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Pulmonology 2 > COPD > Flashcards

COPD Flashcards

1
Q

What diseases are included in COPD?

A

COPD encompasses several diffuse pulmonary diseases including chronic bronchitis, asthma, and emphysema

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2
Q

COPD description

A

Progressive development of irreversible airway obstruction which leads to limited airflow.

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3
Q

COPD vs. Asthma

A

COPD - irreversible

Asthma - reversible

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4
Q

COPD definition

A
  • Chronic airflow limitation
  • Airflow limitation not fully reversible with bronchodilators
  • Minimal variability in day to day symptoms
  • Slowly progressive and irreversible deterioration in lung function leading to progressively worsening symptoms
  • Associated with systemic consequences
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5
Q

COPD Risk factors

A
  • smoking (90%) typically >20 pack years
  • cannabis use (1 joint is equivalent to 2.5-5 cigs)
  • severe viral pneumonia early in life (leads to scarring of lungs)
  • aging
  • airway hyperactivity
  • occupational exposure (dust/chemicals)
  • pollution (outdoor and indoor)
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6
Q

Which obstructive lung diseases act on bronchus?

A
  • Chronic bronchitis
  • Bronchiectasis
  • Asthma
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7
Q

Which obstructive lung disease acts on the bronchioles?

A

Bronchiolitis (small airway disease)

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8
Q

Which obstructive lung disease acts on the alveoli?

A

Emphysema

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9
Q

Chronic bronchitis major pathology

A
  • Mucus gland hyperplasia
  • Excess mucus
  • Inflammation
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10
Q

Bronchiectasis major pathology

A

Airway dilation & scarring

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11
Q

Asthma major pathology

A
  • Smooth muscle hyperplasia
  • Excess mucus
  • Inflammation (eosinophils)
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12
Q

Bronchiolitis major pathology

A

Inflammatory scarring & obliteration

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13
Q

Emphysema major pathology

A
  • Airspace enlargement
  • Wall destruction
  • No fibrosis
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14
Q

COPD is characterized by…

A

varying degrees of chronic inflammation of the small airways and destruction of alveolar walls

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15
Q

COPD pathology

A
  1. Mucous Gland Hyperplasia- more so in larger airways, mucous hypersecretion leading to a chronic productive cough
  2. Squamous Metaplasia- replacement of normal ciliated columnar epithelium by squamous epithelium
  3. Loss of ciliary function-leads to impairment of the normal functioning of mucociliary escalator
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16
Q

COPD chronic inflammation and fibrosis pathology

A
  • occurs in small airways, characterized by CD8 lymphocyte, macrophage, and neutrophil infiltration, with release of pro-inflammatory cytokines
  • recurrent infections may perpetuate airway inflammation
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17
Q

How does COPD cause emphysema?

A

due to alveolar wall destruction causing irreversible enlargement of airspaces distal to the terminal bronchiole (acinus) with subsequent loss of elastic recoil and hyperinflated lungs

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18
Q

Locations of emphysema

A
  1. Panlobular- occur with dilated aispaces evenly distributed
  2. Centrilobular or proximal- occur with dilated airspaces found in association with the respiratory bronchioles
  3. Paraseptal- occur with dilated airspaces at the edge of terminal bronchial unit and abutting a fixed structure, such as the pleural or a vessel
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19
Q

COPD pathology continued…

A
  • Thickened pulmonary arteriolar wall and remodeling-occur with chronic hypoxia (leads to increase in vascular resistance, and pulmonary hypertension in some COPD patients)
  • Increase in airflow resistance- multifactorial. Small airway inflammation reduces the airway lumen. Secretions may be present in the airways.
20
Q

How does emphysema affect small airways?

A

Emphysema destroys the radial attachments to the small airways, which normally holds airways open and resist dynamic compression

21
Q

COPD Symptoms

A
  • Increased sputum production
  • More purulent sputum
  • Progressive dyspnea, decreased exercise tolerance (“I can’t do what I used to.”)
  • Wheezing
  • Chest tightness
  • Non specific symptoms- malaise, sleepiness, depression
22
Q

Symptoms depending on severity

A
  • Increased respiratory rate
  • Hyperexpanded or barrel chest
  • Prolonged expiratory time >5 seconds
  • Pursed lip breathing
  • Use of accessory mm of respiration
  • Diminished breath sounds
  • Possible crackles/rales
23
Q

What are the signs of cor pulmonale?

A

ankle edema, raised jugular venous pressure, warm peripheries, bounding pulse

24
Q

COPD Stage 1: Mild

A
  1. Spirometry shows mild airflow limitation (FEV1 > 80% predicted; FEV1/FVC < 0.70)
  2. Primary symptoms are chronic cough and sputum production
25
Q

COPD Stage 2: Moderate

A
  1. Spirometry shows a worsening airflow limitation (FEV1 > 50% and < 80% predicted; FEV1/FVC < 0.70)
  2. Patients often experience dyspnea, which may interfere with their daily activities
26
Q

COPD Stage 3: Severe

A
  1. Spirometry shows severe airflow limitation (FEV1 > 30% and < 50% predicted; FEV1/FVC < 0.70)
  2. Symptoms of cough and sputum production typically continue, dyspnea worsens, and repeated exacerbations occur.
27
Q

