MS UNIT 5 PT.5

neutrophils, CD8+ T-lymphocytes, and macrophages

which inflammatory cells dominate the chronic inflammatory response in COPD

excess mucus production and airway plugging

in COPD, Bronchial submucosal glands enlarge, leading to ____

elastin in alveolar septa

Destruction of ____ decreases the natural elasticity of the lungs and removes radial traction on small bronchioles

radial support

During exhalation of COPD, the loss of _____ causes airways to collapse prematurely, trapping air within the distal air spaces (hyperinflation)

Alveolar wall destruction

____ reduces the capillary bed surface area needed for gas exchange, causing severe Ventilation-Perfusion (V/Q) mismatching

Ventilation-Perfusion (V/Q) mismatching

Alveolar wall destruction reduces the capillary bed surface area needed for gas exchange, causing severe ____

Chronic hypoxia

____ causes reactive pulmonary vasoconstriction, leading to pulmonary arterial hypertension and eventually Cor Pulmonale (right ventricular enlargement and failure)

Cor Pulmonale

Chronic hypoxia causes reactive pulmonary vasoconstriction, leading to pulmonary arterial hypertension and eventually ___ (right ventricular enlargement and failure)

post-bronchodilator spirometry

In COPD, diagnosis requires ____ demonstrating persistent airflow obstruction

FEV1/FVC <0.70 (70%)

Establishes the presence of non-reversible airflow limitation

Decreased FEV1

Quantifies the severity of airflow obstruction

Decreased FEV1

categorized under GOLD grades 1 through 4

Increased Total Lung Capacity (TLC) & Residual Volume (RV)

Indicates severe air trapping and pulmonary hyperinflation

Spirometry/PFTS

Golden standard of COPD

Post-bronchodilator FEV₁/FVC < 0.70

What spirometry finding confirms persistent airflow obstruction in COPD?

Spirometry/PFTS

Confirms diagnosis and establishes disease baseline.

Arterial Blood Gas (ABG)

Assesses severity of hypoxemia, hypercapnia, and acid-base status

Chest X-Ray (CXR)

Rules out differential diagnoses (e.g., pneumonia, heart failure, lung cancer).

Centrilobular or panlobular bullae, parenchymal destruction

High-Resolution CT (HRCT) findings for COPD

High-Resolution CT (HRCT)

Determines exact anatomical distribution and candidate suitability for surgical volume reduction.

Levels < 11 umol/L

Serum A1-Antitrypsin findings for COPD

Serum A1-Antitrypsin

Recommended for young patients (<45 years) or non-smokers presenting with emphysema

Progressive Dyspnea

Persistent, exertional dyspnea that progresses over years to occur at rest.

clear, mucoid, or purulent sputum

in COPD, Cough may be intermittent or daily, often productive of _____.

long-term hyperinflation

in COPD, Increased anteroposterior (AP) to transverse chest diameter (1:1 ratio) caused by ____

Pursed-Lip Breathing

Exhaling against partially closed lips to maintain positive end-expiratory pressure, preventing small airway collapse during exhalation.

Use of Accessory Muscles & Tripod Position

Leaning forward with hands resting on knees or thighs to optimize diaphragmatic excursion

Hyperresonant chest percussion, distant heart sounds, diminished breath sounds, coarse rhonchi, or expiratory wheezes

Physical Exam Findings of COPD

Smoking Cessation

The most impactful intervention to halt the decline in lung function.

Short-Acting Bronchodilators (SABA / SAMA): Albuterol, Ipratropium

used for acute symptom control in COPD

Long-Acting Bronchodilators (LABA / LAMA): Formoterol, Salmeterol, Tiotropium

used for daily maintenance in COPD

Inhaled Corticosteroids (ICS)

Added to LABA/LAMA for patients experiencing frequent acute exacerbation

Phosphodiesterase-4 (PDE-4) Inhibitors (Roflumilast)

used to decrease exacerbations in severe chronic bronchitis.

PaO2 < 55mmHg or SpO2 < 88%

Oxygen therapy is indicated for resting hypoxemia (PaO2____ or SpO2 ___).

