Term
How does the ATS define chronic obstructive pulmonary disease? |
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Definition
| 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 |
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Term
How does the ATS define chronic bronchitis? |
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Definition
| 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 |
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Term
How does the ATS define emphysema? |
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Definition
| The presence on permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis |
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Term
How does GOLD define chronic obstructive pulmonary disease? |
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Definition
| A preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases |
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Term
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Definition
| To two lung diseases-chronic bronchitis and emphysema-occuring simultaneously |
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Term
What are the primary structures that undergo changes in chronic bronchitis? |
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Definition
| The conducting airways (particularly the bronchi) |
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Term
What are the major pathologic or structural changes that are associated with chronic bronchitis? |
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Definition
Chronic inflammation and swelling of peripheral airways, excessive mucus producton & 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) |
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Term
What is emphysema characterized by? |
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Definition
| A weakening and permanent enlargement of the air spaces distal to the terminal bronchioles and by destruction of the alveolar walls |
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Term
What are the two types of emphysema? |
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Definition
| Panacinar (panlobular) emphysema and centriacinar (centrilobular) emphysema |
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Term
Define panacinar emphysema. |
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Definition
| When there is an abnormal weakening and enlargement of all alveoli distal to the terminal bronchioles, including the respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli-the entire acinus is affected by dilation and destruction. |
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Term
| Define centriacinar/centrilobular emphysema. |
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Definition
| The pathology involves the respiratory bronchioles in the proximal portion of the acinus. The resp bronchiolar walls enlarge, become confluent, and are then destroyed |
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Term
What is the most common form of emphysema? |
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Definition
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Term
What are the major pathologic or structural changes associated with emphysema? |
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Definition
| Permanent enlargement and destruction of the air spaces distal to the terminal bronchioles, destruction of pulmonary capillaries, weakening of the distal airways (primarily the resp bronchioles), and air trapping and hyperinflation |
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Term
What is the prevalence of COPD? |
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Definition
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Term
What factors have been identified by GOLD as risk factors for COPD? |
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Definition
| Tobacco smoke (including smoke from cigarette, pipe, cigar)-most common risk factor; occupational dusts and chemicals-vapors, irritants, and fumes; indoor air pollution; outdoor air pollution; conditions that affect normal lung growth during gestation and childhood; genetic predisposition (alpha 1 antitrypsin deficiency) |
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Term
According to GOLD, who should be considered for the diagnosis of COPD? |
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Definition
| Any pt who is over 40 y/o and has dyspnea, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease, especially cigarette smoking |
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Term
What are the key indicators for considering a COPD diagnosis? |
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Definition
| Dyspnea, chronic cough, chronic sputum production, hx of exposure to risk factors such as tobacco smoke |
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Term
How can the diagnosis of COPD be confirmed? |
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Definition
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Term
What are the three main spirometry tests used to identify COPD? |
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Definition
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Term
What spriometry results will confirm the presence of COPD? |
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Definition
| When both the FEV1 and FEV1/FVC ratio are decreased |
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Term
What are the four stages of COPD according to GOLD? |
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Definition
| Stage I: Mild, Stage II: Moderate, Stage III: Severe, Stage IV: very severe |
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Term
What are four additional tests recommended by GOLD for the study of COPD? |
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Definition
| Bronchodilator reversibility testing, CXR, ABG measurement, alpha1 antitrypsin deficiency screening |
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Term
Which type of patient is referred to as a “pink puffer”? “blue bloater”? |
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Definition
| Pink puffer-emphysema….blue bloater-Chronic bronchitis |
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Term
| Why is the term “pink puffer” used? |
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Definition
| Derived from the reddish complexion and the “puffing” (pursed lip breathing) commonly seen in a pt with emphysema |
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Term
What are the major pathophysiologic mechanisms responsible for the red complexion and puffing? |
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Definition
-emphysema is caused by the progressive destruction of the distal airways and pulmonary capillaries
-the progressive elimination of the pulmonary capillaries leads to a reduced pulmonary bld flow thru out the lungs-that is an overall increased ventilation-perfusion ratio
-to compensate for the increased ventilation perfusion ratio in the pt who has emphysema hyperventilates
-the increased RR, in turn, works to maintain a relatively normal arterial oxygenation level and causes a ruddy or flushed skin complexion. During the end stage of emphysema, the pts oxygenation status decreases and the CO2 level increases |
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Term
Why is the term “blue bloater” used? |
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Definition
| Derived from the cyanosis commonly seen in the pt with c.bronchitis |
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Term
What are the major pathophysiologic mechanisms responsible for the bluish complexion? |
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Definition
-unlike emphysema, the pulmonary capillaries in the pt with c.bronchitis are not damaged. The pt w/c.bronchitis responds to the increased airway obstruction by decreasing ventilation and increasing CO (a decreased ventilation-perfusion ratio)
-the chronic hypoventilation and increased CO leads to a decreased arterial O2 level , an increased arterial CO2 level, and a compensated (normal) pH-or chronic ventilatory failure arterial blood gases. The resp drive is depressed in pts with chronic ventilatory failure.
