What is COPD?
Chronic Obstructive Pulmonary Disease
- characterised by chronic and recurrent obstruction of flow in airways
- progressive and accompanied by inflammatory responses
- usually includes variations of bronchitis and emphysema with or ithout asthma
What is the impact of COPD on indigenous populations?
More common - 2.5x higher
- estimated 8.8% of indig pop aged 45 and overaffected
Where does COPD rank among causes of death?
#5 4.5%
What conditions fall under the COPD umbrella?
Chronic Bronchitis
+
Emphysema
What are clinical features of COPD compared to asthma?
- No airway hyperreactivity
- Poor bronchodilator response
- Poor corticosteroid response
What are clinical features of asthma compared to COPD?
- airway hyperreactivity
- bronchodilator response
- corticosteroid response
What inflammatory cells are activated with COPD?
Neutrophils
Macrophages
What inflammatory cells are activated with Asthma?
Mast Cells
Eosinophils
Macrophages
What are the inflammatory effects of COPD?
- peripheral airways
- epithelial metaplasia
- parenchymal involvement
- Mucous secretion
- Fibrosis
- Oxidative stress
What are the signs of Chronic bronchitis?
Blue Bloater
- overweight
- cyanotic
- elevated haemoglobin
- peripheral oedema
- rhonchi and wheezing
What are the signs of Emphysema?
Pink puffer
- older and thin
- dever dyspnea
- quiet chest
- xray shows hyperinflation with flattened diaphragm
What are the key risk factors for COPD?
Smoking (80-90% get that shit) Asthmatics who smoke Respiratory infections during childhood Occupational exposure to dusts and chemicals Exposure to air pollution Age >40 when signs and symptoms begin Genetic component
what is the difference between chronic bronchitis and emphysema?
Bronchitis:
- obstructive and inflammatory process
Emphysema:
- non inflammatory:
- > dyspnea, non-reversible airway obstruction
- perfusion mismatch
What physiological changes occur with chronic bronchitis?
- mucous gland enlargement
- hypersecretion of mucous
- smooth muscle hyperplasia, inflammation
- Bronchospasm, bronchial wall thickening
- mucous plugging
- Clilia lining stops working
- Loss of supporting alveolar attachments, airflow limitation
- airway wall deformation and airway lumen narrowing
- secondary polycythaemia
What the disease progression steps for Chronic bronchitis?
Smoking - destroys cilia - decreased notility, increased coughing - inflammation - airway thickens - stratified squamous epithelium - goblet cell hypersecretion - increased mucous - increased sputum - accumulation of bacteria - episodic bronchitis - chronic inflammation
What physiological changes occur with emphysema?
- focal destruction of terminal bronchioles and alveoli
- walls of alveoli break down due to loss of elastin
- lost elastin in replaced by collagen
- surrounding capillaries also destroyed
- loss of elastic recoil contributes more significantly to airflow limitation
- significant loss of lung volume
- formulation of bullae may lead to spontaneous pneumothorax
What are some signs and symptoms you may find on assessment of a patient with emphysema?
- history
- pursed-lip breathing
- frail
- productive cough if RTI
- Barrel chest
- gasping
- exertional dyspnoea
- accessory muscle use
- quiet (wheezing)
- finger staining
What are some signs and symptoms you may find on assessment of a patient with chronic bronchitis?
- History
- cyanosis
- normal/overweight
- productive cough
- use of accessory muscles
- increased infections due to cilia malfunction
- clubbing of fingers
- wheezing
What are signs of a severe exacerbation of COPD?
- Use of accessory respiratory muscles
- paradoxical chest wall movement
- worsening or central cyanosis
- development of peripheral oedema
- Haemodynamic instability
- Signs of right heart failure
- ACS due to hypoxia
What are some questions to ask when gathering the history of a patient with COPD?
- how long have they had the disease
- what meds are they taking
- do they have home O2 therapy, if so the flow rate and duration they need it?
- How frequent are hospital admissions? When was the last? Have there been any ICU admissions?
- What other treatments have they received on previous ED admissions?
- When did the patient start to experience symptoms leading to this episode?
- Have they been unwell lately?
- Has there been a change or limitation to daily activities
- Productive cough?
- Colour of sputum
What is Cor Pulmonale?
Abnormal enlargement of the right side of the heart due to disease of the lungs or pulmonary vessles?
How does Cor Pulmonale work?
Pulmonary Hypotension is the result of hypoxic pulmonary vasoconstriction, polycythemia and destruction of the pulmonary vascular bed by emphysema
- Hypoxic pulmonary vasoconstriction diverts blood away from poorly ventilated alveoli to maintain VQ balance
- pulmonary vessles adjacent to underventilated alveoli constrict increasing pulmonary vascular resistance and the work of the right heart
What are signs of Cor Pulmonale?
Peripheral oedema
JVP
ECG with large P waves, RBBB and R axis deviation
What is the indication for the use of CPAP?
SpO2 <90% on room air or <95% on O2.
