define COPD
- disease state characterized by airflow limitation that is not fully reversible
- the airflow limitation is usually both PROGRESSIVE and associated with an abnormal INFLAMMATORY response of the lungs to noxious particles or gases
- LINEAR PROGRESSION
describe the risk factors of COPD
- TOBACCO IS THE MOST SIGNIFICANT RISK FACTOR
- occupational dusts and chemicals
- outdoor and indoor pollution
- infections
describe the physical exam findings
- INCREASED shortness of breath/dyspnea on exertion
- may report increased purulence of sputum (thickens, differs then normal)
- TACHYPNEA with ACCESSORY MUSCLE USE
- VISUALIZATION –> hyperinflation (increased anteroposterior and lateral diamter)
Chest X-ray exam: PA film
Posterior-anterior film
- Elongation of heart shadow (long and thin)
- downgoing diaphragm (don’t like smoke so they are frowning)
- silo lungs (long and tall lungs)
- LOTS OF AIR SPACE –> can see lots of ribs
chest X-Ray: lateral film
lateral film
- INCREASED RETROSTERNAL AIR SPACE –> lots of air in lungs
- lungs feel like buble wrap
COPD vs asthma
- Asthma occurs earlier in life vs COPD occurs LATER IN LIFE (after 40)
- Asthma symptoms are EPISODIC vs COPD which occur PROGRESSIVELY
- Does the history support the diagnosis
- current or prior history of cigarette smoking
FEV1/FVC ratio in COPD
- ratio <0.7 = typical COPD result
TX for mild COPD
SHORT ACTING DILATORS
- Short- acting bronchodilator
–> ALBUTEROL = Beta2-agonist
- SHort-acting Anticholinergics
–> Ipratropium Bromide (ATOVENT) = muscarinic inhibitor
TX for moderate COPD
- ADD LONG-ACTING bronchodilators to the short acting bronchodialtors
–> depends on severity of symptoms
- LONG-acting anticholinergic = SPIRIVA
- LONG-acting beta2agonists = SALMETEROL
tx for severe COPD
- LONG and SHORT term bronchodilators
- ADD INHALED CORTICOSTEROID (esp if frequent moderate to severe exacerations)
–> FLUTICASONE
- can perscribe O2 but lots of hoops to jump through
dsecribe the 3 major criterion for COPD
- Increase sputum volume
- presence of sputume purulence (yellow/green)
- worsening dyspnea
**all 3 would be classified as a severe or type 1**
describe OUTPATIENT MANAGEMENT OF COPD exacerations
- up to 2 weeks oral corticosteroids
- increase dose of short-acting bronchodilators
- consider antibiotics if s/sx of pulmonary infection
- Chest PT, relaxation techniques, breathing control
describe Inpatient management of COPD Exacerbations
- Those who do not respond to outpatient thearpy
- those showing > 2 of the following:
–> dyspnea at rest
–> respriatory rate > 25
–> heart rate > 100
–> use of accessory muscles
