Chronric Bronchitis & COPD
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| Define COPD in terms of component diseases and effect on airflow: | Component diseases:
1.Chronic bronchitis
2.Asthma
3. Emphysema
4.Bronchectasis
5. CF
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| What is the Effect on airflow in terms of COPD: | obstruction/limitation that is not completely reversible
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| What are the Causes of COPD: | •Chronic inflammatory responses, noxious particles, gases
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| Discuss the progressive nature of COPD and relate it to the need for establishing a baseline and follow up: | COPD will get worse over progressive period of time. We should establish a baseline so we know when to start treatment and follow-up to make sure track the progressive of disease.
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| Explain the etiology of COPD and lung damage risk factors: | -Smoking
-Genes
-Age&gender
-Lung growth and development
-Exposure to particles
-Social status
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| Describe the general pathophysiology of COPD: | 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: | dyspnea, cough, sputum, fever, wheezing, chest tightness, fatigue
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| Differentiate the major symptomatic difference between chronic bronchitis and emphysema: | Chronic bronchitis: excessive sputum production for at least 3 months for a year and 2x in a row Emphysema: destruction of the gas exchange surfaces
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| Describe the 2 major ways to diagnose COPD: | Clinical assessment/history, Spirometer•volumes•capacities•flow
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| What are Other tools besides the two most common ways to diagnose COPD: | Lab values,EKG,ABG,CXR
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| List the COPD severity staging guidelines: | 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: | Remove irritant =smoking cessation, Pharmacology agents
Pulmonary rehabilitation
Surgical options
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| Explain the effect of bronchodilators on the decline in lung function: | Drugs don't change the progressive decline in lung function. They will only help dilate the bronchotrachael tree to help aide air movement and mucus movement
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| Explain the main goals of pharmacological COPD management: | Improve symptoms & improve quality of life
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| Describe which medications are used in the management of COPD and in what order they should be used: | 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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| Describe which medications are used in the management of COPD and in what order they | 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: | Inhaled because they don't have the side effects of systemic steroids
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| Discuss when it is appropriate to use systemic steroids: | 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: | 1. PaO2<55% or SaO2 <88% on room air -taken 2 times over 3 weeks period in stable pt 2. PaO2 55-60% if evidence of pulmonary HTN, CHF, or polycythemia
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| Definition of CB: | 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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| Three causes Of CB: | •Smoking!!!,
•Recurring pulmonary infections as a child may increases susceptibility,
•Air pollution
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| Pathophysiology of CB: | Inhale irritant, Bronchial walls inflame, Bronchial mucous glands enlarge,
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| Advance stages of CB: | Larger airways plug, V/Q mismatch, Pulmonary arteries constrict, Polycythemia
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| CBC for Advance stage of CB | 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- | Frequent cough w/mucous expectorate,Slight ↑ RR, Slight ↑ HR, CO, BP, Dyspnea only with lung infection, Breathsounds: no significant changes, Xray – no significant changes, ABG’s slight Resp. Alkalosis with mild hypoxemia (↑PH, ↓PaCO2, ↓HCO3 ↓PaO2)
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| Advanced signs of CB: | 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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| Diagnostic test and result of CB | 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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| Pulmonary function testing of CB: | 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: | Stop smoking–eliminate irritant, Avoid other lung infections, Avoid Dry, cold air, Bronchial hygiene, Humidified O2 – PRN,Dilate airway to help cough – Bronchodilator- sympathomimetic, Beta 2-Parasympatholytic, Xanthines (theophylline) –
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| Treatment -medical and respiratory of CB | ,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 | No significant changes
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| What would an ABG look like if a pt was diagnosed with early stages of CB | ABG’s slight Resp. Alkalosis with mild hypoxemia (↑PH, ↓PaCO2, ↓HCO3 ↓PaO2)
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| What would the breath sounds be in advanced CB | Crackles- wet secretions
wheezes- bronchoconstriction (mucus plug)
Rhonchi- inflammed airways
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| What would an ABG look like if a pt was diagnosed with the advance stage of CB | pH normal,↓ PaO2 (cyanosis & clubbing),↑ PaCO2, ↑ HCO3
Compensated Respiratory Acidosis
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| Why do the pulmonary vessel constrict during chronic bronchitis | because of the hypoxemia leads to PVR
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