Disease

Is defined clinically as chronic productive cough for 3 months in each of 2 successive years in a patient in whom other causes of productive chronic cough have been excluded.

Is defined pathologically as the presence of permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.

The major "clinical manifestations" associated with the disease.

The pathology, or the "anatomic alterations of the lung," associated with the disorder.

• Is a preventable and treatable disease state characterized by airflow limitation that is not fully reversible.
• The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking. Although COPD affects the lungs, it also produces significant systemic consequences

• Chronic inflammation and swelling of the peripheral airways
• Excessive mucus production and accumulation
• Partial or total mucus plugging of the airways
• Smooth muscle constriction of bronchial airways (bronchospasm)
• Air trapping and hyperinflation of alveoli—occasionally in the late stages

• Permanent enlargement and deterioration of the air spaces distal to the terminal bronchioles
• Destruction of pulmonary capillaries
• Weakening of the distal airways, primarily the respiratory bronchioles
• Air trapping and hyperinflation of alveoli (air-trapping)

• Panlobular or Panacinar
• Centrilobular or Centriacinar

• Abnormal weakening & enlargement of all alveoli distal to the terminal bronchioles
• Most severe type
• More serious clinical manifestations
• Effects lower parts of lungs
• Associated with alpha 1 antitrypsin deficiency

• Proximal part of acinus
• Most common form
• Strongly associated with smoking & chronic bronchitis

• Tobacco smoke
• Occupational dusts and chemicals
• Indoor air pollution
• Outdoor air pollution
• Conditions that affect normal lung growth
• Genetic predisposition
• Alpha 1-antitrypsin deficiency
• Airway remodeling with asthma

• Dysypnea
• Chronic cough
• Chronic sputum production
• History of exposure to risk factors

• FVC
• FEV1
• FEV1/FVC ratio

Both the FEV1 and FEV1/FVC ratio are decreased

• Thin
• Barrel Chest
• Hyperventilation & marked dyspnea; often occurs at rest
• Late stage:  diminished respiratory drive & hypoventilation
• Pursed-lip breathing
• Hoover’s Sign
• Reddish skin
• Use od acessory muscles

• Stocky, overweight
• Diminished respiratory drive
• Hypoventilation common, with resultant hypoxia and hypercapnia
• Productive cought with copious amounts, purulent sputum
• Cyanosis
• Perpherial edema
• Neck vein distention 
• Cor pulmonale
• Polycythemia
• Digital Clubbing
• Pulmonary hypertension
• Infections

• Decreased breath sounds
• Decreased heart sounds
• Prolonged expiration
• Hyperresonance
• Decreased diaphragmatic excursion

• Wheezes
• Crackles
• Rhonchi

• Hyperinflation
• Narrow mediastinum
• Normal or small vertical heart
• Translucent
• Depressed or flattened  diaphragms
• Presence of blebs or bullae

• Congested lung fields
• Densities
• Increased bronchial vascular markings
• Enlarged horizontal heart
• Bronchogram Small spikelike protrusions

Decreased DLCO and DLCO/VA

• Excessive Bronchial Secretions
• Bronchospasm
• Distal Airway and Alveolar Weakening

The inward movement of the lower lateral chest wall during each inspiration—indicates severe hyperinflation

• Decreased tactile fremitus
• Decreased chest expansion
• PMI often shifts to the epigastric area

• Streptococcus pneumoniae
• Haemophilus influsenzae
• Moraxella catarrhalis

• Relieve symptoms
• Prevent disease progression
• Improve exercise tolerance
• Improve health status
• Prevent and treat complications
• Prevent and treat exacerbations
• Reduce mortality
• Prevent or minimize side effects from treatment

• Glucocorticosteroids
• Vaccines
• Antibiotics
• Mucolytic
• Antitussives
• Non-pharmacologic treatment
• Rehabilitation
• Oxygen therapy
• Surgical treatment

An event in the natural course of the disease characterized by a change in the patient’s baseline dyspnea, cough, and/or sputum that is beyond normal-day-to-day variations, is acute in onset, and may warrant a change in regular medication in a patient with underlying COPD

• Oxygen
• Bronchopulmonary Hygiene
• Aerosolized Medication
• Mechanical Ventilation
• Other Meds
• ØExpectorants
• ØAntibiotics

• Smooth muscle constriction of bronchial airways (bronchospasm)
• Bronchial wall inflammation
• Excessive production of thick, whitish, bronchial secretions
• Mucus plugging
• Hyperinflation of alveoli (air-trapping)
• In severe cases, atelectasis caused by mucus plugging

• House dust
• Mites
• Furred animal dander
• Cockroach allergen
• Fungi
• Molds
• Yeast

• Extrinsic asthma is an immediate (Type I) anaphylactic hypersensitivity reaction
• Extrinsic asthma is family related and usually appears in children and adults younger than 30 years old. 
• It often disappears after puberty
• Because extrinsic asthma is associated with an antigen-antibody induced bronchospasm, an immunnologic mechanism plays an important role.

