COPD very brief Flashcards

1
Q

Definition: COPD

A

COPD is an umbrella term, which is mainly associated with Emphysema and Chronic bronchitis. It is chronic progressive and irreversible characterised by blocked airflow and breathing difficulty.

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2
Q

Definition: Chronic bronchitis

A

is an inflammation of the lining of the bronchial tubes (trachea, bronchi, terminal bronchioles)

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3
Q

Definition: Emphysema

A

a destruction of the alveolar walls (creating bullae) and loss of lung elasticity resulting in a permanent enlargement of the alveoli

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4
Q

Damage to the lungs from COPD can’t be reversed, but treatment can help

A

control symptoms and minimize further damage

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5
Q

Assessment techniques: COPD

A
  • Percussion
  • Auscultation
  • Sputum
  • X-ray
  • Spirometry
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6
Q

PN (percission note): COPD

A

hyperresonant

[if atelectasis (consolidation) = dull]

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7
Q

Breath sounds: COPD

A

decreased … due to decreased air entry; excess aei in the lung filters sound

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8
Q

Added sounds: COPD

A

Crackles +/- Wheezes

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9
Q

Vocal resonance: COPD

A

normal or decreased

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10
Q

Sputum: COPD

A

white

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11
Q

X-ray: COPD

A
  • Hyperinflation (horizontal ribs)
  • Black (air)
  • Low flat diaphragm
  • Narrow heart … air compresses
  • ring shadows (= air filled bullae)
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12
Q

Spirometry: COPD

A
- FEV1/FVC ratio < 70% & FEV1 as below
>80% mild COPD
50-79% moderate, 
30-49% severe
<30% very severe
(GOLD COPD)
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13
Q

Treatment: COPD

A

SOB => Breathing control, Positioning (forward leaning)

Sputum => ACBT

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14
Q

why forward leaning position?

A

facilitates the abdominal contents to raise the anterior part of the diaphragm

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15
Q

TEE (thoracic expantion exercise)

A
  • Collateral ventilation

- Interdependence

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16
Q

Colateral ventilation

A

assists removal of secretions … air gets behind the secretions

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17
Q

Interdependence

A

increase lung volume … adjacent alveoli may assist in re-expansion of the lung tissues

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18
Q

BC (breathing control)

A

“diaphragmatic breathing” … shifting the WOB away from the rib cage and accessory muscles (relaxation of shoulder girdle and upper chest)

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19
Q

In the obstructed lung, respiration ends prematurely, thus increasing ___ and ___.

A

RV (Residual Volume), FRC (Functional Residual Capacity)

20
Q

In the restricted lung, volumes are small because inspiration is limited due to ______ compliance.

A

reduced

21
Q

In the restricted lung, the FVC is ____than normal, but the FEV1 is relatively _____ in comparison.

A

smaller , large
It is easy to breathe out quickly, because of the high elastic recoil of the stiff lungs (reduced compliance). (e.g fibrosis)
As a result, the FEV1/FVC ratio can be higher than normal, for example 90% (FEV1/FVC ratio >80% = Restrictive)
http://www.medicine.mcgill.ca/physio/vlab/resp/lungdiseases_n.htm

22
Q

In the obstructed lung, the FVC is _____ than normal, but also that FEV1 is much ______ than normal.

A

smaller, smaller
It is very difficult to exhale quickly due to the increase in airway resistance. (eg. asthma, COPD)
As a result, the FEV1/FVC ratio will be much lower than normal, for example 40% (FEV1/FVC ratio < 70% = Obstructive)
http://www.medicine.mcgill.ca/physio/vlab/resp/lungdiseases_n.htm

23
Q

During quiet breathing, expiration is passively driven by the elastic recoil of the lungs in healthy individuals, so in px with Emphysema (elastic recoil lost), forced or active expiration occurs as well as occurring during exercise. which muscle are used for that?

A

-abdominal muscles
-internal and innermost intercostal muscles “Back pocket” [pulls the rib cage down]
help expel air.
(External intercostal = “Front pocket” elevate the ribs, assist in deep inspiration by increasing the anterioposterior diameter of the chest)
(Accessory muscles are typically used during inspiration when the body needs to process energy quickly; when a breathing pattern disorder exists.)

24
Q

Definition: Bronchiectasis

A

an abnormal irreversible destruction and dilation of one or more bronchi, which has vicious cycle of infection and inflammation
(conducting zone: trachea, bronchi, terminal bronchioles), (damage to the bronchial wall = damage/ destroyed cilia => secretions accumulates => bacteria colonise)

25
Q

Progression of Bronchiectasis

A
  • Hypoxaemia (in severe cases)
  • Recurrent Pneumonia
  • Cor pulmonale (is enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance or high blood pressure in the lungs)
26
Q

Pathophysiology: Bronchiecctasis

A

Due to the damaged airway walls, mucociliary escalator becomes damaged or destroyed, leading to pool mucus in pockets of dilated airways (bronchioles) [Inflammation also increases secretions (mucus)]. As a result, bacteria begins to colonise, and resulting in repeated infection and inflammation (daily risk of infection).

27
Q

Definition: Cystic fibrosis

A

an inherited autosomal recessive single gene defect, which is chronic progressive and irreversible.
(defect for CF lies on chromosome 7 - the CFTR gene)
(an extra copy of chromosome 21 = Down syndrome)

28
Q

In NZ, approximately __ in __ Caucasians will be a abnormal CFTR gene “carrier”. More than ____ children and adults in NZ with CF. If both parents carry the gene, each children born has a ___ in ___ chance of inheriting the condition.

