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Focus on Chronic Obstructive Pulmonary Disease (COPD)

Focus on Chronic Obstructive Pulmonary Disease (COPD). COPD Description. Airflow limitation not fully reversible Generally progressive Abnormal inflammatory response of lungs to noxious particles or gases. COPD Description. Includes Chronic bronchitis Emphysema.

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Focus on Chronic Obstructive Pulmonary Disease (COPD)

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  1. Focus on Chronic Obstructive Pulmonary Disease (COPD)

  2. COPD Description • Airflow limitation not fully reversible • Generally progressive • Abnormal inflammatory response of lungs to noxious particles or gases

  3. COPDDescription • Includes • Chronic bronchitis • Emphysema

  4. Chronic BronchitisDescription • Presence of chronic productive cough for 3 or more months in each of 2 successive years • Other causes of chronic cough are excluded

  5. EmphysemaDescription • Abnormal permanent enlargement of the air space distal to the terminal bronchioles • Destruction of bronchioles without obvious fibrosis

  6. COPDSignificance • Fourth leading cause of death in the United States • More than 50% die within 10 years of diagnosis

  7. COPDEtiology • Risk factors • Cigarette smoking • Occupational chemicals and dust • Air pollution

  8. COPDEtiology • Risk factors • Infection • Heredity • Aging

  9. COPDOccupational & Environmental • COPD can develop with intense or prolonged exposure to • Dusts, vapors, irritants, or fumes • High levels of air pollution • Fumes from indoor heating or cooking with fossil fuels

  10. COPDInfection • Recurring infections impair normal defense mechanisms • Risk factor for COPD • Intensify pathologic destruction of lung tissue

  11. COPDHeredity • -Antitrypsin (AAT) deficiency • Genetic risk factor for COPD • Accounts for <1% to 2% of COPD

  12. COPDAging • Some degree of emphysema is common due to physiological changes of aging lung tissue

  13. COPDAging • Natural changes in the aging lungs • Gradual loss of elastic recoil • Lungs become rounded and smaller • Loss of alveolar supporting structures • Decreased number of functional alveoli

  14. COPDAging • Natural changes in the aging lungs • Decreased arterial O2 levels • Thoracic cage changes from osteoporosis and calcification of costal cartilage

  15. COPDPathophysiology • Primary process is inflammation • Inhalation of noxious particles • Mediators released cause damage to lung tissue • Airways inflamed • Parenchyma destroyed

  16. EmphysemaPathophysiology • Two types • Centrilobular • Panlobular

  17. COPDMorphology Fig. 29-8

  18. EmphysemaPathophysiology • Centrilobular (central part of lobule) • Dilation and destruction of respiratory bronchioles and pulmonary capillary bed • Prominent in upper lobes

  19. EmphysemaPathophysiology • Panlobular (destruction of whole lobule) • Affects respiratory bronchioles, alveolar ducts, and alveolar sacs • Prominent in lower lobes

  20. COPDPathophysiology • Supporting structures of lungs are destroyed • Air goes in easily, but remains in the lungs • Bronchioles tend to collapse • Causes barrel-chest look

  21. COPDPathophysiology • Pulmonary vascular changes • Blood vessels thicken • Surface area for diffusion of O2decreases

  22. COPDPathophysiology • Common characteristics • Mucus hypersecretion • Dysfunction of cilia • Hyperinflation of lungs • Gas exchange abnormalities

  23. COPDPathophysiology • Commonly emphysema and chronic bronchitis coexist • Distinguishing symptoms can be difficult with comorbidities

  24. COPDClinical Manifestations • Develops slowly • Diagnosis is considered with • Cough • Sputum production • Dyspnea • Exposure to risk factors

  25. COPDClinical Manifestations • Intermittent cough is earliest symptom • Dyspnea usually prompts medical attention • Occurs with exertion in early stages • Present at rest with advanced disease

  26. COPDClinical Manifestations • Causes chest breathing • Use of accessory and intercostal muscles • Inefficient

  27. COPDClinical Manifestations • Characteristically underweight with adequate caloric intake • Chronic fatigue

  28. COPDClinical Manifestations • Physical examination findings • Prolonged expiratory phase • Wheezes • Decreased breath sounds • ↑ Anterior-posterior diameter

  29. COPDClinical Manifestations • Bluish-red color of skin • Polycythemia and cyanosis

  30. COPD Complications • Cor pulmonale • Exacerbations of COPD • Acute respiratory failure • Peptic ulcer disease • Depression/anxiety

  31. COPDDiagnostic Studies • Diagnosis confirmed by pulmonary function tests • Chest x-rays, spirometry, history, and physical examination are also important in the diagnostic workup

  32. COPDDiagnostic Studies • Spirometry typical findings • Reduced FEV/FVC ratio • Increased residual volume

  33. COPDDiagnostic Studies • ABG typical findings • Low PaO2 • ↑ PaCO2 • ↓ pH • ↑ Bicarbonate level found in late stages COPD

  34. COPD Diagnostic Studies • 6-Minute walk test to determine O2 desaturation in the blood with exercise • ECG can show signs of right ventricular failure

  35. COPDCollaborative Care • Primary goals of care • Prevent progression • Relieve symptoms • Prevent/treat complications

  36. COPDCollaborative Care • Primary goals of care • Promote patient participation • Prevent/treat exacerbations • Improve quality of life and reduce mortality risk

  37. COPDCollaborative Care • Irritants should be evaluated and avoided • Exacerbations treated promptly

  38. COPDCollaborative Care • Smoking cessation • Most effective intervention • Accelerated decline in pulmonary function slows and usually improves

  39. COPDCollaborative Care • Drug therapy • Bronchodilators • Relaxes smooth muscle in the airway • Improves ventilation of the lungs • ↓ Dyspnea and ↑ in FEV1 • Inhaled route is preferred

  40. COPDCollaborative Care • Drug therapy • Commonly used bronchodilators • Β2-Adrenergic agonists • Anticholinergics • Methylxanthines

  41. COPD Collaborative Care • Drug therapy • Inhaled corticosteroid therapy • Used for moderate-to-severe cases • Not for long-term use

  42. COPDCollaborative Care • O2 therapy is used to • Reduce work of breathing • Maintain PaO2 • Reduce workload on heart

  43. COPDCollaborative Care • Long-term O2 therapy improves • Survival • Exercise capacity • Cognitive performance • Sleep in hypoxemic patients

  44. COPDCollaborative Care • Humidification • Used because O2 has a drying effect on the mucosa • Supplied by nebulizers, vapotherm, and bubble-through humidifiers

  45. COPDCollaborative Care • Complications of oxygen therapy • Combustion • CO2 narcosis • O2 toxicity • Absorption atelectasis • Infection

  46. COPDCollaborative Care • Chronic O2 therapy at home improves • Prognosis • Mental acuity • Exercise intolerance

  47. COPDCollaborative Care • Surgical therapy • Lung volume reduction surgery • Remove 30% of most diseased lung to enhance performance of remaining tissue

  48. COPDCollaborative Care • Surgical therapy • Bullectomy • Used for emphysema • Large bullae are resected to improve lung function

  49. COPDCollaborative Care • Breathing retraining • Decreases dyspnea, improves oxygenation, and slows respiratory rate • Pursed-lip breathing

  50. COPDCollaborative Care • Pursed-lip breathing • Prolongs exhalation and prevents bronchiolar collapse and air trapping

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