CVP week 9-13

wk 9 done

What is COPD?

A disease causing obstruction of expiratory airflow → ↑ resistance during expiration

What is the MOST important problem in COPD?

Difficulty with expiration (air getting out)

What happens to the bronchial lumen in COPD?

Decreases → ↑ airway resistance

How does FEV1 change in smokers vs nonsmokers?

Smokers → rapid decline (even if they quit)

Main difference between COPD and restrictive disease?

• COPD → problem getting air OUT (expiration)

• Restrictive → problem getting air IN (inspiration)

Why is inspiration limited in restrictive disease?

↓ lung compliance (can’t expand)

What conditions are included in COPD?

• Chronic bronchitis

• Emphysema

• Asthma (associated)

• Bronchiectasis

Key feature of emphysema?

Destruction of alveolar walls

Chronic Bronchitis Features Key features?

• Mucus accumulation

• Inflammation of the epithelium

• Hyperinflation of the alveoli

What structural changes occur in COPD?

• Narrowed airways

• Destruction of alveoli

• ↓ lung recoil******

COPD general characteristics

Hyperinflated lungs

elevated shoulder girdle

Horizontal ribs

barrel chest

low flattened diagragm

What happens to chest shape in COPD

barrel chest which is increased AP diapter

What happens to diaphragm in COPD

Flattened → weaker (↓ length-tension)

Why do COPD patients lean forward?

To use accessory muscles

Common breathing technique in COPD

pursed lip breating

Common symptoms of COPD?

• Dyspnea (SOB)

• Cough + sputum

• Anxiety

• Fatigue

Why are COPD patients often thin?

↑ energy use for breathing

Best test for COPD?

Spirometry

FEV1/FVC ratio in COPD?< 0.7 (70%)

< 0.7 (70%)

What happens to lung volumes in COPD? What do you hear on auscultation?

• ↑ Residual Volume (RV)

• ↑ FRC

• ↑ TLC

• ↓ ERV

• ↓ breath sounds

• Wheezing

• increased costophrenic angle

Typical ABG changes in people with COPD

• ↓ O₂ (hypoxemia)

• ↑ CO₂ (hypercapnia)

What determines COPD severity?

FEV1 % predicted

COPD stages?

• Stage I: >80%

• Stage II: 50–80%

• Stage III: 30–50%

• Stage IV: <30%

all stages are cough and sputum

stages 2-3 have dyspnea

stage 4 is weight loss and heart/resp/ failure

What is cor pulmonale?

Right-sided heart failure from lung disease

What does BODE stand for?
What indicates poor prognosis?

• B: BMI

• O: Obstruction (FEV1)

• D: Dyspnea

• E: Exercise capacity (6MWT)
  

A:

• Low BMI

• High BODE score (7–10)

• Cor pulmonale

Basic COPD management?

• Smoking cessation

• Medications

• Oxygen therapy

• Surgery (severe cases)

copd pump failure

pump failure resulting in altered alveolar ventilation and hypercapnia

Summarize COPD

Chronic lung disease with expiratory airflow obstruction → air trapping, hyperinflation, ↓ gas exchange; mainly caused by smoking, diagnosed with spirometry (FEV1/FVC < 0.7), leads to dyspnea, cough, and possible respiratory failure

What is emphysema? What are the 3 core problems in emphysema?

Destruction of alveolar walls + enlarged air spaces distal to terminal bronchioles forever

• ↓ airflow

• Hyperinflation

• Poor gas exchange

Why is emphysema considered preventable?

What structures are destroyed?

What happens to elastic recoil?

Strong link to smoking

Terminal bronchioles and Alveoli

Decreases

When do airways collapse in emphesema

During expiration

Why does air trapping occur?

Air can enter but cannot leave → hyperinflation

Why is gas exchange impaired in emphysema

Loss of alveolar surface area

What genetic condition causes emphysema?

Alpha-1 antitrypsin deficiency

Why does A1AT deficiency cause emphysema?

↓ surfactant → ↓ elasticity → ↑ lung damage

3 types of emphysema?

