Term
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Definition
| a preventable, treatable disease with some significant extrapulmonary effects that may contribute to severity of disease. The pulmonary component is characterized by airflow limitations that are not fully reversible. air flow limitation is usually progressive and associated with abnormal inflammatory response of the lung to noxious particles and gases (cigarette smoke), progressive and debilitating, exacerbations and comorbidities contribute to severity |
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Term
| highest rates of COPD wehre |
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Definition
| midwest, industrial areas. but also everywhere |
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Term
| deterioration of lung function in COPD |
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Definition
| gradual, don't see signs/symptoms moving from mild to moderate until FEV1 is 30-40% of predicted, goes unnoticed |
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Term
| factors that can cause COPD |
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Definition
| cigarette smoke, pollutants, occupational agents, repeated respiratory infections, concurrent asthma, alpha-1 antitrypsin deficiency, oxidative stress from lung inflammation |
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Term
| alpha-1 antitypsin deficiency pathophys |
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Definition
| missing antiproteases that keep proteases in check that clean up debris after lung infections and so the proteases keep working and break down lung tissue. specifically unopposed breakdown of elastin fibers by elastase. get destruction of alveoli, enlarged airspaces, impaired gas diffusion, air trapping -> emphysema |
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Term
| smoking leads to interoxidative stress which leads to |
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Definition
| inflammation, fibrosis, thickening of the walls, mucus hypersecretion -> narrowing of the airways -> chronic bronchitis (have inc sputum production). smoking can also lead to destruction of alveolar walls and then emphysema |
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Term
| pathophys of inflammation in the lungs from cigarette smoke |
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Definition
| cigarette smoke affects the alveolar macrophages, affect neutrophils and proteases get released -> destroy lung tissue, alveolar destruction, mucus hypersecretion -> emphysema and chronic bronchitis. also problem w epithelial cells -> inc number of fibroblasts -> lay down more collagen -> fibrosis of the lung -> obstructive bronchiolitis |
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Term
| changes in the large airways in COPD |
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Definition
| due to mucus secretion and hyperplasia -> mucus glands become hyperplastic, goblet cells become hyperplastic -> increased mucus secretion -> hypersecretion. neutrophils in sputum bc of inflammatory process. mucus and inflammation causing airway obstruction |
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Term
| what happens in emphysema |
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Definition
| alveolar wall destruction, break down septa that separate alveoli so airspace decreases, less ability to exchange O2 and CO2, get loss of elasticity, destruction of capillary beds and inflammatory cells |
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Term
| changes in the small airways in COPD |
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Definition
| inflammatory exudate oozing out of the lumen -> narrowing, disruption of alveolar attachments, fibrosis, lymphoid involvement, thickening of the wall |
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Term
| general signs and symptoms of COPD |
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Definition
| easily fatigued, frequent respiratory infections, use of accessory muscles, orthopnic, wheezing, pursed-lip breathing, chronic cough, barrel chest, thin appearance, more likely to develop right-sided heart failure |
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Term
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Definition
| chronic bronchitis, airflow problems, dusky color to cyanosis, recurrent cough, inc sputum production, hypoxic, hypercapnic, respiratory acidosis. bc of hypoxia release erythropoietin and can get inc hgb and hct, polycythemia. exertional dyspnea, clubbing |
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Term
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Definition
| emphysema, inc CO2 retention, minimal cyanosis, difficulty getting air in and out w barrel chest- pursed lip breathing (dec flow rate and get more air w changing pressure), dyspnea, orthopnic, exertional dysnpea, thin, emaciated |
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Term
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Definition
| CAT, ask questions and score, never cough ect. 5-10 stop smoking, 10-20 medium risk- pulmonary rehab, review drug therapy, >20 (high) >30 (very high) refer to pulmonologist |
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Term
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Definition
| blood gasses and spirometry, hypoxic pCO2 inc, elevated hct, check alpha-1 antitrypsin deficiency if indicated, |
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Term
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Definition
| diagnosis requires FEV1 <80% of predicted, get inc TLC and RV due to air trapping, carbon monoxide transfer and coefficient will be markedly reduced, dec FEV1/FVC ratio (mild <70%) |
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Term
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Definition
| prominent vascular markings due to edema and mucus production (stand out more) |
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Term
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Definition