-the persistent low ventilation-perfusion ratio and depressed resp drive both contribute to a chronically reduced arterial oxygenation level and polycythemia, which in turn causes cyanosis |
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Term
Body build
-Emphysema:
-C.Bronchitis: |
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Definition
-Emphysema: thin
-C.Bronchitis: stocky, overwt |
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Term
Barrel chest
-Emphysema:
-C.Bronchitis: |
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Definition
-Emphysema: common; classic sign
-C.Bronchitis: normal |
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Term
Respiratory pattern
-Emphysema:
-C.Bronchitis: |
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Definition
-Emphysema: hyperventilation and marked dyspnea often occurs at rest. Late stage: diminished resp drive and hypoventilation
-C.Bronchitis: diminished resp drive. Hypoventilation common, with resultant hypoxia and hypercapnia |
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Term
Pursed lip breathing
-Emphysema:
-C.Bronchitis:
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Definition
-Emphysema: common
-C.Bronchitis: uncommon
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Term
Cough
-Emphysema:
-C.bronchitis: |
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Definition
-Emphysema: uncommon
-C.bronchitis: common; classic sign |
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Term
Sputum
-Emphysema:
-C.bronchitis: |
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Definition
-Emphysema: uncommon
-C.bronchitis: common; classic sign (copious amts, purulent) |
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Term
Cyanosis
-Emphysema:
-C.Bronchitis: |
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Definition
-Emphysema: Uncommon (reddish skin)
-C.Bronchitis: common |
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Term
Peripheral edema
-Emphysema:
-C Bronchitis: |
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Definition
-Emphysema: uncommon
-C Bronchitis: common (with R-heart failure) |
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Term
Neck vein distention
-Emphysema:
-C.Bronchitis: |
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Definition
-Emphysema: Uncommon
-C.Bronchitis: common (R-heart failure) |
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Term
Use of accessory muscles
-Emphysema:
-CBronchitis: |
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Definition
-Emphysema: common
-CBronchitis: uncommon |
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Term
Auscultation
-Emphysema:
-CBronchitis: |
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Definition
-Emphysema: decreased Br/s, decreased heart sounds, prolonged expiration
-CBronchitis: wheezes, crackles, rhonchi, depending on severity of disease |
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Term
Vital Signs COPD
HR and RR for Stable pts and for pts with Exacerbations: |
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Definition
HR and RR: Stable pts- normal, Exacerbations: usually acute increase in HR and RR (tachypnea) |
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Term
What two chest radiograph findings are consistent with either chronic bronchitis or emphysema? |
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Definition
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Term
What four items does the GOLD program consist of? |
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Definition
| (1)assessing and monitoring the disease, (2)reducing risk factors, (3)managing stable COPD, and (4)managing exacerbations |
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Term
What should COPD patient assessment consist of? |
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Definition
| Exposure to risk factors, past medical hx (including asthma and allergies), family hx of COPD, pattern of symptom development, hx of exacerbations, presence of comorbidities, appropriateness of current medical treatments, impact of the disease on the pts life, social and family support available to the pt, possibilities of reducing risk factors |
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Term
What is the single most effective way to reduce the risk of developing COPD as well as slowing its progression? |
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Definition
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Term
What two categories of medication are recommended for symptom management? |
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Definition
| Pharmacologic txs, bronchodilators |
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Term
What does the term exacerbation mean? |
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Definition
| An event in the natural course of the disease that involves a change in the pts baseline dyspnea, cough, or sputum and is beyond the normal day-to-day variations. |
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Term
What are the characteristics that show a patient should be hospitalized? |
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Definition
| Marked increase in intensity of signs or symptoms, such as resting dyspnea; severe hx of COPD, onset of new physical signs (cyanosis, peripheral edema); failure of exacerbations to respond to initial medical management; significant comorbidities, frequent exacerbations; newly occurring cardiac arrhythmias; diagnostic uncertainty; older age; insufficient home support |
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Term
What respiratory therapy protocols should be utilized in the treatment of COPD? |
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Definition
| O2 therapy protocol, Bronchopulmonary hygiene therapy protocol, aerosolized medication therapy protocol, mechanical ventilation protocol |
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