COPD

Question 1

What is COPD? What diseases does it include?

Answer 1

• chronic obstructive pulmonary disease
• progressive air flow limitation (narrowing, obstruction, loss of elasticity in airways)
• includes chronic bronchitis and emphysema

Question 2

What causes COPD?

Answer 2

• smoking
• inhalation of other irritants and chemicals
• genetic defect of alpha 1 antitrypsin

Question 3

What are signs and symptoms of COPD?

Answer 3

• cough and sputum progression
• SOBOE
• weight loss (eating can be hard)
• barrel chest
• use of accessory muscles
• polycythemia (compensatory mechanism associated with hypoxia)

Question 4

How is COPD diagnosed?

Answer 4

• history and presentation
• arterial blood gas values
• chest x-ray, CT scan
• spirometry (pulmonary function test): a FEV1/FVC of under 70% of predicted after a bronchodilator

Question 5

How is COPD staged?

Answer 5

in all cases, FEV1/FVC is under 70% of predicted

mild: FEV1 is over or equal to 80% of predicted
moderate: FEV1 is under 80%
severe: FEV1 is under 50%
very severe: FEV1 is under 30%

Question 6

What do FEV1 and FVC mean?

Answer 6

they are pulmonary function tests:

FVC = forced vital capacity, the volume of air you can forcibly exhale after a full inhalation

FEV1 = the volume of air you can forcibly exhale in one second

Question 7

What are nursing interventions for COPD?

Answer 7

• oxygen
• flu and pneumonia vaccines
• breathing exercises (inspiratory muscle training)
• smoking cessation
• activity pacing
• nutrition (higher calorie meals but low in carbs, soft foods to reduce chewing, rest after meals, milk can produce thick mucous)

Question 8

What medications are used to treat COPD?

Answer 8

bronchodilators:

1) beta adrenergic agonists
usually aren’t specific, beta 2 causes bronchodilation, beta 1 can increase HR, contractility and BP
ex. albuterol

2) anti-cholinergics
blocks acetylcholine receptors, prevents bronchoconstriction
NOT for acute symptoms
ex. ipatropium

3) methylxanthine derivatives
cause bronchodilation by interfering with cAMP
slow onset, better as preventative adjunct
ex. theophylline, aminophylline

also:

4) antileukotriene drugs
leukotriene is an inflammatory mediator, this drug prevents stimulation of inflammatory response
use for long-term management of asthma
ex. zafirlukast

5) corticosteroids
used to decrease inflammation
use inhaled meds for long-term management (rinse mouth)
use oral meds for acute exacerbations

Question 9

What are complications of COPD?

Answer 9

• infection (look for change in sputum, exacerbation of symptoms)
• respiratory insufficiency or failure
• atelectasis
• pneumothorax (rapid onset SOB, asymmetry of chest movement)
• right-sided heart failure (damage to pulmonary vasculature > pulmonary hypertension)