17. Chronic Bronchitis - Winroth

• Chronic Obstructive Pulmonary Disease (COPD) - is a common preventable and treatable disease
• COPD - characterized by persistent airflow limitation

  • progressive and associated with chronic inflammatory response in the airways and lungs to noxious particles and gases
• COPD - presence of airflow limitation is established by spirometry
• COPD - FEV1/FVC ratio = less than .70

  • indicate obstructive airway
• COPD can overlap with

  • emphysema
  • chronic bronchitis
• COPD - show hyper-responsiveness to exogenous stimuli and histamine
• There is a relationship between smoking and development of COPD
• Pack year of smoking is a predictor of FEV1
• pts with history of smoking with normal spirometry have evidence for worse health related quality of life
• COPD sputum color changes are associated with?

  infection
• In early stages of smoking, physical exam is normal except?


  odor
• Acute exacerbation of COPD pt appears?

  • anxious
  • tachypneic
  • using accessory muscle - wheezing + cyanosis
• COPD severe disease finding?

  • barrel chest - sign of hyperinflation + enlarge lungs
  • use of accessory muscles
  • wheezing

  
• COPD - physical finding

  • cachexia - wasting
  • due to elevated TNF-a
  • poor prognosis
  • clubbing
  • Hoover's sign - inward movement of rib cage with inspiration
• COPD primary diagnostic test?

  PFT and spirometry
• COPD - test for a1-AT deficiency
• COPD PFT finding

  • FEV1 - reduced
  • FEV1/FVC ratio - less than 0.7
  • TLC - increase
  • DLCO - reduced
• use of bronchodilator in COPD can increase FEV1/FVC but never back to normal
• COPD management

  • stop smoking
  • bronchodilator
• non-pharm therapy of COPD

  • exercise and maintain normal body weight
• COPD - vaccine for pneumococcal and flu important for preventing infection