CHRONIC OBSTRUCTIVE PULMONARY DISEASE subtitle style Click to edit Master

4/21/12

4/21/12

Overview

Currently, COPD is the fourth leading cause of mortality and the 12th leading cause of disability. However, by the year 2020 it is estimated thatCOPD will be the third leading cause of death and the forth leading cause of disability (Sin, McAlister, Man. Et al., 2003). People with COPD commonly become symptomatic during the middle adult years, and the incidence of the disease increases with age.

Predisposing Factor
4/21/12

-increasesmucus productioninthe lungsand paralyzesthecilia -toomuchmucus clogsthegas exchange functionofyour airsacs -Smokingcan interferinyour abilitytocough effectively

4/21/12

PATHOPYSIOLOGY

In COPD, the airflow limitation is both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. The inflammatory response occurs throughout the airways, parenchyma, and pulmonary vasculature. Because of the chronic inflammation and the bodys attempts to repair it, narrowing occurs in the small peripheral airways.

4/21/12

. Over time, this injury-and-repair process causes scar tissue formation and narrowing of the airway lumen. Airflow obstruction may also be caused by parenchymal destruction, as is seen with emphysema, a disease of the alveoli or gas exchange units.

4/21/12

What COPD is: The deadly combo

In the vast majority of patients, COPD refers to a combination of a chronic bronchitis and emphysema. Most COPD patients have both conditions, although one maybe more advance than the other.

4/21/12

CHRONIC BRONCHITIS

a chronic inflammation of the bronchi (medium-size airways) in the lungs. It is generally considered one of the two forms of (COPD).It is defined clinically as a persistent cough that produces sputum (phlegm) and mucus, for at least three months in two consecutive years.

4/21/12

-an increased number and increased size of the goblet cells and mucous glands of the airway. -BLUE BLOATERS

4/21/12

Narrow opening Excess mucus Inflamed airway with significant swelling.

4/21/12

Sympotms include chronic coughing and throat clearing, increased mucus and shortness of breath. To meet the clinical definition of chronic bronchitis you must cough up mucus most days for atleast 3months for two consecutive years.

Pathophysiology
smoking/pollutio n continued irritation of lung passages inflamma tion

4/21/12

excessive mucus production narrowing of the bronchi Chronic Bronchitis

4/21/12

EMPHYSEMA
characterized by loss of elasticity (increased pulmonary compliance) of the lung tissue caused by destruction of structures feeding the alveoli.

4/21/12

EMPHYSEMA

-takes time to develop, 9 out of 10 people diagnosed with it are 45 years old and up - characterized by loss of elasticity (increased pulmonary compliance) of the lung tissue caused by destruction of structures feeding

4/21/12

This causes the small airways to collapse during forced exhalation, as alveolar collapsibility has decreased.

Pathophysiology
Smoking/Pollutants

4/21/12

Attraction of inflammation cells

Release of elastase inhibition of alpha 1inherited alpha 1-antitrypsin antitrypsin deficiency destruction of elastic fibers Emphyse ma

Emphysema Age Clinical Findings Barrel Chest Wt. loss Shortness of Breathing Breath Sound Wheezing Rhonchi Sputum Absent Absent Often absent, maybe present in late course Relatively normal until late process Only in advance cases Often dramatic Maybe absent in early disease Maybe frequent 40-50

Chronic Bronchitis 30-40

4/21/12

infrequent Maybe present Maybe present, predominant early symptoms Variable Often prominent Frequent early manifestation Hypercapnia and Hypoxemia is present Frequent

Blood Gasses

Cor Pulmonale

4/21/12

ASSESSMENT
HISTORY Health perception-health management

Greater than normal shortness of breath, with inability to control symptoms with prescribed or non prescribed therapies. Increased fatigue and inability to cope with crisis Increasing anxiety and panic Increasing difficulty expectorating sputum

4/21/12

Nutritional-metabolic pattern

Anorexia Inability to eat and digest without shortness of breath Nausea, possibly associated with medications Bloating, especially after eating foods known cause flatulence Difficulty maintaining adequate fluid intake (at least 8 oz/240ml glasses per day).

