COPD Flashcards
COPD
Smaller airflow limitation not fully reversible (inflammation)
- inability to expire air
- includes: chronic bronchitis and emphysema
- results in hypoxemia, pulmonary HTN, and hypercarpnia
Chronic Bronchitis
cough for 3 or months in each of 2 successive yrs
- blue bloater
- dusky to cyanotic
- hypoxia and hypercapnia
- leads to R HF
Emphysema
destruction of bronchioles
- pink puffer
- high CO2 retention
- purse lip breathing
- dyspnea
COPD Risk Facotrs
- smoking
- occupational
- infection: HIV/tuberculosis
- Genetics: a-antitrypsin
- aging: ephysema
COPD Clinical Manifestations
- develops slowly
- cough, sputum, dyspnea
- early: intermittent cough
- fatigue
- tripod position
Mild COPD
> 80%
- reduction of RF
- flu vaccine
- SABA
Moderate
50-80%
- reduction of RF
- flu vaccine
- SABA & LABA
- rehab
Severe
30-50%
- reduction of RF
- flu vaccine
- SABA & LABA
- rehab
- corticosteroids
Very Severe
<30%
- reduction of RF
- flu vaccine
- SABA & LABA
- rehab
- corticosteroids
- O2 if respiratory failure
COPD Complications
- cor pulmonale
- exacerbations
- acute respiratory failure
- PUD
- Depression/anxiety
Cor Pulmonale
- hypertrophy of right side of heart
- result: pulmonary HTN
- leads to: R HF
- dyspnea
Exacerbations
- change in dyspnea, cough, sputum
- cause: bacterial/viral infection
- severe: accessory muscles
Diagnosis
pulmonary function tests -chest xray -spirometry -history & physical CAT 6 min walk
Spirometry findins
reduced FEV/FVC ratio
increased residual volume
ABG findings
low O2
high PaCO2 & pH
high bicarbonate: late stages
Interprofessional care
- smoking cessation
- vaccines: flu & pneumonia
- avoid irritants
- T: short acting bronchodilators, corticosteroids, antibiotics, and oxygen
Bronchodilators
- relax smooth muscles
- ↓ Dyspnea and ↑ in FEV1
Inhaled Corticosteroids
ICS therapy is beneficial for patients with stage 3 (severe) or stage 4 (very severe) COPD
-combine with LABA
Antibiotics
- azithromycin
- prevent recurrent exacerbations
Phosphodiesterase inhibitor
Roflumilast (Daliresp)
-decrease the frequency of exacerbations in severe COPD
Hypoxia Symptoms
Early: RAT Restlessness Anxiety Tachycardia/pnea Late: BED Bradycardia Extreme restlessness Dyspnea (severe)
Respiratory and physical therapy
Breathing retraining; Decreases dyspnea, improves oxygenation, and slows respiratory rate
- pursed lip & abdominal breathing
- effective coughing
Chest physiotherapy is indicated for
Excessive, difficult-to-clear bronchial secretions
Retained secretions in artificial airway
Lobular atelectasis from mucous plug
Percussion & Vibration
P: Air-cushion impact facilitates movement of thick mucus
V: Facilitates movement of secretions to larger airways
