L6 COPD

  1. COPD Definition
    • -persistent airflow limitation
    • -usually progressive
    • -usually associated with an enhanced chronic inflammatory response in the airways and lung to noxious particles or gases
  2. Pink Puffer
    • -Type A COPD
    • -Predominantly emphysema

    • Sx and Signs:
    • -severe dyspnea
    • -thin, wasted
    • -NOT cyanotic
    • -low/normal PaO2
    • -low/normal PaCO2
  3. Blue Bloater
    • -Type B COPD
    • -Predominantly Bronchitis

    • Sx and Signs:
    • -cough and sputum
    • -obese
    • -cyanotic
    • -low PaO2
    • -High/normal PaCO2
    • -Polycythemia
    • -Cor pulmonale
  4. Mechanisms of Airflow Limitation
    • 1. Small Airways Disease
    •      -airway inflammation
    •      -airway fibrosis, luminal plugs
    •      -increased airway resistance

    • 2. Parenchymal Destruction
    •      -loss of alveolar attachments
    •      -decreased elastic recoil

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  5. Chronic Bronchitis
    • -presence of chronic productive cough for 3 months within 2 successive years
    • -exclude other causes

    • Pathology:
    • -airways narrowed by plugged and swollen mucous membranes
    • -mucus and pus impede action of respiratory cilia
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  6. Emphysema
    -abnormal permanent enlargement of the air spaces distal to the terminal bronchioles -accompanied by destruction of bronchiole walls and without obvious fibrosis

    • Pathology:
    • -destruction of the alveolar wall damages pulmonary capillaries by tearing, fibrosis or thrombosis
    • -walls of individual sacs torn (not repairable)
    • -enlarged air sacs due to destruction of alveolar walls (Bullae)
    • -inelastic collapsible bronchioles
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    • Gross Pathology:
    • -large holes in parenchyma
    • -hyperinflated (larger)
    • -black deposits
    • (vs. bronchitis)
  7. COPD vs Asthma
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  8. Features that distinguish COPD from asthma
    Cell: NPs, CD8 T cells

    Mediators: LTB4, IL8, TNFa

    • Consequences:
    • -squamous metaplasia of epithelium
    • -parenchymal destruction
    • -mucus metaplasia
    • -glandular enlargement
  9. Alpha1- Antitrypsin Deficiency
    -1-2% of patients with emphysema

    • S variant:
    • -28% of southern europeans
    • -AAT levels = 60%
    • -NO PULMONARY EFFECTS

    • Z Variant:
    • -severe ATT deficiency (10%)
    • -accumulation of ATT in RER of liver
    • -predisposed to: juvenile hepatitis, cirrhosis and HCC
  10. COPD Pathophysiological Features
    • 1. Airflow Limitation
    • -bronchoconstriction
    • -mucus hypersecretion
    • -loss of elastic recoil
    • -airway narrowing

    • 2. Inflammation
    • -increased neutrophils
    • -increased macrophages
    • -increased CD8 T cells
    • -increased IL8 and TNFa
    • -protease/antiprotease imbalance

    • 3. Structural Changes
    • -alveolar destruction
    • -gladular hypertrophy
    • -airway fibrosis
  11. COPD Epidemiology
    -COPD deaths have increased steadily since the 1940s, preceded by a parallel increase in cigarette smoking 40 years earlier

    • -prevalence: 10-20% >55 years
    • -3rd leading cause of death in the US
    • -COPD mortality is increasing (vs. accidents, heart disease)
    • -not an "old man's disease" anymore

    -Subclinical COPD is more common than clinical COPD
  12. Risk Factors for COPD
    • -Genes
    • -Infections
    • -Socioeconomic status
    • -Aging populations

    • -CIGARETTE SMOKE
    • -occupational dust and chemicals
    • -indoor/outdoor air pollution
  13. Increasing burden of COPD
    • -increase in tobacco use (esp in women and developing countries)
    • -more ppl are living into the COPD age range
  14. COPD Risk and Smoking Cessation
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    Quitting smoking can decrease the rate of progressive decline in FEV1
  15. COPD Spirometry
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    Decreased FEV1 and FVC (reflects severity of COPD)

    FEV1/FVC < 0.70

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  16. Classification of COPD
    • Mild: FEV1 > 80% predicted
    • Moderate: 50% < FEV1 < 80% predicted
    • Severe: 30% < FEV1 < 50%
    • Very Severe: FEV1 < 30% predicted
  17. COPD Therapy by Stages
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    • Mild:
    • -reduction of risk factors
    • -short acting bronchodilator

    • Moderate:
    • -add regular tx with 1+ long acting bronchodilator
    • -add rehabilitation

    • Severe:
    • -add inhaled GCs

    • Very Severe:
    • -add long term O2
    • -consider surgery
  18. Goals of Treatment
    • 1. Prevention
    •      -slow progression
    •      -maintain function
    •      -minimize complications

    2. Reduce sx

    3. Improve fxn
  19. Treatment of COPD
    • 1. Stop smoking
    • 2. Meds (BDs, Steroids)
    • 3. O2
    • 4. Vaccination
    • 5. Rehabilitation
    • 6. Surgery: LVRS, Transplant
    • 7. Disease Modification?

    * None of existing meds has been shown to modify long term decline of lung fxn
  20. Bronchodilators
    -Rx as needed or on a regular basis

    -principally: Beta2-agonists, anticholinergics, theophylline, combo therapy

    -can combine classes

    -long acting bronchodilators are convenient and more effective for sx relief than short acting bronchodilators
  21. Corticosteroids
    -regular tx (improves sx, lung fxn, QOL, reduces exacerbation)

    -in pts with FEV1 < 60%

    -increased risk of pneumonia

    -chronic treatment should be avoided
  22. Pulmonary Rehabilitation
    • -exercise training programs
    • -improve exercise tolerance
    • -improve sx of dyspnea and fatigue

    -individually tailored

    -GOAL: restore pt to highest level of independent function

    -improve disability not necessarily change disease process

    • CONTENT:
    • -education
    • -chest physiotherapy
    • -psychosocial support
    • -exercise
  23. O2 Therapy
    -longer term in pts with chronic resp failure

    -can increase survival in pts with resting hypoxemia (PaO2 < 55)
  24. COPD vs Asthma
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  25. COPD Comorbidities
    • CV disease
    • Osteoporosis
    • Respiratory infections
    • Anxiety and Depression
    • Diabetes
    • Lung Cancer

    • Weight Loss/Gain
    • Nutritional Abnormalities
    • SKM dysnfunction
    • Sleep Apnea
Author
jknell
ID
198474
Card Set
L6 COPD
Description
Pulm II
Updated