Low-flow supplemental oxygen (1-2 L/min)

it reduces mortality, pulmonary vascular resistance, and secondary erythrocytosis

Annual influenza vaccination and pneumococcal vaccines (PPSV23 / PCV20)

used to to prevent infection-triggered exacerbations in COPD

Lung Volume Reduction Surgery (LVRS)

 Resection of 20% to 30% of hyperinflated, diseased lung tissue to improve chest wall mechanics and diaphragmatic function.

Bullectomy

Surgical excision of large, non-functional air pockets compressing healthy lung parenchyma

Bronchoscopic Lung Volume Reduction (Endobronchial Valves)

One-way valves inserted via bronchoscope into target airways to collapse hyperinflated lobes without open surgery

Lung Transplantation

Indicated for severe, end-stage COPD in selected candidates refractory to all medical interventions

carbonated beverages or gas-forming

for COPD, advise avoiding ____ foods that distend the stomach and compress the diaphragm

“PINK PUFFER” (PRIMARY EMPHYSEMA)

Primary Pathology: Permanent destruction of alveolar septa and elastic recoil.

“PINK PUFFER” (PRIMARY EMPHYSEMA)

Primary Clinical Appearance: Mild/absent cyanosis; pink/flushed skin due to compensatory hyperventilation

“PINK PUFFER” (PRIMARY EMPHYSEMA)

Body Habits: Often thin, emaciated, or cachectic with marked weight loss

“PINK PUFFER” (PRIMARY EMPHYSEMA)

Dyspnea: Severe and progressive dyspnea, even at rest

“PINK PUFFER” (PRIMARY EMPHYSEMA)

Cough & Sputum: Minimal cough; scanty or non-productive sputum.

“PINK PUFFER” (PRIMARY EMPHYSEMA)

Arterial Blood Gases (ABGs): Near-normal PaO2 until late stages; normal or low PaCO2 (compensated hyperventilation)

“PINK PUFFER” (PRIMARY EMPHYSEMA)

Chest Configuration: Classic Barrel Chest (increased 1:1 AP-to-transverse diameter) due to air trapping.

“PINK PUFFER” (PRIMARY EMPHYSEMA)

Breathing Technique: Marked pursed-lip breathing and use of accessory muscles (tripod position)

“PINK PUFFER” (PRIMARY EMPHYSEMA)

Complications: Cor Pulmonale appears only in end-stage disease; bullae/spontaneous pneumothorax risk.

“BLUE BLOATER” (PRIMARY CHRONIC BRONCHITIS)

Primary Pathology: Chronic mucosal inflammation, hypersecretion of mucus, and bronchial obstruction

“BLUE BLOATER” (PRIMARY CHRONIC BRONCHITIS)

Primary Clinical Appearance: Prominent cyanosis (bluish tint to skin and mucous membranes) due to severe hypoxia

“BLUE BLOATER” (PRIMARY CHRONIC BRONCHITIS)

Body Habits: Frequently stocky, overweight, or obese with peripheral edema.

“BLUE BLOATER” (PRIMARY CHRONIC BRONCHITIS)

Dyspnea: Moderate dyspnea; less prominent than in pure emphysema.

“BLUE BLOATER” (PRIMARY CHRONIC BRONCHITIS)

Cough & Sputum: Severe, chronic productive cough with abundant mucoid/purulent  sputum.

“BLUE BLOATER” (PRIMARY CHRONIC BRONCHITIS)

Arterial Blood Gases (ABGs): Marked hypoxemia (low PaO2) and chronic hypercapnia (elevated PaCO2).

“BLUE BLOATER” (PRIMARY CHRONIC BRONCHITIS)

Chest Configuration: Normal or slightly increased chest AP diameter.

“BLUE BLOATER” (PRIMARY CHRONIC BRONCHITIS)

Breathing Technique: Shallow respiration; less dependence on pursed-lip breathing

“BLUE BLOATER” (PRIMARY CHRONIC BRONCHITIS)

Complications: Early onset of Cor Pulmonale (right-sided heart failure), secondary polycythemia, and peripheral edema