A

1 in 25, 500, 1 in 4

29
Q

Pathophysiology: Cystic fibrosis

A

The defective CFTR protein affects the chloride, sodium and water movement across the epithelium, causing abnormally thick mucus secretion, resulting in impaired mucociliary clearance. It encourages bacteria to colonise leading to infection. These factors increase resistnace to ventilation, resulting in impaired gas exchange; therefore, the body increases RR to increase minute ventilation causing SOB.

30
Q

Definition: Pneumonia

A

an acute infection of the alveoli due to a viraety of bacteria, virus or fungi, and can occur as a secondary complication of surgery or mechanical ventilation.

31
Q

Pneumonia is usually classified into two types

A
  • Community acquired pneumonia

- Hospital acquired pneumonia … hospitalised for more than 2 days in the last 90 days

32
Q

Typical pneumonia (there is also Atypical)

A

acute onset with fever (>38), chills and a productive cough

dry cough, fever, sore throat and headache

33
Q

Categorisation of pneumonia from the “site”

  • Lobar pneumonia
  • Bronchopneumonia
A
  • affects one or more lobes of the lung caused by Steptococcus pneumonia (80%); younger adults
  • acute inflammation of the walls of the bronchioles; infants, young children, elderly
34
Q

Risk factors: Pneumonia

A

Environment factors: exposure to cigarette smoke, lack immunisation, poor nutrition, poor housing, over-crowding, reduced access to primary health care
Underlying conditions: Chronic lung disease (CF, Asthma, Bronchiectasis), Chronic health condition (diabetes, heart failure, cancer), Age (75), HIV, reduced rate of breast feeding

35
Q

Epidemiology: pneumonia is the leading cause of death in children worldwide killing ___ million children a year.
Those less than __ yrs or over __ yrs have the highest rates of mortality. NZ has high rates, and ____ times more prevalent in Maori than non-Maori.

A

1.1 million, 6yrs, 75yrs, 3 times

36
Q

Pathophysiology: Pneumonia

A

as a consequence of infectious pathogens, an inflammatory response occurs resulting in proliferation of neutrophils which damages lung tissue, and can lead to pulmonary oedema and fibrosis as well as reduced lung expansion. This inflammatory response can lead to pleural effusion, which can result in lobar collapse or emphyma. Therefore px with pneumonia, gas exchange is reduced, resulting in increase of RR and HR , which may lead to hypoxaemia.

37
Q

Progression: Pneumonia
Uncomplicated pneumonia usually shows improvement within __ - __ hrs of antibiotic treatment and continue to improve over time. The antibiotics must be continued for the full course of __ days

A

24 - 48hrs, 7 days

38
Q

PT management: Pneumonia

A
  • Optimise V/Q (to prevent hypoxaemia)
  • Secretion clearance if present
  • Mobility assessment
39
Q

Chronic Hypoxaemia leads to

A
  1. Polycythaemia (incr RBC = thick blood => try to give more O2)
  2. Pulmonary hypertension
  3. Right ventricular hypertrophy
  4. Cor pulmonale (right sided heart failure form long term pulmonary hypertension)
  5. Systemic congestion
40
Q

Antibiotics: first line antibiotic for Pneumonia

A

Amoxicillin 500mg - 1g three times daily for 7 days

41
Q

Pathophysiology: Chronic bronchitis

A

Mainly due to the toxin from Tabaco, the airways are inflamed, and causing hypertrophy and hyperplasia of the mucus gland; hyper secretion of mucus; dysfunctional cilia, resulting in impaired mucociliary clearance. These factors increase resistance to ventilation, which leads to air flow obstruction, and resulting in impaired gas exchange. Therefore the body increases respiratory rate to increase minute ventilation causing SOB.
It also causes cough that is productive and chronic, as the body attempts to open and clear the airways of particles and mucus or over reaction to ongoing inflammation (cough assists in sputum clearance).

42
Q

Pathophysiology: Emphysema

A

Mainly due to the long term exposure to toxin from Tabaco, inflammation becomes chronic and causes thickening and destruction of the alveolar walls, which leads to form bullae, resulting in a reduction in surface area available for gas exchange.
Moreover, the alveolar walls lose its elasticity and surfactant, leading to floppy air ways, and air becomes trapped in these spaces of damaged lung tissues.
As a result, the lungs slowly enlarge and breathing requires more effort as there is no elastic recoil.
Hence, due to hyperinflation body increases respiratory rate to increase minute ventilation causing SOB.

43
Q

Pathophysiology: asthma

A

Asthma attack can be triggered by multiple factors, such as dust, animal hair, pollen, grass, mold, exercise, cold air, stress, and certain cells lining the airways release multiple inflammatory mediators (histamine, nitric oxide). Then the inflammation in the airways cause bronchospasm, vascular congestion, excessive mucus production, thickening of air way walls, which increase resistance to ventilation, leading to air flow obstruction, resulting in impaired gas exchange. Therefore, on exertion the body increases respiratory rate to increase minute ventilation resulting in SOB.

44
Q

Epidemiology: COPD

A
  • more common in men (who smoke/ exposed to inhaled polution)
  • 14% of NZers >40yrs have COPD
45
Q

Epidemiology: Bronchiectasis

A
  • 3.7/ 100, 000 children per year in NZ
  • 1 in 3000 children in NZ gets bronchiectasis
  • 80% are Maori or Pacific Islanders
46
Q

Epidemiology: CF

A
  • > 500 children and adults in NZ

- 1 in 25 caucasians will be a “carrier” in NZ