Chapter 13 RCP 370

What is Chronic Bronchitis

• Chronic bronchitis is classified as “blue bloater” or a patient with type B COPD

• Chronic Bronchitis is based on the major clinical manifestations of COPD

What is Emphysema?

• Emphysema is classified as a “Pink Puffer” or a patient with type A COPD

• Emphysema is based on the pathology

What does FEV1/FVC ratio tell us? When does it indicate restrictive vs obstructive

• Indicates obstructive

• The FEV1/FVC ratio tells how much air you can forcefully exhale

What is Comorbidity?

• The simultaneous presence of two or more diseases or medical conditions in a patient

General body build for emphysema and chronic bronchitis

• Chronic bronchitis: overweight and cyanotic

• Emphysema:Older thin

Breath sounds for emphysema and chronic bronchitis

• Chronic Bronchitis: Rhonchi and wheezing

• Emphysema: Severe dyspnea, quiet chest

Management of acute COPD exacerbation for Mild,Moderate,Severe

• Mild Exacerbation:Requires the initial use of inhaled SABA with or without a short acting antimuscarinic bronchodilator

• Moderate Exacerbation:Requires the use of SABA, plus an antibiotic and/or oral corticosteroids.

• Severe Exacerbation:requires an ER visit, hospitalization, or ICU admission. Associated with acute ventilatory failure.

Laboratory test:How is Hct and Hb affected with emphysema and chronic bronchitis

• Emphysema: Normal -mild to moderate stage

• Elevated- Late stage

• Chronic Bronchitis- polycythemia common during the early and late stage.

Chest Radiograph findings for obstructive/COPD

Common

• Translucent

• Depressed or flattened diaphragms

• Long and narrow heart

• Increased retrosternal air space

Occasionally

• Cor pulmonale

• Emphysematous bullae

Define Blue Boater

• Chronic bronchitis patients are overweight due to it being related to exercise intolerance (shortness of breath caused by physical activity) can lead to a sedentary lifestyle, a risk of which is obesity.

Define Pink Puffer

• Emphysema patients are thin due to elevated levels of circulating leptin, which negatively affects dietary intake and consequently muscle mass.

What is pan lobular emphysema

• Permanent enlargement and destruction of the air spaces distal to the terminal bronchial

What is centri lobular emphysema

• Respiratory bronchial walls in the proximal(central) portion of the acinus enlarge and are destroyed

Anatomic alteration for emphysema

• Panacinar emphysema or pan lobular emphysema

• Centriancinar emphysema or centrilobular emphysema

Gold initial diagnosis of COPD age(age in patients over age 40)

• Dyspnea

• Chronic Cough

• Chronic sputum production

• History of chronic exposure to risk factors

• Family history of COPD

DLCO in COPD patients

• Emphysema:Decreased. A decreased DLCO. is a classic diagnostic sign of emphysema

• Chronic bronchitis: Normal

Emphysema clinical manifestations

• Thin, underweight

• Barrel chest (classic sign)

• Altered sensorium- anxiety, irritability, common at severe stage.Classic sign of Hypoxemia

• Peripheral edema and venous distention at end stage emphysema

• Digital clubbing in late stage

• Often reddish due to working hard to breath

• Pursed lip breathing

• Some coughing during severe stage with infection

• Sputum:Little mucoid

• Percussion of the chest: Hyperresonace. Decresed diaphragmatic excursion.

• Auscultation of the chest:Diminished breath sound prolonged expiration, Diminished heart sound.

What does FVC,FEV1/FVC ratio shows us?

• Nonpharmacologic treatment of COPD

• Hoover sign

• Late-stage chronic bronchitis clinical manifestations

Risk factors for COPD

• Genetic predisposition

• Age and gender-COPD increases with age

• Conditions that affect normal lung growth

• Exposure to particle

• Tobacco smoke

• Occupational dusts and chemical

• Indoor air pollution

• Outdoor air pollution

• Socioeconomic status

• Asthma/ bronchial hyperactivity

• Chronic Bronchitis

• Respiratory infections

• Tuberculosis

Anatomic alteration for chronic bronchitis

• Chronic inflammation and thickening of the wall of the peripheral airways

• Excessive mucous production and accumulation

• Partial or total mucous plugging of the airway

• Smooth muscle constriction of bronchial airway(bronchospasm) - a variable finding

• Air trapping and hyperinflation of alveoli may occur in late stages