COPD, D Kinder, DSA Flashcards
onset COPD
middle age or elderly 20-30 yrs after exposure
what is leading cause of COPD
smoking
what other exposures can lead to COPD
workplace dusts from mining, cotton mills and grain handling facilities
what is genetic predisposisition to COPD
alpha 1 antitrypsin deficiency
emphysema
enlargement of air spaces distal to terminal bronchiole with destruction of alveolar wlals
imbalance of elastase anti-elastase in lungs
what is centriacinar emphysema
respiratory bronchioles distal to terminal bronchiole and the remainder is spared
smoking
what is pancacine emphysema
alveolar ducts, adjacent alveoli coalescence and bullae formation
common in alpha 1 antitrypsin deficiency
occurs with smoking
what is most severe form of COPD
combined centriacinar and panacinar
what is chronic bronchitis and bronchiolitis
enlargement of bronchial mucous glands and increased epithelial goblet cell production leads to cough and icnreased mucous production
how does emphysema lead to pulmonary HTN
hypoxemia leads to vasoconstriction and increased pulmonary vascular R in small pulmonary aa
leads to vascular remodeling including medial smooth mm enlargement and intimal fibrosis
What happens to elastic recoil in COPD
decreased and airway resistance is increased
what acid base can COPD lead to
hypercapnea so respiratory acidosis
What is significatn in Hx for COPD
current or past smoking, dyspnea with slow progression, Hx of acute bronchitis, chronic cough sputum production and wheezing
What are physical findings of COPD
barrel chest, prolonged expiratory phase, accessory muscle use, low diaphragm, distant heart sounds, diminished breath sounds, rhonchi, wheezing, cyanosis, pedal edema, distended jugular veins, hepatic congestion and cachexia
Stage I PFT for COPD
mild FEV1/FVC 80%
Stage II PFT for COPD
moderate FEV1/FVC <80%
Stage III PFT for COPD
severe FEV1/FVC <50%
Stage IV PFT for COPD
very severe FEV1/FVC <50% plus chronic respiratory failure
CXR for COPD
hyperinflation, flattened diaphragm, increased retrosternal space, bullae
Ddx for COPD
asthma, bronchiectasis, bronchiolitis obliterans
Tx COPD
stop smoking
bronchodilators
What bronchodilator can increase FEV1 by 50 ml and reduce COPD excacerbations
phosphodiesterase 4 inhibitors
roflumilast
Why is O2 Tx helpful in COPD
chronic hypoxemia can lead to pulm HTN and cor pulmonale
What additional immunizations should patients with COPD receive
influenza and pneumococcus
what are surgical options for COPD
lung volume reduction surgery used in severe emphysema in upper lobes
lung transplanataion for severe incapacitation must have no other comorbidities
What is a COPD exacerbation
dyspnea, cough and productive sputum that is worse than usual
What type of infections are more common with COPD
H influenze, S penumoniae, M catarrhalis
Pseudomonas and enteric bacilli
Viral: rhinovirus, influenza, parainfluenza, respiratory syncytial virus
what do you hospitalize COPD patients for
dyspnea, accessoyr muscle use, ABG, hemodynamic stability
antibiotics if purulent sputum
systemic corticosteorids
increase short acting bronchodilator frequency
O2 maintained 90% sat
noninvasive +pressure ventilation
prognosis COPD
50% patients with FEV1 40% survive 5 yrs
smoking cessation reduces mortality in patients with mild to moderated COPD
O2 reduces mortality in subset with chronic hypoxemia
