Lecture 5 - COPD Flashcards
T/F
COPD is a common, preventable and treatable disease
T
T/F
COPD is fully reversible and progressive
F
Not reversible
COPD is associated with an abnormal response?
Inflammatory response of the lung to noxious particles or gases
COPD is caused primarily by what?
by cigarette smoking, air pollution: wood burning + other biomass fuels also identified as risk factors
T/F
COPD includes asthma
F
In obstruction disease yes, not in copd
What are the dx symptoms of copd?
- cough
- sputum
- dyspnea
- hx of exposure to risk factors for the disease
what are the risk (8) factor of copd?
Exposure to particles:
Tobacco smoke
Environmental and occupational exposure to particulate matter, i.e. pollution
Host factors:
Genes (alpha-1-antitripsin deficiency)
Hyperresponsiveness
Other factors: Respiratory infections, asthma, TB Lung Growth and Development Gender, age>65 years, socioeconomic status Nutrition
What are FEV1/FVC and FEV1 values for stage I - IV of COPD
All: fev1/fvc <0.70 FEV1 I (mild): FEV1: 80+% II (moderate): 50< <80 III (severe): 30< <50 IV (very sev): <30 OR <50 +chronic resp failure
What are the s/s in stage I copd?
Chronic cough & sputum production may be present (not always).
Individuals usually unaware that lung function is abnormal.
What are the s/s in stage II copd?
SOB on exertion
Cough & sputum sometimes present.
Patients typically seek medical attention because of chronic respiratory symptoms or exacerbation of their disease.
What are the s/s in stage III copd?
Greater SOB, decr exercise capacity, fatigue, repeated exacerbations
-> decrHRQoL.
What are the s/s in stage IV copd?
May lead to cor pulmonale (R heart failure) : incr jugular venous pressure; pitting ankle edema.
Decrease HRQoL - exacerbations may be life threatening.
What are the extra pulmonary s/s of copd?
Weight loss: cachexia
Skeletal muscle dysfunction decreased muscle mass and increased weakness - apoptosis and/or muscle disuse decrease proportion of type I fibers increase proportion of type II fibers decrease oxidative enzyme activity
What are the factors (5) contributing to extra-pulmonary effects in COPD
Negative nutritional balance Oral corticosteroids Physical inactivity Hypoxemia: oxidative stress Systemic inflammation
What are the co-morbid conditions (8)
MI, angina Osteoporosis, bone fractures Respiratory infection, lung Ca Depression Diabetes Sleep-disorders Anemia Glaucoma
How is emphysema anatomically defined (2) ?
Permanent enlargement of the airspaces distal to the terminal bronchioles
Destructive changes of the alveolar walls and without obvious fibrosis.
The destruction of interstitial lung tissue supporting the lung and bronchi results in what (5)?
Airway collapse during expiration Air trapping distally Increased FRC Decreased lung elastic recoil Uneven distribution of ventilation
T/F in COPD the air is trapped proximally?
F distally
The centriacinar touches A) acinus B) LL C) alveolar ducts & sacs D) UL E) superior segment
Centrilobular (centriacinar): resp bronchioles, ULs and superior segments LLs
The panacinar touches A) acinus B) LL C) alveolar ducts & sacs D) UL E) superior segment
Panlobular (panacinar): acinus, LLs
The paraseptal touches A) acinus B) LL C) alveolar ducts & sacs D) UL E) superior segment
Paraseptal: alveolar ducts and sacs, LLs
When the spaces are greater than ?? cm (may go to ?? cm) called bullae, and called bullous emphysema.
When the spaces are greater than 1 cm (may go to 10 cm) called bullae, and called bullous emphysema.
Emphysema: what are the findings with auscultations?
decreased breath sounds
prolonged expiratory phase
no adventitious breath sounds
Comment on characteristics of emphysema concerning:
Body
Cough
Respiration and chest observation
Thin
No cough or a mildly productive cough
Very dyspneic
Use accessory muscles of breathing
Paradoxical indrawing of the lower margins of the rib cage
Hyperinflated
Barrel-shaped chest- ie. increased anterior to posterior chest diameter