| overdistension of lungs, barrel chest, flattening of diaphragm, maybe emphysematous bullae, lots of air space between sternum and mediastinum and heart |
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Term
| COPD pts are at greater risk of developing |
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Definition
| cardiovascular disease, cancer, malnutrition, muscular dysfunction, weight loss, anemia, depression |
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Term
| key to treatment for COPD |
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Definition
| prevention, pneumovax and annual flu shot |
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Term
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Definition
| short-acting bronchodialator (beta 2 agonists, anti-muscarinic) (rapid onset sec-min, last 4-6 hrs, good for acute flares) |
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Term
| treatment for moderate, severe COPD |
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Definition
| pulmonary rehab, long-acting bronchodialator (improve lung function, dec symptoms, dec exacerbations) |
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Term
| treatment for very severe COPD |
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Definition
| glucocorticoids, long term oxygen |
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Term
| side effects of beta-2 agonist bronchodilators |
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Definition
| (esp seen w short-acting), tachycardia, tremor, nervousness, hypokalemia, vasodilation, mild hypoxia due to shunting, hypotenison, reflex tachycardia, dec cardiac output |
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Term
| anti-muscarinic bonchodialators |
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Definition
| anticholinergics, block muscarinic acetylcholine receptors, have long-acting and short acting, reduce symptoms, reduce exacerbations, improve FEV1, improve funcitonal status, work well w beta agonists, classic is atropine but not used for bc can cross BB barrier, we use ipatropium (poorly absorbed in GI, doesn't cross BBB) |
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Term
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Definition
| M1- parasympathetic ganglia, M2- postganglionic nerve terminals, M3- in airway smooth muscle cells and mucous glands, mediate parasympathetic excitation of these tissues |
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Term
| side effects of anticholinergic drugs |
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Definition
| dry mouth, glaucoma, urinary retention |
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Term
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Definition
| reduce inflammation, dec airway hyperresponsiveness, reduce exacerbations, reduce chronic bronchitis symptoms but SEs: can develop thrush (Candida albicans overgrowth), dysphonia, inc pneumonia risk, systemic complications- elevated glucose or osteoporosis |
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Term
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Definition
| PDE4 inhibitor, little better than theophylline (xanthine), anti-inflammatory, reduces frequency of exacerbaitons, SEs: nausea, vomiting, diarrhea, dec appetite , weight loss. worsening depression, headaches, insomnia (SEs dec over time) |
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Term
| nonpharmaceutical therapy for COPD |
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Definition
| smoking cessation, influenza vaccine, pneumococcal vaccine, pulmonary rehab, oxygen therapy (for pp w PaO2 under 55 and O2 sat under 88, or start developing right heart failure cor pulmonale or have polycythemia) |
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Term
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Definition
| cough, dysnpea, sputum production, maybe some altered mental status, impaired gas exchange. masqueraders: pulmonary embolism, CHF |
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Term
| treatment for acute COPD exacerbations |
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Definition
| bronchodilators, corticosteroids, maybe antibiotics, beta blockers probably underprescribed (have to be careful about which ones you use but can be useful with heart failure) |
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Term
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Definition
| reduce symptoms, palliative care, damage is irreversible, most pts don't receive optimal palliative care |
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Term
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Definition
| midwest, northern, not the south |
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Term
| definition of asthma, what you see, what happens, type of disease |
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Definition
| chronic inflammatory disorder of the airway in which many cells and cellular elements play a role (mast cells, eosinophils, T lymphs, neutrophils, epithelial cells) variable and reversible airflow obstruction- spontaneously or due to medication. get recurrent episodes of wheezing, breathlessness, chest tightness, cough, esp early morning hrsl. airway inflammation contributes to airway hyperresponsiveness to stimuli. atopic disease, body develops IgE in response to environmental allergens |
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Term
| diseases related to asthma |
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Definition
| allergic rhinitis, asthma, hay fever, eczema |
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Term
| 3 major pathophysiology components to asthma |
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Definition
-inflammation (inc eos, mast cells, lymphs)
-persistent changes in the airway structure (fibrosis, mucus hypersecretion, smooth muscle hypertrophy)
-airflow obstruction (variable and responsive to bronchodilators) |
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Term
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Definition
| turbulent airflow due to bronchoconstriction and inflammation |
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Term
