Dyspnea Flashcards
What interventions would reduce the exacerbations of COPD?
- Smoking cessation
- Long acting bronchodilator
- Inhaled corticosteroid
- Influenza vaccine
What are the two most common causes of dyspnea and wheezing in adults?
- COPD
- Asthma
Describe the typical presentation of asthma.
- Asthma => begins earlier in life, may/not associated with cigarette smoking, episodic exacerbations with return to normal baseline lung functioning
Describe the typical presentation of COPD.
- COPD => present in midlife or later, usually result of long term smoking, progressive disorder, pulmonary function never return to normal
What are the mainstays of acute asthma and COPD exacerbations?
- Oxygen
- Bronchodilators (beta 2 agonist for rapid bronchodilation)
- Steroids
What clinical signs of dyspnea should be noted in patients who complain of SOB?
- Hypoxemia => cyanosis of the perioral region or digits
- Pulse oxygen should be taken
What are the various classes of bronchodilators?
- Beta 2 agonists => rapid bronchodilation and reduce airway obstruction
- Anticholinergic agents (ipratropium) => may work synergistically with the beta 2 agonist
- Corticosteroids act to reduce the airway inflammation that underlies the acute exacerbation
Define chronic bronchitis.
- Cough and sputum production on most days for at least 3 months during at least 2 consecutive years
Define emphysema.
- SOB caused by the enlargement of respiratory bronchioles and alveoli caused by destruction of lung tissue
What are other etiologies of COPD apart from smoking?
- Second hand smoke
- Occupational exposures to dusts or chemicals
- Alpha1 antitrypsin (rare, but more common in whites) => when emphysema develops
What pathologic changes are associated with COPD?
- mucous gland hypertrophy with hypersecretion
- ciliary dysfunction
- destruction of lung parenchyma
- airway remodeling
- All resulting in narrowing of the airways/airway obstruction, poor mucous clearance, cough, wheezing, and dyspnea
What are symptoms of COPD?
- Daily cough that can be productive of white, thick mucus
- Cough may worsen and produce yellow/green mucus
- Wheezing
- Exacerbations often with viral/bacterial infections
- Dyspnea (represents a decrease in lung function by 1/2)
What are signs of advanced COPD?
- Barrel chest => increased anteroposterior chest diameter
- Distant heart sounds=> hyperinflation of the lungs
- Distant breath sounds
- Prolonged expiratory wheezes
- Use accessory muscles to breath, tachypneic
- Hypoxic
What are the xray findings in COPD?
- Unless the COPD is severe there will be NO xray findings (normal)
- In severe cases: hyperinflation of the lungs, increased posteroanterior diameter, flattening of diaphragms, and bullae
What normal, age related changes are seen in spirometry?
With normal aging FVC and FEV-1 both decrease => the FVC/FEV-1 ratio is >0.7
Describe the type of COPD and treatment:
- FVC/FEV-1 ration 80% predicted
- With or w/o symptoms
Mild COPD => short acting bronchodilator
- beta 2 agonists => albuterol
- anticholinergics => ipratropium
Describe the type of COPD and treatment:
- FVC/FEV-1 ration
- Moderate COPD => long acting bronchodilator
- beta 2 agonists => salmeterol
- anticholinergics => tiotropium
- Oral methylxanthines => phylline and theophylline (higher toxicity)
Describe the type of COPD and treatment:
- FVC/FEV-1 ration
- Severe COPD => inhaled steroids
- Fluticasone, triamcinolone, mometasone
Describe the type of COPD and treatment:
- FVC/FEV-1 ration
- Very severe COPD => Consider oxygen therapy
- oxygen is the only therapy known to decrease mortality and must be worn 15hrs/day
What is the benefit of smoking cessation to a patient with COPD?
- Smoking cessation reduces the rate of further deterioration to that of a nonsmoker
What vaccines should all COPD patients receive?
- Pneumococcal and annual flu vaccinations
What are common precipitants of acute COPD exacerbations?
- Viral or bacteria infections
- Be careful to exclude => pulmonary embolism, CHF, and MI
What are the most common bacteria implicated in purulent COPD exacerbations?
- Pneumococcus
- Haemophilus influenzae
- Moraxella catarrhalis
- Klebsiella
- Pseudomonas
