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Definition of COPD
- airflow limitation (obstruction) that is not fully reversible.
- progressive inflammatory disease with hypersensitive reactions to noxious stimuli
- involves the parenchyma AND small airways (bronchioles)
- - COPD is preventable and treatable
What conditions/diagnoses are under the COPD umbrella?
Definition/diagnosis of Chronic bronchitis
Chronic, persistent cough and/or sputum production for 3 consecutive months each year for 2 consecutive years with periodic acute exacerbations (symptoms worsen).
Definition of Emphysema
Enlargement of air spaces secondary to alveolar wall destruction
Alveolar wall destruction probably secondary to neutrophil-produced elastases - without elastin, the airways collapse upon expiration.
Diagnosis of COPD (general)
Spirometry - PFT's necessary for diagnosis, staging, and monitoring.
Subjective symptoms may not be present & are not necessary for diagnosis.
- - age over 40
- - dyspnea (progressive, worse with exercise, persistent)
- - chronic cough
- - chronic sputum production
- - Hx of exposure to risk factors
Symptoms of COPD
- sputum production
- dyspnea on exertion
- 40-50% loss of lung capacity before symptoms begin
Risk Factors for COPD
Genetic (alpha-1 antitrypsin deficiency) AAT
Exposure to inhaled irritants (tobacco, occupational dust/chemicals, air pollution)
2 Most effective measures:
FEV1 (forced expiratory volume in the 1st second of expiration)
FVC (forced vital capacity)
*** FEV1 to FVC ratio = considered the most sensitive indicator of early airflow limitation ***
Spirometry evidence of obstruction if FEV1/FVC is < _______.
Created to increase awareness & disseminate research.
GOLD Stages of COPD (0)
At Risk: Normal spirometry, chronic symptoms of cough or sputum production
GOLD Stage I
Mild COPD; FEV1/FVC < 70%, FEV1 > or = 80%, with or without chronic symptoms of cough & sputum prod.
GOLD Stage II
Moderate COPD; FEV1/FVC <70%, FEV1 50-80% with or without chronic symptoms of cough, sputum prod., dyspnea
GOLD Stage III
FEV1/FVC < 70%
w/ or w/o symptoms
GOLD Stage IV
Very severe COPD
FEV1/FVC < 70%
Respiratory failure (PaO2 < 60 with or without PaCO2 > 50)
COPD Treatment (All stages)
Avoidance of risk factors (smoke)
COPD treatment (Stage I)
Short acting bronchodilator when needed
COPD Treatment (Stage II)
Short-acting bronchodilator PRN
COPD Treatment (Stage III)
- INH glucocorticosteroids if sign. symptoms, or if repeated exac.
COPD Treatment (Stage IV)
LABA + Inh. corticosteroid
O2 therapy if failure
* consider surgical options
Antibiotics in COPD
- Only shown to be useful in acute exacerbations with
- breathlessness and cough that are assoc. with altered sputum production (change
- in color, consistency, amount).
Low risk for resistance: tetracycline, bactrim.
- 2nd gen. cephalosporins: cefuroxime, cefaclor,
- Macrolides: clarithromycin (biaxin) effective in
- uncomplicated acute bronchitis. Azithromycin.
- 3rd gen. cephalosporins: cefdinir (omnicef),
- cefoperazone, ceftibuten VERY EFFECTIVE and few interactions.
Bacterial pathogens common in COPD exac
First line therapy for COPD
Beta-2 agonist is first line therapy
Inh.anticholinergics 2nd line
Theophylline 3rd line
Antibiotics for selected pathogens
Sleep related hypoxemia
Dx established with pulse oximetry
Right-heart failure secondary to lung disease
P.E.: peripheral edema, JVD, congested liver
EKG: RV hypertrophy and right axis deviation
- Form of COPD characterized by destruction of the alveolar
- walls due to imbalance of enzyme activity in lungs.
- Characterized by air trapping, increased residual
- lung volume, decreased expiratory flow, retained CO2