L6 COPD

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Author:
jknell
ID:
198474
Filename:
L6 COPD
Updated:
2013-02-07 01:13:18
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Pulm II
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Description:
Pulm II
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  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

  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
  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

    • Gross Pathology:
    • -large holes in parenchyma
    • -hyperinflated (larger)
    • -black deposits
    • (vs. bronchitis)
  7. COPD vs Asthma
  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


    Quitting smoking can decrease the rate of progressive decline in FEV1
  15. COPD Spirometry


    Decreased FEV1 and FVC (reflects severity of COPD)

    FEV1/FVC < 0.70

  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


    • 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
  25. COPD Comorbidities
    • CV disease
    • Osteoporosis
    • Respiratory infections
    • Anxiety and Depression
    • Diabetes
    • Lung Cancer

    • Weight Loss/Gain
    • Nutritional Abnormalities
    • SKM dysnfunction
    • Sleep Apnea

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