COPD Stage 4: Very Severe

A
  1. Spirometry shows very severe airflow limitation (FEV1 < 30% or < 50% predicted; FEV1/FVC < 0.70 plus chronic respiratory failure)
  2. Complications such as a respiratory failure or heart failure may develop
28
Q

Chronic Bronchitis definition

A
  • Increased mucus production and recurrent cough present on most days for at least 3 months (out of 12 months) during at least 2 consecutive years
  • Increased sputum production is the result of mucus hypersecretion
  • Enlargement of seromucus glands in the tracheobronchial tree, along with an increase in the density of glands
29
Q

Chronic Bronchitis Clinical Presentation

A

Patient will c/o: productive cough, SHOB with or without wheezing, cough up blood, morning headache (hypercapnia) and frequent infections (lung), weight gain

30
Q

Chronic Bronchitis Physical Exam

A
  • cyanosis (hypoxemia)
  • wheeze may or may not be heard on auscultation
  • course breath sounds/rhonchi (mucus in airways)
  • diminished breath sounds (secondary to barrel chest/hyperinflation and air trapping)
  • distant heart sounds
  • pedal edema
  • tachycardia
  • fatigue

*blue bloaters

31
Q

Emphysema Definition

A

The destruction of interalveolar septa, occurs in the distal or terminal airways and involves both airways and lung parenchyma
*Most severe form of COPD

32
Q

Emphysema Clinical Presentation

A

Patient will c/o: minimal cough, little to no sputum, SEVERE SHOB, weight loss

33
Q

Emphysema Physical Exam

A
  • thin (cant eat because working so hard to breath/using so much energy to breath)
  • barrel chest
  • minimal wheezing
  • accessory muscle use (elbows on thighs)
  • pursed lip breathing
  • pink in color
  • breath sounds diminished
  • tachycardia

*pink puffers

34
Q

Emphysema Auscultation, Palpation, Percussion

A
  • Auscultation: decreased breath sounds (decreased airflow, prolonged expiratory time, decreased vocal resonance, dry basilar rales
  • Palpation: decreased tactile fremitus
  • Percussion: hyperresonance with, decreased excursion of diaphragm
35
Q

Emphysema work-up

A

Labs: ABG and CBC

Tests: PFT, ECG, CXR, CT scan, pulse ox, nocturnal oximetry/sleep study, sputum culture, exercise test – walk them to see how low their pulse ox drops.

36
Q

What will CXR show for emphysema?

A

small heart, hyperinflated lungs, flat diaphragms and possible bullous changes

37
Q

When should you do ABG on Emphysema patient?

A

if the patient is always hypoxic or if there’s a risk of CO2 increase.

38
Q

What are GOLD guidelines for COPD?

A

GOLD guidelines use a combined COPD assessment approach to group pts according to symptoms and risk for exacerbations.

39
Q

General treatment of COPD exacerbations

A

Nebulizer + steroids +/- antibiotics

40
Q

Mild COPD

A
  1. Symptoms: Dyspnea, cough, change in sputum color/thickness
  2. Signs: Wheeze, +/-fever, DOE, chest tightness
  3. No need for ABG
  4. Treatment @ home
  5. Quick relief meds: increase dose and/or frequency of albuterol and ipratropium
  6. Corticosteroids: Consider if inadequate response to initial BD treatment or FEV1< 50% pred.
  7. Antibiotics if fever present, color of phlegm
41
Q

Moderate COPD

A
  1. Symptoms: New or more intensity of sx; failure to respond to tx
  2. Signs: accessory MM use, cyanosis, hypoxia
  3. ABG: If O2 sat <90% on RA
  4. Treatment in hospital
  5. Quick relief meds: Albuterol Q 1 hour
  6. Corticosteroids: IV steroids
42
Q

Severe COPD

A
  1. Symptoms: severe sx not responding to initial tx, confusion, lethargy
  2. Signs: Hemodynamic instability
  3. ABG: PaO2 <50, PaCO2 >70, pH <7.30
  4. Treatment in ICU
  5. Quick relief meds: high dose albuterol + ipratropium
  6. Corticosteroids: IV steroids
43
Q

COPD Treatment

A
  • Vaccinations: Pneumonia + Influenza

- Home oxygen is the ONLY drug therapy that is documented to improve the natural history of COPD

44
Q

Home oxygen for COPD

A
  • Helps to prevent cor pulmonale
  • Decreases mortality if used >15 hours/day
  • Start as soon as they meet requirements
  • Indications: PaO2<55, SaO2<89 consistently
45
Q

COPD Complications

A
  • Pulmonary HTN due to reactive vasoconstriction secondary to hypoxemia
  • Cor Pulmonale refers to the altered structure (hypertophy or dilatation) and/or impaired function of the RV that results from chronic pulmonary hypertension that is associated with diseases of the lung (COPD)
  • Pneumothorax due to formation of bulla in emphysema
46
Q

What questions should you ask COPD patients?

A
  • Have your ever been prescribed oxygen? If so, where is it?
  • How often have you been using inhaler or nebulizer?
  • Do you even have a nebulizer?
  • How often do you usually take these?
  • Have you taken steroids before? If so, what has worked in the past? MDP vs high dose prednisone x amount of days or taper?
  • Do you have a pulmonary physician?

Pulmonology 2 (17 decks)

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