What is COPD
Preventable and treatable disease
-airflow limitation not fully reversible
-worsens over time
Primary causes of COPD
prolonged exposure to noxious gas and particles
-smoking *common
-air pollutant
-occupational hazard
Two main conditions of COPD
-chronic bronchitis
-emphysema
What is chronic bronchitis
Affects airways causing inflammation swelling and overproduction of mucus—> persistent cough
American thoracic society definition of Chronic bronchitis
Based on clinical manifestations associated with disease: productive cough that persist for 3 months in each of 2 consecutive years
What is emphysema
Walls is alveoli are destroyed reducing the surface area for gas exchange and making it harder for O2 to get into blood stream
American thoracic society definition of emphysema
Based on pathological changes in the lungs
Anatomical alterations of lungs associated with emphysema
-Permanent enlargement and destruction of air spaces distal to the terminal bronchioles
-Destruction of alveolar- capillary membrane
-Weakening of the distal airways,primarily the respiratory bronchioles
-Air trapping and hyperinflation
Anatomical alterations of lung associated with chronic bronchitis
-Chronic inflammation and thickening of the walls of the peripheral airways
-Excessive mucous production and accumulation
-Partial or total mucous plugging of the airways
-Smooth muscle constriction of bronchial airways (bronchospasm)
-Air trapping and hyperinflation of alveoli
GOLD: Risk factors that contribute to COPD
-Age and gender
*COPD increases with age
-Lung growth and development
*Low birth weight
*Respiratory infections
-Exposure to particles
Tobacco smoke common cause
*Occupational dusts and chemicals
*Indoor air pollution
*Outdoor air pollution
-Socioeconomic status
*Poverty
*Poor nutrition
-Asthma
-Chronic bronchitis
*Lead to emphysema (may)
-Respiratory infections
*History of severe childhood respiratory infections
-Tuberculosis
Diagnosis of COPD according to GOLD
-Establish the degree of airflow limitation
-Determine the effect of COPD on the pt health status
-Prevent the risk for future events
*Exacerbations or hospital; admissions
symptoms of COPD
-Dyspnea
*Progressive overtime
*Worsen w/ exercise
*Persistent
-Chronic cough
*Intermittent or unproductive
*Recurrent wheeze
-Chronic sputum production
*Recurrent lower respiratory tract infection
must take risk factors into consideration
PFT in the diagnosis of COPD according to gold
1st: FEV1/FVC ratio
* <70%
*confirmed obstructive disorder
2nd: FEV1
* gold for diagnosing severity
* FEV1/ predicted
Mild:80-100%
Mod:50-79%
Severe: 30-49%
Very severe: <30%
DLCO
-emphysema : decreased
*destruction of alveolar cap membrane
-chronic bronchitis: normal
Clinical manifestations for COPD
-Distal airway and alveolar weakening
*Seen in emphysema
-Excessive bronchial secretions
-bronchospasm
What are chronic bronchitis pts also known as?
Blue bloaters
What are pt with emphysemas also known as?
Pink puffers
What are physical examinations of a COPD exacerbations
-tachycardia
-Tachypnea
-hypoxemia
Physical examination of chronic bronchitis
-Overweight
-Barrel chest-less common
-Digital clubbing
-Cyanosis
-Peripheral edema and venous distension
-Distended neck vein
-Pitting edema
-Cough- Chronic
-Sputum:Copious amounts, Purulent
Chest assessment findings:wheezing crackles
Physical examination of emphysema
-Underweight
-Barrel chest- hyperinflation of lungs/ alters shape of thorax
-Digital clubbing- late stage
-Peripheral edema and venous distension
*End stage
*Distended neck vein
*Pitting edema
-Use of accessory muscles
-Pursed lip breathing
-Chest assessment findings
*Decrease tactile fremitus
*Hyperresonant percussion
*Diminished breath sound
ABG: stable COPD
ph:N
PaCO2: elevated
HCO3: elevated
PaO2: decreased
SaO2/SpO2: deceased
ABG: Acute on chronic respiratory alkalosis
pH: increased
PaCO2: decreases
HCO3: incre
PaO2:decreased
SaO2/SpO2: decreased
ABG:Acute on chronic respiratory acidosis
pH: decreased
PaCO2: increased
HCO3: increased
PaO2: decreased
SaO2/SpO2: decreased
Lab test results for : polycythemia
Chronic bronchitis: Normal
Emphysema :late stage