• Centrilobular -

  • destruction of respiratory bronchioles

  • Upper lobes

  • Associated with smoking

  • Often with chronic bronchitis

• Pan lobular -

  • Affects entire alveolus

  • Lower lobes (bases)

  • Linked to A1AT deficiency

• Distal -

  • Affects area under pleura → risk of pneumothorax

Most common emphysema type?

Centrilobular

Common imaging findings in emphysema?

• Flattened diaphragm

• Hyperinflated lungs

• Increased air spaces

What are bullae? Why are bullae dangerous?

Air pockets from alveolar destruction

Can rupture → pneumothorax

Summarize emphysema

Lung disease with alveolar destruction + loss of elastic recoil → air trapping, hyperinflation, and ↓ gas exchange; mainly caused by smoking or A1AT deficiency

What is chronic bronchitis?

Productive cough ≥3 months/year for 2 consecutive years

Hallmark of chronic bronchitis?

Excessive mucus production

Why are airways narrowed in chronic bronchitids?

What happens to mucus glands?

What happens to cilia?

Swelling + inflammation

Hypertrophy (increase in size)

Decreased → poor mucus clearance (cilia clears mucus)

Common symptoms in bronchitis?

What breath sounds are heard?

• Chronic productive cough

• Sputum

• Dyspnea

Rales + rhonchi

What is a classic physical appearance of somene with chronic bronchitis?

“Bloated” (fluid retention)

Why do patients appear blue in people with chronic bronchitis

Hypoxemia → cyanosis

Body type in bronchitis vs emphysema?

• Bronchitis → overweight/bloated, cough, SOB DOE, cyanosis, barrel chest, cor polemone

• Emphysema → thin // accessory muscles, forward lean, pursed lip, DOE

Main difference from emphysema vs bronchitis?

• Bronchitis → mucus + cough

• Emphysema → alveolar destruction, little mucus

Sequence leading to cor pulmonale?

1. Hypoxemia → vasoconstriction → pulmonary HTN → RV hypertrophy → failure

Summarize chronic bronchitis

COPD type with chronic productive cough + excess mucus → airway obstruction, hypoxemia, and risk of cor pulmonale

Common symptoms of chronic bronchitis

• Chronic productive cough

• Sputum

• Dyspnea

What breath sounds are heard?

Rales + rhonchi

Other late-stage findings in people with chronic bronchitis

• hypoxemia

• Polycythemia

• ↑ CO₂ (hypercapnia)

cor polmonale and phases

right ventricular failure SECONDARY to chronic pulmonary HTN

1. airway obstruction

2. intrapulmonary shunt

3. hypoxic vasoconstriction (pressure)

4. pulmonary HTN (RV has to work harder)

5. RV heart failure

What is bronchiectasis?

Irreversible dilation and destruction of airways due to chronic infection

Irreversible airway damage + dilation

Chronic bacterial infections (e.g., pneumonia)

What happens to the bronchi?

• Dilated of the bronchi

• Destroyed walls

• ↓ elastic recoil

• Large, copious amounts accumulate

symptoms of brinchiectactisis

• Chronic cough

• Recurrent infections

• Hemoptysis (blood in sputum)

What can bronchiectasis lead to?

• Pneumonia

• Chronic bronchitis

• Emphysema

• Cor pulmonale

• Respiratory failure

Summarize bronchiectasis

Chronic condition with irreversible airway dilation + destruction → massive mucus buildup, recurrent infections, and risk of respiratory failure

What is asthma?

Chronic inflammatory disease with hyperresponsive airway smooth muscle

What is the MOST important feature of asthma?

Airway hyperresponsiveness (reactivity to triggers)

Is asthma permanent or episodic?

Episodic (attacks/flare-ups)

What are the 3 main components of asthma?

• Bronchospasm (smooth muscle constriction)

• Edema (airway swelling)

• Mucus production

• ****INCREASED RESPONSIVENESS OF THE AIRWAY SMOOTH MUSCLE

Why is airflow limited in asthma?

Narrowed airways from spasm + swelling + mucus

What happens during an asthma attack?