4/21/12

Activity-exercise pattern

Shortness of breath with even minimal exertion or when performing activities of daily living Shortness of breath and panic controlled with breathing techniques

Sleep-rest pattern

4/21/12

PSYCHOSOCIAL Cognitive-perceptual pattern

Fluctuating compliance with therapeutic regimen Multiple role changes, resulting in depression, isolation and increased dependence Difficulty verbalizing feelings because emotions intensify shortness of breath

Role-relationship pattern

4/21/12

Sexuality-reproductive pattern

Complex interpersonal role changes with spouse or partner, with decreased desire for and frequency of sexual activity because of actual or potential shortness of breath.

4/21/12

Coping-stress tolerance pattern

Difficulty expressing either positive or negative emotions because of shortness of breath Fluctuating behaviour Ambivalence about resuscitative measures that may be necessary during hospital stay but may not ultimately improve quality of life

Value-belief pattern

4/21/12

PHYSICAL General Appearance

Apprehension and anxiety; maintenance of upright tense posture Tendency to panic easily if activity is requested Cachexia (emphysema); plethora (chronic bronchitis)

Cardiovascular

4/21/12

Pulmonary

Accentuated accessory neck muscles Barrel chest hyperinflation Decreased breath sounds bilaterally Prolonged expiratory phase Productive cough: tapioca-like plugs or copious amounts of sputum Gurgles if secretions are copious; crackles if heart

4/21/12

Neurologic

Anxiety Restlessness with hypoxemia Lethargy and sleepiness with increased partial pressure of carbon dioxide levels Skin that discolours (mottling and cyanosis) easily during coughing spells, strenuous activity, or episodes of acute shortness of breath

Integumentary

DIAGNOSIS

4/21/12

Spirometry- used to evaluate airflow obstruction, which is determined by the ration FEV1 to force vital capacity (FVC) Broncodilator Testing- peformed to rule out the diagnosis of asthma. Arterial blood gas (ABG) measurements- assess baseline oxygentation and gas exchange and is important in advance COPD. Theopylline level- normal is 10 to 15ug/ml; may be elevated if the patient has adjusted

4/21/12

Alpha1-antitrypsin assay- uncommon; performed to determine alpha1 antitrypsin deficiency in young patients with suspected emphysema Other tests- white blood cell count, hematocritand serum electrolytes levels are performed according to suspected causes. Chest X-ray- shows hyperinflation, with flattening of the diaphragm caused by air trapping in the chest, that may worsen during exacerbation; may also show infiltrates, depending on exacerbation

TREATMENT
The goals of COPD treatment are:

4/21/12

1) to prevent further deterioration in lung function, 2) to alleviate symptoms, 3) to improve performance of daily activities and quality of life. The treatment strategies include 1) quitting cigarette smoking,

PROBLEM LIST

4/21/12

Impaired Gas Exchange related to airway narrowing secondary to mucus secretions and inflammation Ineffective airway clearance related to excessive secretions Nutritional deficit related to shortness of breath during and after meals and adverse reactions to medication. Ineffective cardiopulmonary tissue perfusion related to impaired ventilation secondary to

4/21/12

UPDATES

PatientsWithCOPDHaveHigherRiskof Shingles,StudyFinds ScienceDaily (Feb. 23, 2011) Patients with chronic obstructive pulmonary disease (COPD) are at greater risk of shingles compared with the general population, according to a study published in CMAJ(Canadian Medical Association Journal). The risk is greatest for patients taking oral steroids to treat COPD. Shingles, or herpes zoster, is a reactivation of the

4/21/12

People with a compromised immune system are at greater risk of developing shingles although it has not been previously studied in patients with COPD. There is increasing evidence that COPD is an autoimmune disease. "Given that various immune-mediated diseases, such as rheumatoid arthritis and inflammatory bowel disease, have been reported to be associated with an increased risk of herpes zoster, it is reasonable to hypothesize that immune dysregulation found in

4/21/12

This study, using data from the Taiwan Longitudinal Health Insurance Database, included 8486 patients with COPD and 33 944 subjects from the comparison cohort. Of the total sample of 42 430 patients, 1080 had incident of herpes zoster during the follow-up period. There were 321 cases of shingles identified in the COPD cohort, 16.4 per 1000 person years, and 759 cases in the comparison cohort, 8.8 per 1000 person years.

4/21/12

"Our cohort study demonstrated that patients with COPD are at an increased risk of developing herpes zoster compared with the general population, after controlling for other herpes zoster risk factors," write the authors. "The risk of herpes zoster associated with COPD is greater for patients with inhaled or oral corticosteroids therapy than patients without." The authors conclude it is possible that "increased disease severity further contributes to the increased risk of herpes zoster associated with

4/21/12

THANK YOU