COPD Flashcards
normal FEV1/FVC ratio
- 70%
what conditions are included in COPD
- chronic bronchitis
- emphysema
where in the US do we see higher incidence of COPD
what is it correlated with
- tobacco belt
- lower SES classes
risk factors for COPD
- cigarette smoking
- passive smoking
- biomass fuels
- hyper-responsive airways
- occupational factors
genetic cause of emphysema
- alpha1 antitrypsin deficiency
pathogenesis of emphysema
- elastase (degrades elastin) and alpha-1 antitrypsin inactivation
- involves innate and adaptive immunity
vicious circle hypothesis
- initiating factors (smoking or childhood disease) + genetic predisposition
result of pathogenesis of COPD
- small airway remodeling (fibrosis)
- alveolar wall destruction (emphysema)
- mucus hypersecretion
mechanisms of physiologic obstruction
- filling of lumen with mucus in chronic bronchitis
- wall thickening/airway fibrosis in chronic bronchitis
- loss of tethering in emphysema
emphysema leads to loss of _________ and results in _________
- loss of elastic recoil
- results in airway collapse
symptoms of COPD
- shortness of breath
- cough
- wheezing
- fatigue
- weakenss
symptoms of COPD late in illness
- morning headaches
- lower leg swelling due to cor pulmonale
signs of COPD
- barrel chest
- accessory muscles
- wheezing
- tripod
- decreased breath sounds
- lower extremity edema
spirometry of COPD
- reduced FEV1/FVC ratio below 70%
FEV1/FVC lower limits of normal declines with
- age
FRC in emphysema
- increased FRC
RV in emphysema
- increased RV
TLC in emphysema
- increased TLC
chest x ray features in COPD
- low, flattened diaphragm
- air trapping
- increased A-P diameter
effect of exercise on hyperinflation
- gas trapping will get worse when you exercise
- inspiratory capacity will get smaller
symptoms with COPD correlate with
- inspiratory capacity
classic ABG levels for COPD
- 60 pCO2
- 60 pO2
V/Q of COPD
- V/Q mismatching
complication of chronic hypoxemia associated with COPD
- cor pulmonale
treatment of COPD
- smoking cessation
how do you start treatment of COPD
then if it gets worse
and worse
and worse
and even worse
- avoid risk factors and vaccinate
- add short acting bronchodilator
- add long acting bronchodilator + rehab
- add inhaled corticosteroid
- add O2 and consider surgery
surgery for COPD
- transplant
- lung volume reduction surgery
noninvasive ventilation for COPD
- CPAP
- BiPAP
if someone develops emphysema in the base of their lung, think
- alpha-1 antitrypsin deficiency
three things that reduce mortality in COPD
- discontinue smoking
- oxygen
- lung volume reduction surgery in the right patient
what is the number 1 cause of antibiotic abuse in the US
- acute bronchitis
symptoms of acute bronchitis
- sudden onset of cough, greater than 5 days
- no fever, tachycardia, tachypnea
- possible chest soreness
mean duration of acute bronchitis
- 18 days
most common cause of acute bronchitis
- viral
what is a normal FEV1
- above 80%
helium dilution is not a good test for what condition
- COPD
patients with what kind of emphysema will we use lung reduction volume surgery?
- apical emphysema
