COPD Part 1 Flashcards
is a preventable and treatable slowly progressive respiratory disease of airflow obstruction
Chronic Obstructive Pulmonary Disease
COPD involves
airways, pulmonary parenchyma, or both
parenchyma includes any form of lung tissue, including
Bronchioles, bronchi, blood vessels, interstitium and alveoli
Is copd reversible?
Irreversble, not fully reversible
Most patients with COPD present with overlapping signs and symptoms of _____ that can cause airflow obstruction
emphysema and chronic bronchitis
Other diseases classified as COPD
cystic fibrosis (CF), bronchiectasis, and asthma
are the fourth leading cause of death for people of all ages in the United States
COPD and lower respiratory diseases
they are the third leading cause of death for people ages 65 and over
COPD and lower respiratory diseases
What age do COPD become symptomatic
Middle adult years, disease increases with age
COPD inflammatory response occurs throughout
Proximal airway and peripheral airway, and lung parenchyma and pulmonary vasculature
a disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years.
Chronic bronchitis
imbalances of these substances in the lung may also contribute to airflow limitation
Proteinases and antiproteinases
play an important role in destroying foreign particles, including bacteria.
Macrophages
impaired oxygen and carbon dioxide exchange results from destruction of the walls of overdistended alveoli.
Emphysema
is a pathologic term that describes an abnormal distention of the airspaces beyond the terminal bronchioles and destruction of the walls of the alveoli
Emphysema
one of the complications of emphysema, is right-sided heart failure brought on by longterm high blood pressure in the pulmonary arteries.
Cor pulmonale
high pressure in the pulmonary arteries and right ventricle lead to back up of blood in the venous system, resulting in
dependent edema, distended neck veins, or pain in the region of the liver
two main types of emphysema, based on the changes taking place in the lung. Both may occur in same pt.
Panlobular (panacinar) and Centrilobular (centroacinar)
panlobular (panacinar) type of emphysema, there is destruction of the
respiratory bronchiole, alveolar duct, and alveolus
All airspaces within the lobule are essentially enlarged, but there is little inflammatory disease.
Panlobular (panacinar)
Typically occurs with panlobular emphysema
hyperinflated (hyperexpanded) chest, marked dyspnea on exertion, and weight loss
Instead of being an involuntary passive act, expiration becomes active and requires muscular effort.
Panlobular emphysema
pathologic changes take place mainly in the center of the secondary lobule, preserving the peripheral portions of the acinus
Centrilobular (centroacinar)
the terminal airway unit where gas exchange occurs
Acinus
Centroacinar emphysema has a derangement of ventilation–perfusion ratios, producing
chronic hypoxemia, hypercapnia, polycythemia and episodes of right-sided heart failure which leads to central cyanosis and respiratory failure. The patient also develops peripheral edema
Risk factors for COPD include
environmental exposures and host factors
The most important environmental risk factor for COPD worldwide is
cigarette smoking
environmental risk factors
smoking other types of tobacco (e.g., pipes, cigars) and marijuana
Secondhand smoke
prolonged and intense exposure to occupational dusts and chemicals
indoor air pollution, and outdoor air pollution
electronic nicotine delivery systems
low socio economic status
Host risk factors
person’s genetic makeup
* alpha1-antitrypsin deficiency
*gene–environment interactions
Age
depresses the activity of scavenger cells and affects the respiratory tract’s ciliary cleansing mechanism, which keeps breathing passages free of inhaled irritants, bacteria, and other foreign matter
Smoking
irritates the goblet cells and mucous glands, causing an increased accumulation of mucus, which in turn produces more irritation, infection, and damage to the lung
Smoking
by-product of smoking
Carbon monoxide
a by-product of smoking combines with hemoglobin to form
carboxyhemoglobin
an enzyme inhibitor that protects the lung parenchyma from injury. This deficiency may lead to lung and liver disease.
alpha1-antitrypsin deficiency
How many percent of people with COPD have been diagnosed with this deficiency
2%
This deficiency predisposes young people to rapid development of lobular emphysema, even in the absence of smoking.
alpha1-antitrypsin deficiency
slows the progression of the disease, is available for patients with this genetic defect and for those with severe disease.
Alpha-protease inhibitor replacement therapy,
often identified as a risk factor for COPD, but it is unclear whether is an independent risk or whether the risk is related to cumulative exposures to risks over time
Age
at risk for increased patterns of exposure (indoor and outdoor pollutants, crowding, poor nutrition, infections, and increased smoking).
lower socioeconomic status
three primary symptoms
chronic cough, sputum production, and dyspnea
often precede the development of airflow limitation by many years.
Chronic cough and sputum production
may be severe and interfere with the patient’s activities and quality of life. It is usually progressive, worse with exercise, and persistent.
Dyspnea
is common, because dyspnea interferes with eating and the work of breathing is energy depleting
Weight loss
This configuration results from a more fixed position of the ribs in the inspiratory position (due to hyperinflation) and from loss of lung elasticity
“barrel chest” thorax configuration
systemic or extrapulmonary manifestations of COPD
musculoskeletal wastingmetabolic disturbances, and depression
a frequent comorbidity that accompanies chronic debilitating illnesses
Depression
are frequent comorbidities of COPD
depression, metabolic syndrome, and diabetes
may ameliorate metabolic syndrome, diabetes, and depression may also deter the development of COPD
promote healthy eating and activity
Cinical manifestations
chronic cough, sputum production, and dyspnea
Weight loss
Use of accessory muscles
Barrel chest
musculoskeletal wasting, metabolic disturbances, and depression
Diabetes
are recruited in an effort to breathe as the work of breathing increases over time
Use of accessory muscles
