Respiratory Lecture: Lower respiratory tract condition – COPD and Asthma a Flashcards
Chronic Obstructive Pulmonary Disease
common preventable and
treatable disease, is characterised by persistent respiratory symptoms and airflow
limitation that is due to airway and /or alveolar abnormalities usually caused by
significant exposure to noxious particles or gases…
exacerbations
COPD may be punctuated by
periods of acute worsening of respiratory symptoms
Pathological changes characteristic of COPD
found in the airways, lung parenchyma and
pulmonary vasculature.
▪Progressive airflow limitation associated with an abnormal inflammatory response of the
lungs usually associated with noxious gas or particles.
▪Pathological changes include
inflammation, with increased numbers of specific
inflammatory cell types in different parts of the lung and structural changes resulting from
repeated injury and repair
Noxious particles and gases
Inflammation of central airways Peripheral airway Parenchymal destruction Pulmonary
Inflammation of central
airways
Inflammatory cells (lymphocytes, macrophages, neutrophils) • Inflammatory mediators
Peripheral airway
remodelling
Parenchymal destruction
Imbalance between
proteinase and
antiproteinase
Pulmonary vascular
changes
Thick vessels • Inflammatory cells infiltrate • Collagen disposition • Destruction of capillary bed
Noxious particles and gases lead to
COPD Pathology/characteristics • Mucus hypersecretion • Cilia dysfunction • Airflow limitation • Hyperinflation of lungs • Gas exchange abnormalities • Pulmonary hypertension • Cor pulmonale
Main characteristics of COPD
▪Airflow limitation and air trapping leading to hyperinflation ▪Gas exchange abnormalities ▪Mucus hyper secretion ▪Pulmonary hypertension ▪Exacerbations ▪Systemic features
COPD:
Symptoms
Breathlessness/dyspnoea • Cough • Sputum • Hypoxia • Fatigue • Depression • Chest pains • Oedema • Wheeze • Weigh loss and anorexia • Muscle weakness
: causes and risk factors
Genes Age and gender Lung growth and development Exposure to particles Asthma/bronchial hyper-reactivity Chronic Bronchitis Infections
Genes
- Deficiency of Alpha 1 antitrypsin, which is an inhibitor of proteases
- Gene:MMP12 – related to declining lung function
Age and gender
Age reflects a cumulative expose throughout life
• Men/Women prevalence almost equal.
• ? Women more susceptible to effects of tobacco smoke
Lung growth and
developmen
Any factor that affects lung growth during gestation and childhood has
potential for increasing individuals risk of developing COPD
• Low birth weight
Exposure to particles
Cigarette smoking (most common risk factor) • Occupational exposure – dust, chemicals, fumes • Indoor air pollution • Outdoor air pollution
Socioeconomic status
Poverty
How does smoking damage lungs
Irritates bronchioles and alveolar sacs damaging the lining
▪Damages the elastin in the lungs
▪Damages and eventually destroys the cilia
▪Cause chronic inflammation
▪Can trigger asthma attacks
COPD: Diagnosis
Full health history+ physical examination + Spirometry • General practice surgery, specialised laboratory or by a specialist. Other tests that may also be carried out include: • Gas transfer and lung volume tests • Blood tests • Sputum analysis • Chest x-ray • Computed tomography (CT) scan. • ECG
COPD
Management:
medical and
nursing
•Risk reduction Smoking cessation Occupational/environmental exposure •Pharmacological therapy •Management of Acute Exacerbations (change in baseline •Surgical Management ▪Referral for pulmonary rehabilitation -Patient education (breathing, vaccinations, smoking, nutrition, management plans and when to seek assistance, LTOT, Complications) -Breathing exercises -Activity pacing -Self care -Physical conditioning -Oxygen therapy -Nutritional therapy -Coping measures
Management of Acute Exacerbations (change in baseline)
Change in medication management (oral corticosteroids) ABG or VBG Spirometry Antibiotics Controlled Oxygen Therapy !!! (Acute or LTOT) may need BiPAP/CPAP if resp failure Refer to pulmonary rehabilitation
•Pharmacological therapy
Bronchodilators
Corticosteroids
Oxygen
COPD: affect
on mental
health and
quality of life
Adjustment to illness ▪Impact on person and their family ▪ Stress incontinence ▪ Travel restrictions ▪Depression and anxiety ▪Use a quality of life questionnaire
COPD: lifestyle advice
Quit smoking Physically active as possible. Eat a healthy diet. Adjustments to lifestyle and home environment to ensure plenty of rest. Hydration – mucus Avoid smoky or dusty environments. Join a support group
COPD:
Nursing
practice
Varies across settings ▪Aim to minimise disease progression and
maximise quality of life. Examples ✓ Encourage patient motivation ✓ Assess insomnia, encourage sleep habits ✓ Monitor changes in mental health status ✓ Smoking cessation ✓ Education and support to family ✓ Influenza vaccination ✓ Monitor function capabilities, BMI, nutrition, airway
clearance techniques
✓ Education on exacerbations ✓ Assess use of inhaled medication
COPD:
Nursing
practice
▪Key principles ✓ Encourage medication compliance ✓ Maximise functional ability ✓ Recognise signs/symptoms of
deterioration
✓ Education patient/family/carer ✓ Support activity modification ✓ Support symptom relief
