COPD Flashcards
What is the destruction of the gas-exchanging surfaces of the lung (alveoli)?
Emphysema
What is the presence of cough and sputum production for at least 3 months in each of two consecutive year?
Chronic bronchitis
What are the systemic effects of COPD?
- Hypoexemia; hypercapnia
- Respiratory acidosis
- Cyanosis
- Cor pulmonale
- Weight gain or weight loss
What is the most commonly early symptoms in COPD?
Dyspnea on exertion
What are symptoms associated with COPD?
- Dyspnea
- Chronic cough
- Sputum production
Why is smoking such a big risk factor for COPD?
Smoking stimulates elastase, a proteolytic enzyme which causes the following:
- Degenerative changes in elastin and alveolar structures
- Release of cytotoxic oxygen radicals from WBCs in lung tissue
What does Alpha-1 Antitrypsin Deficiency cause in regards to COPD?
- Causes premature emphysema as AAT is an inhibitor of proteases (elastase), so w/ a deficiency the elastase is able to cause degenerative changes
- Process of lung destruction is accelerated in smokers with AATD
What kind of physical exam findings might you find in someone with COPD?
- Tripod positioning, use of accessory muscles
- Pursed lip breathing
- Cyanosis
- Muscle wasting
- Peripheral edema
- S3 gallop or RV lift
- Barrel chest
- Prolonged expiration
- Decreased breath sounds
- Wheezing or rhonchi
Why do patients exhibit pursed lip breathing in COPD?
- In COPD, ordinary breathing allows early bronchial collapse on exhalation
- Pursed-lip breathing achieves resistance to outflow at the lips; raising intrabronchial pressure, keeping the bronchi open
- More air can be expelled
What is the most common cause of Cor Pulmonale?
COPD
What can Cor Pulmonale lead to?
S3 gallop, RVH, hepatomegaly, peripheral edema
What is Cor Pulmonale?
Altered structure and/or impaired function of the right ventricle that results from pulmonary HTN associated with lung disease
What diagnostic study is required to make a diagnosis of COPD?
Spirometry
What is the role of spirometry in COPD?
Used to establish the diagnosis AND to determine the severity of airway obstruction
What is the amount of air that is forcefully exhaled during maximal forced expiration?
Forced Vital Capacity (FVC)
What PFT confirms an obstructive pattern?
A Post-bronchodilator FEV-1/FVC ratio that is < 0.7
The following will be increased or decreased in COPD:
TLC
DLCO
TLC: Increased
DLCO: Decreased
What does FEV-1 determine in COPD?
GOLD Class I-IV (severity of obstruction)
Will the following be increased, decreased, or normal in an obstructive disorder:
FEV-1
FVC
FEV-1/FVC
Exhalation
FEV-1: Decreased
FVC: Normal
FEV-1/FVC: Decreased
Exhalation: Prolonged
When might you consider ordering an ABG?
- FEV-1 < 50%
- SPO2 < 92%
- Depressed LOC
- Acute exacerbation of COPD
When might you consider obtaining Alpha-1 Antitrypsin?
- Young patient (< 45 years old)
- Non-smoker
- Family hx of emphysema
What findings will be seen on chest x-ray that are consistent with COPD?
Signs of air trapping: - Increased AP diameter - Hyperinflation (elongation of the lungs) and hyperlucency - Flattened diaphragm Blebs or bullae Perivascular or peribronchial markings
What can be seen on chest x-ray and is pathognomonic for emphysema?
Blebs or bullae (radiolucent areas)
For a patient with Gold Grade A with low risk/less symptoms, what is the suggested treatment?
Short-acting bronchodilators (SABA, SAMA, or combo)
