COPD Flashcards
emphysema
air spaces are enlarges as a consequence of destruction of alveaolar septae
chronic bronchitis
dz w/ chronic cough that is productive of phlegm occuring on most days for 3 mnths of the year or for 2 + consectutive yers w. out a defined cuase
what are other causes of COPD?
environmental pollutants, recurrent URI, eosinophilia, bronchial hyperresponsivemenss, alpa 1 antitrypsin
PE of emphysematous COPD
dry cough and weight loss
PE of pt w/ advanced COPD
asthenia, dyspnea, pursed-lip breathing, grunting expirations
Chest exam
- barrel chest=increased AP diameter
- percussion yields increased resonance=caused by hyperinflaion and air trapping
what do you hear on auscultaion?
decreased breath sounds, early inspriatory crackles (cuased by airway inflammation and mucus oversecreation)
what about wheezing in COPD
may not be present at rest, but can be evoked w. forced expiration or exertion
-common finding in exacerbation “continuous musical lung”
what do you hear in pts w. chronic bronchitis?
rhonchi- reflect secretions in the airways, breathing is raspy and loud
Laboratory testss
CXR,, PFT, CBC Puls ox, ABG
CXR
+/- hyperinflation- not sensitive enough to serve as a diagnostice tool
emphysema pathognomic?
parenchymal bullae or subpleural blebs
chronic bronchitis pathogonomic?
nonspecific peribronchal and pervascular markings
PFTS
-The FEV1/FVC ratio is decreased (< 0.70 or less than the lower limit of normal
**must be incompletely reversible w. inhaled bronchodilator
what would a CBC show?
polycythemia from chronic hypoxia
-think impaired gas exchange in lung parenchyma-worsens w/ exercise
what are 3 signs of impending respiratory failure?
hypercapnea, hypoxia, and respiratory acidosis
where is theophylline metabolized?
the liver
Stage 1
mild.
FEV1/FVC < 70% and FEV1 ≥ 80%, with or without symptoms
o Often minimal SOB with or without cough and/or sputum. Usually goes unrecognized that lung function is abnormal
stage 2
moderate.
FEV1/FVC < 70% and FEV1 = 50-80% predicted value, with or without symptoms
o Often moderate or severe SOB on exertion, with or without cough, sputum or dyspnea. Often the first stage at which medical attention is sought due to chronic respiratory symptoms or an exacerbation
STage 3
severe. FEV1/FVC < 70% and FEV1 = 30-50% predicted value, with or without symptoms
o More severe SOB, with or without cough, sputum or dyspnea – often with repeated exacerbations which usually impact quality of life, reduced exercise capacity, fatigue
Stage 4
very severe. FEV1/FVC < 70%, FEV1 < 30% predicted value or FEV1 < 50% with chronic respiratory failure
o Appreciably impaired quality of life due to SOB – possible exacerbations which may even be life threatening at times
How is COPD defined by the GOLD?
a common preventable and treatable disease characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases
what is a COPD exacerbatopm?
an acute event characterized by a worsening of the pts respiratory sx that is beyond normal day to day variations and leads to a change in meds
what are clinical features of an exacerbation?
increase in baseline dyspnea, cough, and or sputum production
