CPP - COPD Flashcards
Chronic excessive mucus production, resulting from an increase in the number and size of mucus glands and goblet cells. Symptoms are a cough and increased mucus production for at least 3 months of the year for more than 2 consecutive years. Males are most commonly affected.
Chronic Bronchitis
It is derived form the cyanosis, and is commonly seen in the patient with Chronic Bronchitis
Blue Bloater (Type B COPD)
Cyanosis or Bluish Complexion is CAUSED by the following:
- Chronic bronchitis responds to the increased airway obstruction by decreasing ventilation and increasing cardiac output.
- The persistent low V/Q ratio and depressed respiratory drive both contribute to a chronically reduced arterial oxygenation level and polycythemia that turn in causes CYANOSIS.
Major pathologic or structural changes are associated with Chronic Bronchitis.
a. Chronic inflammation and thickening of the walls of the peripheral airways.
b. Excessive mucous production and accumulation.
c. Partial or total mucous plugging of the airways.
d. Smooth muscle constriction of bronchial airways (Bronchospasm) - a variable finding.
e. Air trapping and hyperventilation pf alveoli may occur in late stages.
Pathophysiology of Chronic Bronchitis
a. Increase in the size of mucus glands
b. Increase in the number of goblet cells
c. Inflammation of bronchial walls
d. Mucus plugs in peripheral airways
e. Loss of cilia
f. Emphysematous changes in advanced stages of
disease
g. Narrowing airways, leading to airflow limitation
Clinical signs and symptoms of Chronic Bronchitis
a. Cough with sputum production
b. Dyspnea on exertion progressing to dyspnea
with less effort
c. CO2 retention and hypoxemia in advanced
stages
d. Increased pulmonary vascular resistance (PVR)
in advanced stages
e. Increased Hb level, Hct, and RBC count in
advanced stages
f. Cor pulmonale in advanced stages
g. Breath sounds: coarse crackles and wheezes
Characteristics of pulmonary function studies of Chronic Bronchitis
a. None in early disease
b. Increased RV
c. Decreased FEV1
d. Decreased expiratory flow rates
Two most common risk factors affecting COPD
a. Smoking
b. Al[ha-1 antitrypsin (AAT) deficiency
Risk factors (High-risk of developing COPD )
- gene
- Age
- Lung Growth & development
- Exposure to particles
Abnormalities of Chronic Bronchitis (X-ray)
- Flattened Diaphragm
- Hyperlucent, Darkening (Represents air)
- Enlarge Heart
- Tear-shaped heart
Auscultative for COPD
- Diminish breath sound
- crackles, discontinuous sound
- Rhonchi
- Wheezes
An abnormal, irreversible dilation of
the bronchi caused by destructive and inflammatory
changes in the walls of the airway
Bronchiectasis
Causes of Bronchiectasis
- Chronic respiratory infections
- TB lesion
- Secondary to cystic fibrosis
- Bronchial obstruction
a permanent abnormal enlargement
of the air spaces distal to the terminal bronchioles,
associated with destructive changes of the alveolar
walls
Emphysema
(1) The acinus is the anatomic gas exchange
unit of the lung, made up of the respiratory
bronchiole, alveolar duct, alveolar sacs, and
the alveoli.
(2) The entire acinus is involved.
(3) There is significant loss of lung parenchyma.
(4) Alveoli are destroyed.
(5) Bullae are present.
(6) Usually is associated with emphysema resulting from a1-antitrypsin deficiency.
- MOST SEVERE
Panlobular (Panacinar) type
(1) Lesion is in the center of the lobules, which
results in enlargement and destruction of
the respiratory bronchioles.
(2) Usually involves the upper lung fields and
is most commonly associated with chronic
bronchitis
Centrilobular (centriacinar)
(1) Emphysematous changes are isolated and
accompanied by the development of bullae,
which are weak air spaces and susceptible
to rupture
Bullous emphysema
- defined as air spaces in their distended state, more than 1 cm in diameter.
- is air pockets greater than one centimeter in the lung
parenchyma. .
Bullae
- defined as air spaces adjacent to
the pleura, usually less than 1 cm in diameter
in their distended state. - is the accumulations of air within the layers of the visceral pleura. This is usually smaller than bulla
Blebs
Alpha-1 Antitrypsin normal value
150 - 350 mg/dl or 1.5 - 3.5 g/L
If neutrophil is present in the lungs what will happen?