Trigger → inflammation → bronchoconstriction → ↓ airflow

What happens to expiration during asthmas

• Prolonged expiration

• Wheezing (often audible)

• Unproductive (mucus trapped)

• Shortness of breath

• Chest tightness

• Tachypnea

What indicates severe asthma?

• tachypnea

• hyperinflation

• ↑ accessory muscle use

• need to sit upright

• Pulsus paradoxus

Asthma - PFTS

• during attack decreased FEV/FVC 1

• important to preform after bronchodilators

• improvement of 15% or more is good

What is a key early indicator of asthma?

Peak Flow Rate (PFR)

What must asthma treatment address?

• Bronchospasm → bronchodilators

• Inflammation → anti-inflammatory meds

• Mucus → secretion control

What is an asthma action plan?

Guideline using symptoms + PFR (green/yellow/red zones)

Summarize asthma

Episodic disease with airway hyperresponsiveness → bronchospasm, edema, and mucus causing reversible airflow obstruction

What is cystic fibrosis?

Inherited disorder of ion transport in exocrine glands → thick, sticky mucus

What is the main issue in CF?

Abnormally thick mucus → obstruction + infection caused by Genetic mutation (CFTR) affecting chloride transport

What happens in the lungs in CF

• Mucus plugging

• Inflammation

• Airway obstruction

How does CF progress?

Bronchiolitis → bronchitis → bronchiectasis → pneumonia → fibrosis

Why is gas exchange impaired in CF

Obstruction + infection + inflammation

What is unique about sweat in CF?

↑ sodium and chloride (salty sweat)

Key diagnostic test for CF?

Sweat test (Cl⁻ ≥ 60 mEq/L) or Newborn CFTR mutation screen

Summarize cystic fibrosis

Genetic disease causing thick mucus buildup → lung infections, airway obstruction, and malabsorption

What is a restrictive lung condition?

Reduced lung volume → difficulty with inspiration

Obstructive vs restrictive main difference?

• Obstructive → problem getting air OUT

• Restrictive → problem getting air IN

What is the main issue in restrictive conditions?

Decreased lung compliance (stiff lungs)

Decreases → lungs can’t expand

Why is gas exchange affected in RLD

↓ lung expansion → ↓ ventilation

What happens to FEV1/FVC ratio in RLD

Normal or increased

Key PFT pattern in restrictive disease?

↓ volumes but preserved ratio

Which phase is affected?

• Restrictive → Inspiration

• Obstructive → Expiration

• Restrictive → Lung tissue / chest wall

• Obstructive → AirwaysWhat causes restrictive conditions?

What causes restrictive conditions?

• Lung tissue problems

• Chest wall issues

• Developmental issues

How does aging affect lungs?

• ↓ chest wall compliance

• ↓ muscle strength

• ↓ gas exchange

What is pulmonary fibrosis?

Scar tissue replaces lung → stiff lungs

What causes Bronchopulmonary Dysplasia?

Ventilation + high oxygen in infants → lung damage

What is atelectasis? Causes of atelectasis?

Incomplete lung expansion (collapse)

• Air in pleural space (pneumothorax)

• Fluid (effusion)

• Tumor/obstruction

What does atelectasis look like on X-ray?

White/opaque area

Treatment for atelectasis?

• Deep breathing

• Incentive spirometry

• Coughing

Summarize restrictive lung conditions

Conditions with ↓ lung compliance and ↓ lung volumes → difficulty with inspiration and ↑ work of breathing

What is pneumonia?

begins as an infection in the lower resp tract

Infection of lung parenchyma → inflammation + impaired gas exchange

Types of pneumonia by location?

• Lobar (one lobe)

• Bronchopneumonia (patchy)

• Interstitial (diffuse)

Bacterial pneumonia features? Viral pneumonia features?

bacterial

• Acute onset

• Fever/chills

• Productive cough

• Lobar consolidation

• wet and local

viral

• Diffuse/bilateral

• Dry cough

• Less consolidation

• dry cough

What is ARDS/acute lung injury

Acute lung injury → fluid in alveoli

Why does ARDS cause hypoxemia?

Fluid replaces air → ↓ gas exchange