COPD GENERAL
FACTS ABOUT COPD
Airflow limitation that is not fully reversible, generally progressive.
6th leading cause of death in world
4th leading cause of death in U.S.A.
3rd most common reason for hospitalization.
Rare under 40, Common in elderly.
SYMPTOMS
SSx. Exertional dyspnea, cough,
85% have chronic bronchitis (productive cough > 3 mos of the yr for > 2 yrs)
Blue bloaters. Chronic sputum production.
15% have Emphysema (RECENTLY POP STAR MICHAELJACKSON DIED WITH THIS)
Pink puffers. Barrel chested, wt loss due to poor nutrition.
Pathology
Smoking accounts for 80 – 90% risk of developing COPD.
Only 15% of smokers clinically get COPD.
Caused by bronchial irritation and swelling of airway.
Chronic Compensated COPD
Dx
Dx
Best tool is pulmonary function testing (table 69-1)
ABG Hypoxia is main sign, increases with severity of disease.
CXR
R sided heart failure (Cor Pulmonal)
BNP (helps more to dif from CHF)
ECG or recent Echo with EF
Usually due to increased airway obstruction 2°
Increased bronchospasm
CV deterioration
Continued smoking, really, Smoking.
Noncompliance with medication.
Noxious / Environmental exposures
Clinical Apperance:
Dyspnea
Orthopnea
Pursed lip exhalation
Accessory muscles of resperation used.
Diaphoresis
Pt speaks in shorter increments as obstruction progresses
DX
Assesment of O2 status is Key.
Pluse ox ok but does not give PCO2 or pH.
ABG is best, PaO2 <60>
FEV1 <>
CXR
ECG could reveal concurrent disease process.
TX
O2 titrate to PaO2 >60 mmHg SaO2 >90%
Bronchodilators b2 agonist (albuterol, levalbuterol)
Anticholinergics Ipatropium Bromide 0.5 mg (atrovent)
Corticosteroids Prednisone 60 – 180 mg per/day for 7 to 14 days.
(methylprednisolone 60 -125 mg IV given in asthma exacerbations)
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