| inflammatory remodeling in asthma |
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Definition
| acute response -> bronchoconstriction, edema, inc secretions, mucus production, cough. chronic inflammation -> inc cell recruitment, epithelial damage, some early structural damage -> airway remodeling -> smooth muscle hypertrophy/proliferation, mucus, inc protein, basement membrane thickening -> fibrosis |
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Term
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Definition
| treat the obstruction, hyperresponsiveness, inflammation. use steroids and beta agonists to open the airway, inc airflow, dec obstruction, dec inflammation. inflammation ect could have been going on 6-8 weeks before symptoms of asthma attack |
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Term
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Definition
| genetic predisposition, exposure to allergens/smoke/pollution/microbes, stress, diet, obesity, inactivity, sudden temp changes, respiratory infection, strenuous exercise |
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Term
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Definition
| recurrent episodes of wheezing, troublesome cough at night, cough or wheezing after exercise, chest tightness after exposure. lung function and FEV1 might not be that bad, variable symptoms |
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Term
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Definition
| FEV1, look for improvement after bronchodilator, spirometry (obstructive pattern but not always). may need to repeat testing. fractional exhaled nitrous oxide- measures the nitrous oxide released by damaged epis (inflammometer), check IgE levels or specific Ags, CBC looking at eos, radiographic imaging, bronchoprovocation- trigger airway hyperactivity |
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Term
| determining severity of asthma |
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Definition
| look at current impairment (frequency/intensity) and functional limitations |
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Term
| to be classified as persistent asthma have to have |
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Definition
| any one of the following: albuterol use greater than 2 days per week, not daily, asthma symptoms greater than 2 days per week ,not daily, nighttime awakenings >2x/month, minor limitations to activity, FEV1 >80% predicted |
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Term
| quick relief asthma medicaxtions |
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Definition
| short acting beta 2 agonists, albuterol or anticholinergics -ipatropium |
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Term
| treatment for acute exacerbations in the ER |
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Definition
| systemic corticosteroids and short-acting beta 2 agonists |
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Term
| for long term asthma treatment |
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Definition
| daily inhaled corticosteroids, leukotriene modifiers, long-acting beta 2 agonists, cromolyn (mast cell stabilizers- only good for allergy induced), methylxanthines (theophylline) |
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Term
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Definition
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Term
| asthma intermittent vs mild vs mod vs severe chart |
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Definition
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Term
| order of adding meds for asthma |
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Definition
| short term beta 2 agonists, low dose inhaled corticosteroid, long term beta 2 agonists, medium dose inhaled corticosteroids, high dose inhaled corticosteroids, oral steroids, prednisone |
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Term
| how do inhaled beta agonists work |
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Definition
| bind the beta-2 cells on smooth muscle leading to vasodilation and opening up the airways |
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Term
| asthma exacerbation treatment |
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Definition
| beta agonists- nebulizer, every 2 hrs if needed, O2, steroids, ipatropium, corticosteroids a couple hrs after 1st albuterol, may have to do continuous inhaled albuterol, IV magnesium sulfate can help (reduces hospitalization but can cause hypotension so give fluids), IV terbutaline (cardiac SE) if albuterol fails, IV epinephrine if anaphylaxis , IV fluids for dehydration (also restores lactic acidosis, tachypnea and distress due to rapid breathing) |
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Term
| side effects of beta agonists |
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Definition
| tachycardia, superventricular tachycardia, hypokalemia, prolong QT intervals (avoid macrolides or antibiotics to avoid arrhythmia), IV administration can lead to systolic hypertension or diastolic hypotension |
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Term
| antibiotic for asthmatic with mass on CXR |
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Definition
| azithromycin (has anti-inflammatory effects). chlmaydia and mycoplasma are implicated in severe asthma and macrolides or tetracyclines can be used to treat those |
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Term
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Definition
| unrelenting, unremitting asthma with rapidly increasing severity due to diffuse bronchiole obstruction leading to hypoxia and respiratory muscle fatigue, get chest tightness, SOB, cough, tachycardia, tachypnea, cyanosis, use accessory muscles, intercostal retractions, no wheezing (no airflow). may be hypoxic, hypercapnic. CXR may show hyperinflation due to air trapping. Treat w O2. bronchodilaters every 2 hrs or continuous. high dose IV corticosteroids. mechanically ventilate if they get too tired to breathe, |
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