- diseases that cause obstruction of the airways, usually through a combination of bronchoconstriction and inflammation
- includes asthma, acute or chronic bronchitis, emphysema
obstructive pulmonary diseases
- a specific progressive disorder that slowly alters the structures of the respiratory system over time, irreversibly affecting lung function
- periodic exacerbations, often related to respiratory infection, with increased symptoms of dyspnea and sputum
- not curable
- typically includes components of both emphysema and bronchitis
- results from repeated exposure to irritants
Chronic Obstructive Pulmonary Disease (COPD)
- condition related to COPD
- excessive bronchial mucous secretion
bronchitis
- condition related to COPD
- destruction of the walls of the alveoli
emphysema
what is the cause of COPD?
repeated exposure to irritants that begin to damage the structures in the lungs
what happens in COPD when there is damage to the small and large airway passages?
- increase in mucous production
- arrest in cilia action
- fluid accumulates and causes edema
- edema cases air trapping > hyperinflation of lungs
- disorder of excessive bronchial mucous secretions
- characterized by productive cough lasting 3+ months in 2 consecutive years
- narrowed airways and excess secretions obstruct airflow
- expiration is affected first, then inspiration
- recurrent infection is common
- cigarette smoking is strongly implicated
chronic bronchitis
- disorder characterized by the destruction of the walls of the alveoli, with resulting enlargement of abnormal air spaces
- wall destruction causes alveolar spaces to enlarge, causing loss of portions of the capillary bed
- surface area for alveolar-capillary diffusion is reduced (affecting gas exchange)
- cigarette smoking is strongly implicated
emphysema
what condition often exists as a comorbid disease with COPD?
asthma
- progressive, nonreversible process of airway narrowing and loss of supporting tissue
- includes chronic bronchitis with persistent airway edema, excess mucous production and impaired airway clearance
- includes emphysema with loss of interstitial membranes and airway support tissue, resulting in airway collapse and loss of alveolar surface area for gas exchange
- small airway disease with bronchoconstriction
COPD
what are the risk factors for COPD?
- smoking (80% of cases)
- short term exposure to high levels of irritating substances
what increases as the effort to breathe increases?
caloric demand
NOTE
classification of COPD by severity (BOB p1270)
stage 1: mild (usually chronic cough, sputum production, mild airflow limitation)
stage 2: moderate (SOB on exertion, worse symptoms than stage 1)
stage 3: severe (worse symptoms, with noticeable SOB)
stage 4: very severe (severe symptoms, respiratory failure or clinical signs of right heart failure)
what are some diagnostic tests for COPD?
- PFT
- V-Q scanning
- serum alpha1-antitrypsin levels
- ABG
- pulse oximetry
- exhaled CO2
- CBC with WBC differential
- CXR
COPD test:
-performed to establish diagnosis and evaluate progression of COPD
-based on calculated norms for individual based on age, height, sex, weight
-
Pulmonary Function Testing (PFT)
COPD test:
- screening that may be performed to determine the extent to which lung tissue is ventilated but not perfused or perfused but inadequately ventilated
- radioisotope is injected or inhaled to illustrate areas of shunting or absent capillaries
Ventilation Perfusion Scanning (V-Q scanning)
COPD test:
- screen for deficiency
- normal adult level range from 80 to 260 mg/dL
serum alpha1 antitrypsin levels
COPD test:
-values used to evaluate gas exchange, particularly during acute exacerbations
Arterial Blood Gases (ABGs)
COPD test:
- method of monitoring oxygen saturation of the blood
- marked airway obstruction and hypoxemia often cause levels of less than 95%
Pulse Oximetry
COPD test:
- measurement to evaluate alveolar ventilation
- elevated when ventilation is inadequate and decreased when pulmonary perfusion is impaired
Exhaled Carbon Dioxide
COPD test:
- blood test to detail the kinds and numbers of blood cells in your body
- addition of WBC can indicate infection, allergic reaction or toxic reaction
Complete Blood Count with White Blood Cell Differential
COPD test:
- test that will show small white patches indicative of hyperinflated alveolar sacs filled with secretions that are common in emphysema
- advanced chronic bronchitis will show larger white area
- may show flattening of the diaphragm
Chest X-ray (CXR)
what immunizations are recommended for COPD patients?
- pneumococcal pneumonia vaccine
- yearly flu vaccine
NOTE
antibiotics
- broad spectrum may be prescribed if infection is suspected
- clients with purulent sputum and increased dyspnea (but no other signs of infection) may benefit from antibiotics
- prophylactic antibiotics may be ordered for clients who have more than 4 exacerbations a year
