COPD Flashcards
Anatomically/histologically permanent and destructive enlargement of airspaces distal to the terminal bronchioles WITHOUT obvious fibrosis yet with loss of normal architecture
Emphysema
Productive cough not attributable to other causes on most days for
at least 3 MONTHS over 2 CONSECUTIVE YEARS
Chronic Bronchitis
Affected in small airway disease
Small bronchioles are narrowed
Major site of increased resistance in most individuals with COPD
Small airways
Emphysema pathologic types
Centriacinar: respiratory bronchioles
Panacinar: large spaces
Emphysema more frequent with cigarette smoking
Centriacinar
Prominent locations of centriacinar emphysema
Upper lobes
Superior segments of lower lobes
Emphysema usually observed a1AT deficiency
Panacinar
Predilection of panacinar emphysema
Lower lobes
Most typical finding in COPD
Persistent reduction in forced expiratory flow rates
Found late in the course of COPD
(+) air trapping and hyperinflation
May cause severe pulmonary hypertension causing cor pulmonale and RV failure
Decreased FEV1 (<25% of predicted + chronic hypoxemia PaO2 <55mmHg)
Cause of reduction of PaO2 in COPD
VQ mismatch
Risk factor for mortality from chronic bronchitis and emphysema
Cigarette smoking
Risk factor for COPD and a significant predictor of subsequent decline in pulmonary function
AHR
PROVEN genetic factor for COPD
Severe a1 antitrypsin (a1AT) deficiency
3 MC complaints in COPD
cough
sputum production
exertional dyspnea
“Pink puffers”
Predominantly emphysema
“Blue bloaters”
Predominantly chronic bronchitis
Independent poor prognostic factor in COPD
Wasting
Paradoxical inward movement of the rib cage with inspiration
Hoover’s sign
RV failure signs
Inc JVP RV heave or S3 Hepatic congestion Ascites Peripheral edema
Gold standard for COPD diagnosis
Pulmonary function testing
Hallmark of COPD
airflow obstruction
PFT with Decreased FEV1 and FEV1/FVC
Confirms presence of airflow obstruction
FEV1/FVC ratio <70%
+
postbronchodilator FEV1 <80% predicted
Decreased DLCO
Emphysema (due to parenchymal destruction characteristic of the disease)
Most important sign of severe exacerbation in patients with very severe COPD
Mental status changes
Only pharmacologic therapy demonstrated to unequivocally decrease mortality rates in COPD
O2 therapy
Bacteria frequently implicated in exacerbations
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
