Chronric Bronchitis & COPD
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| Define COPD in terms of component diseases and effect on airflow: | show 🗑
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| What is the Effect on airflow in terms of COPD: | show 🗑
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| What are the Causes of COPD: | show 🗑
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| Discuss the progressive nature of COPD and relate it to the need for establishing a baseline and follow up: | show 🗑
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| show | -Smoking
-Genes
-Age&gender
-Lung growth and development
-Exposure to particles
-Social status
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| show | 1. Airflow limitation & air trapping 2. Traps air in exhalation leading to hyperinflation3. Break down of the alveolar walls, excess mucus inflamed lining and bronchial
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| List the general symptoms of COPD: | show 🗑
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| Differentiate the major symptomatic difference between chronic bronchitis and emphysema: | show 🗑
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| show | Clinical assessment/history, Spirometer•volumes•capacities•flow
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| What are Other tools besides the two most common ways to diagnose COPD: | show 🗑
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| show | Gold standards-Stages:1 (mild)-FEV1<80% of predicted
2(moderate)-FEV1=50-80% predicted
3 (severe)-FEV1=30-50%pred
4 (very severe)-<30% pred
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| Explain the main “intervention” for managing COPD: | show 🗑
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| Explain the effect of bronchodilators on the decline in lung function: | show 🗑
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| show | Improve symptoms & improve quality of life
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| show | Racemic epinephrine/micronefrin-vaponefrine, Albuterol/Proventil, ventilin, Levalbuterol/xopenex,Salmeterol/serevent, Formoterol/foradil, Arformoterol/brovana, Ipratropium/atrovent,Tiotropium/sprivia, Budesonide/pulimcort,
Mometasone/asmanex
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| show | Mometasone/asmanex
Fluticasone/Flovent
Beclomethasone/QVAR,
Acetylcysteine/mucomyst,
Dornase alpha/rhDNAse
Cormide/intal
Nedocromil/tilade
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| Explain the preferred long term steroid administration route and why it is preferred: | show 🗑
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| show | Symptom/airflow limitation despite maximal therapy with other drugs.•IV,•shot,•orally, When nothing else works
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| List the criteria for home oxygen use: | show 🗑
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| show | Chronic ↑↑ production of mucus from bronchi, Not from a specific disease,Cough and ↑ sputum 3 consecutive months Each year for 2 years
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| show | •Smoking!!!,
•Recurring pulmonary infections as a child may increases susceptibility,
•Air pollution
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| Pathophysiology of CB: | show 🗑
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| show | Larger airways plug, V/Q mismatch, Pulmonary arteries constrict, Polycythemia
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| show | CBC-RBC 4.6-6.2 million/UL for M, 4.2-5.4 for F, Hgb 13-18 gm/dl for M, 12-16 gm/dl for F., Cor Pulmonale (hypertrophy R. Ven), Respiratory Failure
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| Clinical Manifestations of CB:Include: signs, symptoms, observation, percussion, palpation & auscultation- | show 🗑
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| show | Chronic cough with increased mucus,Increased RR, HR, CO, BP, Dyspnea esp. with exertion, Increased WOB – prolonged expiration, Diagnostic palpation/percussion, Decreased tactile & vocal fremitus
Hyperresonant percussion note
Breathsounds,Decreased, Cr
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| show | CXR, Hyperinflation (air trapping), Translucent (very dark), Increased A-P diameter(barrel chest),Flattened Diaphragm-< or blunted costophrenic angle, Spider like projection in the bronchogram, Enlarged heart
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| show | Decreased Expiratory maneuver – Flows, FVC-Lung Volume & Capacity-Increased – Vt, RV,-RV/TLC, FRC-Decreased – VC, IRV, ERV, Normal FEV1/FVC 78 – 83% if less than 50% significant disease
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| Treatment – medical & respiratory of CB: | show 🗑
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| show | ,Dilate airway to help cough – Bronchodilator- sympathomimetic, Beta 2-Parasympatholytic, Xanthines (theophylline) – aid bronchial dilation,Thin the thick mucous
–Mucolytic–P & PD–USN–Heated Aerosol•Antibiotics – bacterial
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| What are the Breath sounds in early CB | show 🗑
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| show | ABG’s slight Resp. Alkalosis with mild hypoxemia (↑PH, ↓PaCO2, ↓HCO3 ↓PaO2)
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| show | Crackles- wet secretions
wheezes- bronchoconstriction (mucus plug)
Rhonchi- inflammed airways
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| show | pH normal,↓ PaO2 (cyanosis & clubbing),↑ PaCO2, ↑ HCO3
Compensated Respiratory Acidosis
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| Why do the pulmonary vessel constrict during chronic bronchitis | show 🗑
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laney21882
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