COPD and Bronchiectasis Flashcards
what does COPD include and how is it characterized?
COPD: includes chronic bronchitis (inflammation/excess mucus) and emphysema (damaged alveoli)
*note it’s really a spectrum
characterized by irreversible airflow obstruction and persistent inflammation
how is chronic bronchitis characterized, and who is primarily affected?
chronic cough + sputum production for at least 3 months per year for 2 consecutive years
men more commonly affected, primary risk factor is smoking
describe the pathophysiology of chronic bronchitis
mucous metaplasia - difficulty in clearing secretions because of poor ciliary function, distal airway occlusion, and ineffective cough secondary to respiratory muscle weakness and rescued peak expiratory flow
mucus hyper-secretion obstructs airways and alters airway surface tension (predisposes to expiratory collapse)
abnormal permanent enlargement of the air space distal to the terminal bronchioles
emphysema - accompanied by destruction of bronchioles
lysis of lung tissue by proteolytic enzymes from neutrophils and macrophages
how does tobacco contribute to the development of emphysema?
free radicals (ROS) inactive antiproteases —> “functional” alpha anti-trypsin deficiency —> enhanced elastase production by neutrophils —> tissue damage distal to terminal bronchioles —> emphysema
describe the structural changes that occur in emphysema
destruction of alveoli capillary walls —> reduced surface area for gas exchange
narrowed/tortuous small airways
loss of lung elasticity (= loss of recoil, air is trapped) —> hyperinflation of alveoli (compensate with increased ventilation, which makes condition worse)
centrilobular vs panlobular emphysema
centrilobular: central part of lobule, most common
panlobular: destruction of whole lobule, usually associated with anti-alpha-trypsin (AAT) deficiency
which patients will experience hypoxemia earlier, those with chronic bronchitis or emphysema?
chronic bronchitis is a diffuse disease - hypoxemia develops earlier
patients with emphysema will develop hypoxemia later (gradual destruction of alveoli)
how will chronic bronchitis vs emphysema affect the V/Q ratio?
chronic bronchitis (diffuse disease): perfusion of under-ventilated areas results in low V/Q ratio and subsequent physiological shunt
emphysema: increased ventilation of poorly perfused lung units results in HIGH V/Q ratio and increased physiological dead space
what are 4 major complications of COPD?
- pulmonary HTN
- cor pulmonale (RV failure)
- pneumonia
- acute respiratory failure
how is pursed-lip breathing and diaphragmatic breathing used in respiratory therapy for COPD patients?
pursed-lip breathing: prolongs exhalation and prevents bronchiolar collapse/air trapping
diaphragmatic breathing: focuses on using diaphragm instead of accessory muscles to achieve max inhalation and slow respiratory rate
match the following with either chronic bronchitis or emphysema:
a. earlier presenting age
b. severe/early dyspnea
c. copious sputum
d. common infections
e. terminal respiratory insufficiency
f. common cor pulmonale
g. prominent vessels/ large heart
h. “pink puffer”
a. earlier presenting age - chronic bronchitis
b. severe/early dyspnea - emphysema
c. copious sputum - chronic bronchitis
d. common infections - chronic bronchitis
e. terminal respiratory insufficiency - emphysema
f. common cor pulmonale - chronic bronchitis
g. prominent vessels/ large heart - chronic bronchitis (small heart in emphysema)
h. “pink puffer” - emphysema (chronic bronchitis is “blue bloater”)
permanent and abnormal widening of the bronchi
bronchiectasis: destruction of bronchi causes dilation, small airways are obstructed from inflammatory infiltrate
occurs in context of chronic airway infection and inflammation
congenital conditions such as cystic fibrosis, intralobar sequestration of the lung, immunodeficinecy, and primary ciliary dyskinesia are all possible etiology of which lung disease?
bronchiectasis: destruction of bronchi causes dilation, small airways are obstructed from inflammatory infiltrate
abnormal mucus clearance (stasis) —> bacterial colonization —> neutrophil inflammation/ elastase —> bronchial destruction
