abnormali’es • Mucus hypersecre’on • Pulmonary Hypertension • Exacerba’ons • Systemic features
Normal terminal bronchioles and alveoli ->
• Distended bronchioles communica’ng -> with each other • Destruc’on of bronchioles and capillary bed
Hyperinfla-on
Airway obstruc’on progressively traps air in the lungs during expira’on resul’ng in hyperinflation ___________________ Consequence of air trapping • The lungs become overinflated and cause pa’ents to breathe (uncomfortably) at much higher lung volumes.
elasticity decreases in the lung
exercise where : not exhaling all the way and trying to breath again
co2 build up
risk factors
environmental
Exposure to par’cles • Tobacco smoke • Occupa’onal exposures • Air pollu’on • Second hand smoke • Across lifespan (prenatal, childhood, adolescence)
host:
Genes (including alpha-1 an’trypsin deficiency) • Age and gender • Lung growth and development • Asthma/bronchial hyperreac’vity • Chronic bronchi’s • Childhood infec’ons • Physical inac’vity • Nutri’on
COPD Severity: Symptoms and Breathlessness Scale
grade from 0 to 4 (very severe)
Grade 1/
Shortness of breath (SOB) -strenuous exercise to I am too breathless to leave the house, or breathless when dressing or undressing; or presence of chronic respiratory failure/clinical signs of right heart failure
Metabolic Phenotypes of COPD
Emphysema • Cachexia, loss of skeletal muscle mass and fat mass • Anxious facial expression • Accessory muscle use • Indrawing (substernal, subclavicular, intercostal) • Paradoxical movement of the lower ribcage (due to limited movement of the diaphragm) • Use of pursed lip breathing • A “tripod” posture – a posi’on in siqng leaning forward with hands supported on the knees.
Chronic Bronchitis:
Cough with sputum • Central cyanosis • Obesityà Increased subcutaneous and visceral adipose ’ssue • Increased CV risk
Why Skeletal Muscle Dysfunc-on in COPD
Related to COPD Skeletal muscles -reduced strength/ endurance; fa’gue/weakness Ie: malnutrition inflammation hypoxia- low blood oxygen hypercapnia- high co2 levels in blood
Related to co/multi morbidies:
Condi’ons/diseases that can result in muscle dysfunc’on Ie: Deconditoning (not exercising so getting out of shape) Cardiovascular dysfunction (not pumping blood well enough Age-related changes (comorbidities) Electrolyte imbalance Steroid induced myopathy
Consequence of body deple-on
• Respiratory muscle impairment àIncreased lung infec’ons and subsequent respiratory failure • Skeletal and diaphragm muscle weakness àDecreased exercise capacity • Decreased quality-of-life • Weight loss, low body weight àrisk for poor survival
Common co/mul–morbidi-es in COPD
Cardiovascular disease (CVD) - more pressure on the right ventricule• Heart failure • Ischaemic heart disease (IHD) • Arrhythmias • Peripheral vascular disease • Hypertension • Osteoporosis • Anxiety and depression • COPD and lung cancer • Metabolic syndrome and diabetes • Gastroesophageal reflux (GERD) • Bronchiectasis • Obstruc’ve sleep apnea
Hypoxemia
•
Low oxygen levels in the blood • Signs: cyanosis, clubbing, polycythemia • Oxygen > 15 hours/day in chronic hypoxemia improves survival • If not treated: pressure in blood vessels increaseà pulmonary artery hypertension à right sided heart failure
Does COPD affect a person’s nutri-on status? How?
Observa’onal studies have shown that people with COPD do experience issues that impact dietary intake and nutri’on status: Nutri’on issues: fatigue, medication, meal size, severity of COPD, dry mouth, dysphagia, poor apetite • Malnutri’on in 30-60% of inpa’ents and 10-45% of outpa’ents (BMI <20 or <90% IBW)
• Bo\om Line: Small, frequent meals and supplements to limit and avoid early sa’ety, dyspnea; improves compliance to dietary rec. -
Interven-on: COPD Pa-en
issues: inadequate food intake,
reason:
Poor food choices, Appetite is reduced
strategie:
Selecting foods which are higher in calories and protein Use Canada’s Food Guide to plan Adding protein Adding a supplement Adequate milk products
issue: dyspnea/fatigue
reason:
Tired, lack of energy. Early satiety related to hyperinflation of the lungs, causing flattening of the diaphragm and pressure on the abdominal cavity during eating
stratefies:
encourage patient to rest before meals Easy to prepare food suggestions, 6 smaller meals Use bronchodilator and secretion clearance techniques before meals