• Asthma episode cannot be directly linked to a specific antigen or extrinsic factor.
• Onset usually occurs after the age of 40 years
• Immunologically mediated
• Latency period of months to years after exposure

• Not directly linked to a specific antigin
• Contributing factors are elusive
• Normal serum IgE levels
• Usually occurs > 40 years age
• Some overlap with atopic asthma
• Non-specific stimuli

• Spriometry
• Peak expiratory flow
• Responsiveness to metacholine, histamine, mannitol, or exercise challenge
• Positive skin tests with allergens or measurement of specific IgE in serum

• Bronchospasm
• Excessive Bronchial Secretions

• Increased respiratory rate (Tachypnea)
• Increased heart rate (pulse)
• Increased blood pressure

• Use of accessory muscles of inspiration
• Use of accessory muscles of expiration
• Pursed-lip breathing
• Substernal intercostal retractions
• Barrel chest
• Cyanosis
• Cough and sputum production
• Pulsus paradoxus

• Expiratory prolongation
• Decreased tactile and vocal fremitus
• Hyperresonant percussion note
• Diminished breath sounds
• Diminished heart sounds
• Wheezing and rhonchi

• Eosinophils
• Charcot-Leyden crystals
• Casts of mucus from small airways (Kirschman spirals)
• IgE level (elevated in extrinsic asthma)

• Increased anteroposterior diameter (barrel chest)
• Translucent (dark) lung fields
• Depressed or flattened diaphragms

A progressive increase in shortness of breath, cough, wheezing, or chest tightness, or a combination of these symptoms.

• Oxygen Therapy Protocol
• Bronchopulmonary Hygiene Therapy Protocol
• Aerosolized Medication Protocol
• Mechanical Ventilation Protocol

• Excessive mucus production and accumulation of thick, tenacious mucus in the tracheobronchial tree
• Partial or total bronchial obstruction (mucus plugging)
• Atelectasis
• Hyperinflation of the alveoli

Autosomal recessive gene disorder caused by mutations in a pair of genes located on chromosome 7.

• Sweat Test
• Immunoreactive Trypsinogen Test
• Stool Fecal Fat Test
• Nasal Potential Difference (NPD)
• Genetic Testing
• Prenatal Testing
• Amniocentesis
• Chorionic villus biopsy

• Atelectasis
• Bronchospasm
• Excessive Bronchial Secretions

• Increased respiratory rate (Tachypnea) Increased heart rate (pulse)
• Increased blood pressure

• Use of accessory muscles of inspiration
• Use of accessory muscles of expiration
• Pursed-lip breathing
• Barrel chest
• Cyanosis
• Digital clubbing
• Peripheral edema and venous distension
• Productive cought
• Hemoptysis
• Spontaneous Pneumothorax

• Decreased tactile and vocal fremitus
• Hyperresonant percussion note
• Diminished breath sounds
• Diminished heart sounds
• Bronchial breath sounds (over atelectasis)
• Crackles, rhonchi, and wheezing

• Increased hematocrit and hemoglobin
• Increased white blood count

• Translucent (dark) lung fields
• Depressed or flattened diaphragms
• Right ventricular enlargement
• Areas of atelectasis and fibrosis
• Bronchiectasis (often a secondary complication)
• Pneumothorax (spontaneous)
• Abscess formation (occasionally)

• Oxygen therapy protocol
• Bronchopulmonary Hygiene Therapy Protocol
• Lung Expansion Therapy Protocol
• Aerosolized Medication protocol
• Mechanical Ventilation Protocol

• Xanthines
• Expectorants
• Antibiotics
• Lung or heart/lung transplantation
• Future Treatments
• ØSome advances in gene therapy

• Seasonal
• Droplet transmission
• Contact isolation

Oxygen and humidity often done with oxyhood or tent

• Hyperinflation
• Mucus accumulation
• Inflammation airways
• Damaged paralyzed cilia

• Increased risk of aspiration pneumonia
• Upper airway is partially paralyzed
• History of OSA

• Speech therapy
• Reduce risk of aspiration

• Ischemic
• Hemorrhagic

Due to a sudden interruption of blood flow to the brain

When a blood vessel in the brain leaks, causin blood to spill in surrounding spaces of the brain tissue!

Not have AIDs

Acquried immune defficiency syndrome

• T cells are reduced CD4
• Kaposi sarcoma
• TB
• PCP
• only assicioated with AIDS

Western BLOT test

• HAART
• Highly active anti retra viral therapy
• 3 or more drugs
• Used to supress the progression of the disease

• During Sex
• Blood transfusions
• From mother to child
• Organ donors

• O2 therapy
• Bronchopulmonary Hygiene therapy
• Thoracentesis
• Mechanical ventilation protocol
• Antibiotics
• Prophylactics

• motor neurons in the spinal cord, brain, and brain stem
• Upper and lower neurons are affected

• Primarily a disease in Africian americans
• 8 percent of AA have trait
• .15% have disease
• 50k USA
• Mandatory screening
• Early penicillin profolatic
• Hyper reactive airways

• SOB
• Pain
• Dizziness
• Headache
• Cold hands/feet
• Pulmonary emboli
• Pulmonary hypertension

• Airway obstruction
• Retructive
• Hypocemia