Emphysema and COPD

Question 1

Emphysema changes in the lungs

Answer 1

Anatomical changes in the lungs characterized by hyperinflation especially at the alveolar level

Break down of capillary wall

Blebs (balloon like stretched out alveoli) when stressed can cause a pneumothorax

Question 2

Causes of emphysema

Answer 2

Cigarette smoking or other irritants ↑ macrophages and neutrophils in the lung leading to alveolar destruction
Rarely, caused solely by inherited deficiency of Alpha-1 antitrypsin (protects elastic prop of lung)
Alveoli lose elastic recoil, air is trapped, gas exchange is impeded
Pockets of air form between the alveolar spaces (blebs) or within the parenchyma (bullae)

Question 3

Pathogenesis of emphysema

Answer 3

Cigarette smoking

Leads to a disruption of the elastic fiber network

Lungs have ↑ compliance coupled with ↓
elasticity

Leads to air trapping

Remember we rely on elastic recoil to drive normal, unforced exhalation

lungs get stretced out and cant snap back
loss alveolar rebound as well

Question 4

Do all smokers develop COPD?

Does all COPD come from smoking?

Answer 4

No, only about 20%

Sort of 85% to 90% of emphysematics have a history of smoking

Question 5

Clinical Picture of Emphysema

Answer 5

DOE → Dyspnea at rest

Cough but have scant production (mucus plugs)

Thin (cachectic), eating effortful

Tachypneic with prolonged exhalation

Use accessory muscles for ventilation

Typical posture braced on knees

Barrel Chest

ANXIOUS

Question 6

Emphysema and Polycythemia: ↑ production of RBCs, why?

Answer 6

need more RBC to carry the limited O2

Question 7

COPD X-ray looks like

Answer 7

See hyperinflation, flattening of diaphragm

Costophrenic angle becomes less acute

blacker (hyperlucency)

Question 8

PFT and COPD

Answer 8

Obstructive Components will see: Air trapping, Increased RV and disproportionate

Reduction in the FEV1 as compared to the FVC (FEV1/FVC ratio on a PFT) are the hallmarks of obstructive lung disease

will see an inc. in residual volume → TLC increases

(amount someone can expel in 1 second / amount they can expell entirely) FEV1/FEVC is much less in someone with emphysema

Question 9

PFT and restrictive lung disease

Answer 9

reminder that everything is reduced in restrictive - tlc is well under what it should be despite the percentage being normal

Question 10

*what abg with someone have with copd or emphysema

Answer 10

The pCO2 rises because of the retention of CO2
This drives the pH down (lower #s are more acid)

The HCO3 (bicarbonate produced by the kidneys) also rises to attempt to balance the pH

Typically resulting in:
Respiratory acidosis with partial metabolic compensation

Question 11

Emphysema Pharmacology

Answer 11

Lots of overlap with asthma meds (remember, asthma and COPD can coexist)

Beta-2 selective agonists frequently prescribed (both short and long acting)

Inhaled corticosteroids frequently prescribed

Anticholinergics: (Spiriva, Atrovent) bind competitively at acetylcholine receptor sites, long lasting
(Pts frequently c/o dry mouth)

Mucolytics like Mucomyst thin secretions to aid with expectoration, pulmonary toileting

Question 12

Recommendations for treatment of COPD staging

Answer 12

FEV1/FEC ratio less than 70

then you just look as fev1 for staging
<80 - Mild
50-80 - Mod
30-50 - severe
under 30 - very severe (discuss surgery)

Question 13

Should people with COPD take deep breaths

Answer 13

NO

Question 14

Role of PT and emphysema

Answer 14

Advocate smoking cessation
Teach energy conservation
Teach breath control, PLB
DO NOT ASK THESE PATIENTS TO TAKE DEEP BREATHS
Teach controlled huffing, active cycle of breathing, forced expiration technique

Question 15

Is COPD a disease

Answer 15

COPD IS NOT A DISEASE IN ITSELF

IT IS A DESCRIPTIVE DIAGNOSIS

A BLANKET TERM WHICH CAN BE USED TO REFER TO CHRONIC BRONCHITIS OR EMPHYSEMA ALONE OR IN COMBINATION