COPD Flashcards
Characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities caused by significant exposure to noxious particles or gases
COPD
Persistent respiratory symptoms and airflow limitations that is NOT fully reversible
Chronic Obstructive Pulmonary Disease (COPD)
Major physiologic change in COPD
airflow limitation
3 MC symptoms in COPD
cough
sputum production
exertional dyspnea
A PROVEN GENETIC RISK FACTOR for COPD
α1AT deficiency
Associated with MARKEDLY REDUCED Α1AT LEVEL
Z allele
Individuals with two Z alleles or one Z and one null allele and the MC form of severe α1AT deficiency
PiZ
Changes in LARGE AIRWAYS will give rise to
cough and sputum
Changes in small airways ≤2 mm and alveoli
physiologic alterations
Reduction of this can↑ surface tension at the air-tissue interface –> airway narrowing or collapse
Surfactant
Cells that will undergo biological pathways of PROTEASE-ANTIPROTEASE IMBALANCE ECM DESTRUCTION
Macrophages
Cells that will undergo biological pathways of OXIDANT/ANTIOXIDANT IMBALANCE –> CHRONIC INFLAMMATION
Neutrophils
Cells that will undergo biological pathways of APOPTOSIS –> CELL DEATH
Epithelial Cells
Cells that will undergo biological pathways of LUNG REPAIR –> INEFFECTIVE REPAIR
Lymphocytes
Paradoxical inward movement of the rib cage with inspiration and a result of chronic hyperinflation
Hoover sign
Hallmark of COPD
airflow obstruction
Radiographic findings in COPD
EMPHYSEMA
obvious bullae
paucity of parenchymal markings
hyperlucency
The current definitive test for establishing the presence or absence of emphysema, the pattern of emphysema, and the presence of significant disease involving medium and large airways
Chest computed tomography (CT) scan
The STRONGEST SINGLE PREDICTOR OF EXACERBATIONS
history of a previous exacerbation
Pink puffers
emphysema
thin, non-cyanotic, prominent use of accessory muscles
Blue bloaters
chronic bronchitis
heavy and cyanotic
Signs of hyperinflation
barrel chest
hyperresonance on percussion
Severe cases - signs of cor pulmonale
bipedal edema
ascites
Spirometry
FEV1/FVC <0.70
REDUCED FEV1, FEC1/FVC
INCREASED TLC, FRC and RV (d.t. air trapping)
GOLD 1
FEV1 > 80% predicted
MILD
chronic cough and sputum production
patient unaware that lung function is abnormal
GOLD 2
FEV1 50 - <80% predicted
MODERATE
chronic cough and sputum production
SOB on exertion
patients seek medical attention
GOLD 3
FEV 1 30 - <50 % predicted
SEVERE
greater SOB
reduced exercise capacity
fatigue
repeated exacerbations
GOLD 4
FEV 1 < 30 % predicted
VERY SEVERE
signs and symptoms of respiratory failure (PaO2 <60 mmHg +/- PaCO2 > 50 mmHg)
cor pulmonale
Most prominent in the UPPER lobes and SUPERIOR segments of lower lobes
most frequently associated with CIGARETTE SMOKING
Centriacinar emphysema
Abnormally large air spaces evenly distributed within and across acinar units
α1AT deficiency
has a predilection for the LOWER lobes
Panacinar emphysema
abnormally large air spaces evenly distributed w/n and across acinar unit
significant airway inflammation and w/ centrilobular emphysema
Paraseptal emphysema
Clinically defined condition with chronic cough and phlegm
CHRONIC BRONCHITIS
Major site of ↑ resistance
SMALL AIRWAYS
Characteristic of COPD
Non-uniform ventilation and V/Q mismatching
The current DEFINITIVE TEST for establishing the presence or absence of emphysema
computed tomography (CT) scan
3 INTERVENTIONS WHICH IMPROVE SURVIVAL OF PATIENTS W/ COPD
smoking cessation
oxygen therapy in chronically hypoxemic patients
lung volume reduction surgery in selected patients with emphysema
PHARMACOLOGIC APPROACHES FOR SUCCESSFUL SMOKING CESSATION:
- bupropion
- nicotine replacement therapy available as gum, transdermal patch, lozenge, inhaler, and nasal spray
- Varenicline - a nicotinic acid receptor agonist/antagonist
Used for symptomatic benefit in patients with COPD
Bronchodilators
inhaled route – preferred
improves symptoms and produces acute improvement in FEV1
Ipratropium bromide
Beta Agonists
SABA – ease symptoms w/ acute improvement in lung function
LABA – symptomatic benefit and reduce exacerbations
tremor and tachycardia – main side effects
Inhaled Glucocorticoids
reduce exacerbations
S.E.
oropharyngeal candidiasis, pneumonia and loss of bone density
Reduce exacerbation frequency in patients w/ severe COPD, chronic bronchitis and prior history of exacerbations
Roflumilast
The only pharmacologic therapy demonstrated to unequivocally decrease mortality rates in patients with COPD
Supplemental Oxygen