- It breakdown connective tissue of our lungs
What type of Emphysema is more common?
Centrilobular (Centroacinar)
What parts of the lungs does panlobular emphysema
affect?
Respiratory bronchioles,
Alveolar ducts, and
Alveolar sacs which are destroyed by ELASTASE.
What parts of the lungs does centrilobular emphysema
affect?
Respiratory bronchioles and upper lobes.
What can be observed in pulmonary function test on
patients with emphysema?
Decreased forced expiratory flow, increased total lung capacity, residual volume, and functional residual capacity, increased residual capacity over total lung volume and low diffusion.
How is emphysema similar to chronic bronchitis?
It is very similar, except the airways have obstruction due to the reduced elastic recoil of the lungs. The inspiratory flowrates are normal if the patient has pure emphysema. The patient has dyspnea initially only on exertion with it intensifying at variable rates until shortness of breath at rest.
What happens to alveolar walls in emphysema?
It enlarges and then degenerates.
What kind of damage of the alveoli does emphysema
cause?
Permanent and irreversible.
What position is best for clients with emphysema
under normal circumstances?
Semi-fowlers or higher.
What is the rare inherited deficiency of the protein that
protects the elastic function of lungs?
Alpha-1 antitrypsin deficiency; seen in emphysema.
What is the breath sounds associated with a severe
state of bronchiectasis?
Rales and rhonchi.
How does the pulmonary function test of a patient with
bronchiectasis show?
It can show obstructive patterns. Remember “CBABE”.
Bronchiectasis is a part of CBABE.
C - CYSTIC FIBROSIS B - BRONCHIRCTASIS A - ASTHMA B - CHRONIC BRONCHITIS E - EMPHYSEMA
What does the ABG show on a patient with mild to
moderate bronchiectasis?
The ABG will show respiratory alkalosis with hypoxemia
What are some common infections associated with
bronchiectasis?
Haemophilus influenzae, streptococcus, staphylococcus, pneumonia, moraxella catarrhalis, and pseudomonas in cystic fibrosis patients.
How do you diagnose bronchiectasis?
CT scan and a history of a chronic cough with sputum.
What will the spirometry results show for patients with
bronchiectasis?
Decreased Flow Rates (FEV1, FEV1/FVC, FEF25-75).
What pattern might spirometry show in a patient with
bronchiectasis?
Obstructive
What are the main symptoms associated with
bronchiectasis?
A persistent cough with purulent sputum, hemoptysis (may be
massive), fever, and weight loss
What is panlobular/pancinar emphysema?
Panlobular/Panacinar is an abnormal weakening and
enlargement of all air spaces distal to the terminal bronchioles.
It is related to alpha1-antitrypsin deficiency.
What is centrilobular/centriacinar emphysema?
Centrilobar/Centriacinar is the abnormal weakening and enlargement of the respiratory bronchioles and alveoli in the proximal portion of the acinus. It is related to inflammation. Most common.
Common factor of Centrilobular emphysema
Cigarrete smoking and Chronic Bronchiitis
What are pink puffers?
- Reddish complexion
- commonly seen in patient with Emphysema
- Weight loss
What happens when the lungs do not recoil properly?
Increased compliance (floppy airways), premature airway closure leading to air trapping, hyperinflation, and increased residual volume, functional residual capacity, and total lung capacity.
What are the shapes of the destroyed bronchial walls?
Varicose, fusiform, saccular, cystic and cylindrical.
What are the key anatomic alterations of rigid and
dilated bronchi?
Cylindrical bronchiectasis
What are the key anatomic alterations of irregularly
dilated and constricted bronchi?
Varicose bronchiectasis.
What is the other name for cystic bronchiectasis?
Saccular
The alpha 1 antitrypsin deficiency can lead to focal
bronchiectasis. How will the left lung pocket looks like
after a patient with alpha 1 antitrypsin deficiency 1 and 2 undergoes a CT scan?
The left lung’s pocket will show an abnormally large bronchi branch
Tuberculosis causes bronchiectasis as it damages the
airways. How will the CT scan look like for a patient post-tuberculosis bronchiectasis
The lower left lung will show evidence of a very local damage.
It is important to note that it is just a coincidence that all of these occurrences happen in the lower left lung.
