Term
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Definition
a preventable, treatable disease with some significant extrapulmonary effects that may contribute to severity of disease. The pulmonary component is characterized by airflow limitations that are not fully reversible. air flow limitation is usually progressive and associated with abnormal inflammatory response of the lung to noxious particles and gases (cigarette smoke), progressive and debilitating, exacerbations and comorbidities contribute to severity |
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Term
highest rates of COPD wehre |
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Definition
midwest, industrial areas. but also everywhere |
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Term
deterioration of lung function in COPD |
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Definition
gradual, don't see signs/symptoms moving from mild to moderate until FEV1 is 30-40% of predicted, goes unnoticed |
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Term
factors that can cause COPD |
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Definition
cigarette smoke, pollutants, occupational agents, repeated respiratory infections, concurrent asthma, alpha-1 antitrypsin deficiency, oxidative stress from lung inflammation |
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Term
alpha-1 antitypsin deficiency pathophys |
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Definition
missing antiproteases that keep proteases in check that clean up debris after lung infections and so the proteases keep working and break down lung tissue. specifically unopposed breakdown of elastin fibers by elastase. get destruction of alveoli, enlarged airspaces, impaired gas diffusion, air trapping -> emphysema |
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Term
smoking leads to interoxidative stress which leads to |
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Definition
inflammation, fibrosis, thickening of the walls, mucus hypersecretion -> narrowing of the airways -> chronic bronchitis (have inc sputum production). smoking can also lead to destruction of alveolar walls and then emphysema |
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Term
pathophys of inflammation in the lungs from cigarette smoke |
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Definition
cigarette smoke affects the alveolar macrophages, affect neutrophils and proteases get released -> destroy lung tissue, alveolar destruction, mucus hypersecretion -> emphysema and chronic bronchitis. also problem w epithelial cells -> inc number of fibroblasts -> lay down more collagen -> fibrosis of the lung -> obstructive bronchiolitis |
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Term
changes in the large airways in COPD |
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Definition
due to mucus secretion and hyperplasia -> mucus glands become hyperplastic, goblet cells become hyperplastic -> increased mucus secretion -> hypersecretion. neutrophils in sputum bc of inflammatory process. mucus and inflammation causing airway obstruction |
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Term
what happens in emphysema |
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Definition
alveolar wall destruction, break down septa that separate alveoli so airspace decreases, less ability to exchange O2 and CO2, get loss of elasticity, destruction of capillary beds and inflammatory cells |
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Term
changes in the small airways in COPD |
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Definition
inflammatory exudate oozing out of the lumen -> narrowing, disruption of alveolar attachments, fibrosis, lymphoid involvement, thickening of the wall |
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Term
general signs and symptoms of COPD |
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Definition
easily fatigued, frequent respiratory infections, use of accessory muscles, orthopnic, wheezing, pursed-lip breathing, chronic cough, barrel chest, thin appearance, more likely to develop right-sided heart failure |
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Term
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Definition
chronic bronchitis, airflow problems, dusky color to cyanosis, recurrent cough, inc sputum production, hypoxic, hypercapnic, respiratory acidosis. bc of hypoxia release erythropoietin and can get inc hgb and hct, polycythemia. exertional dyspnea, clubbing |
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Term
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Definition
emphysema, inc CO2 retention, minimal cyanosis, difficulty getting air in and out w barrel chest- pursed lip breathing (dec flow rate and get more air w changing pressure), dyspnea, orthopnic, exertional dysnpea, thin, emaciated |
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Term
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Definition
CAT, ask questions and score, never cough ect. 5-10 stop smoking, 10-20 medium risk- pulmonary rehab, review drug therapy, >20 (high) >30 (very high) refer to pulmonologist |
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Term
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Definition
blood gasses and spirometry, hypoxic pCO2 inc, elevated hct, check alpha-1 antitrypsin deficiency if indicated, |
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Term
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Definition
diagnosis requires FEV1 <80% of predicted, get inc TLC and RV due to air trapping, carbon monoxide transfer and coefficient will be markedly reduced, dec FEV1/FVC ratio (mild <70%) |
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Term
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Definition
prominent vascular markings due to edema and mucus production (stand out more) |
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Term
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Definition
overdistension of lungs, barrel chest, flattening of diaphragm, maybe emphysematous bullae, lots of air space between sternum and mediastinum and heart |
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Term
COPD pts are at greater risk of developing |
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Definition
cardiovascular disease, cancer, malnutrition, muscular dysfunction, weight loss, anemia, depression |
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Term
key to treatment for COPD |
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Definition
prevention, pneumovax and annual flu shot |
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Term
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Definition
short-acting bronchodialator (beta 2 agonists, anti-muscarinic) (rapid onset sec-min, last 4-6 hrs, good for acute flares) |
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Term
treatment for moderate, severe COPD |
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Definition
pulmonary rehab, long-acting bronchodialator (improve lung function, dec symptoms, dec exacerbations) |
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Term
treatment for very severe COPD |
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Definition
glucocorticoids, long term oxygen |
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Term
side effects of beta-2 agonist bronchodilators |
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Definition
(esp seen w short-acting), tachycardia, tremor, nervousness, hypokalemia, vasodilation, mild hypoxia due to shunting, hypotenison, reflex tachycardia, dec cardiac output |
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Term
anti-muscarinic bonchodialators |
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Definition
anticholinergics, block muscarinic acetylcholine receptors, have long-acting and short acting, reduce symptoms, reduce exacerbations, improve FEV1, improve funcitonal status, work well w beta agonists, classic is atropine but not used for bc can cross BB barrier, we use ipatropium (poorly absorbed in GI, doesn't cross BBB) |
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Term
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Definition
M1- parasympathetic ganglia, M2- postganglionic nerve terminals, M3- in airway smooth muscle cells and mucous glands, mediate parasympathetic excitation of these tissues |
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Term
side effects of anticholinergic drugs |
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Definition
dry mouth, glaucoma, urinary retention |
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Term
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Definition
reduce inflammation, dec airway hyperresponsiveness, reduce exacerbations, reduce chronic bronchitis symptoms but SEs: can develop thrush (Candida albicans overgrowth), dysphonia, inc pneumonia risk, systemic complications- elevated glucose or osteoporosis |
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Term
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Definition
PDE4 inhibitor, little better than theophylline (xanthine), anti-inflammatory, reduces frequency of exacerbaitons, SEs: nausea, vomiting, diarrhea, dec appetite , weight loss. worsening depression, headaches, insomnia (SEs dec over time) |
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Term
nonpharmaceutical therapy for COPD |
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Definition
smoking cessation, influenza vaccine, pneumococcal vaccine, pulmonary rehab, oxygen therapy (for pp w PaO2 under 55 and O2 sat under 88, or start developing right heart failure cor pulmonale or have polycythemia) |
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Term
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Definition
cough, dysnpea, sputum production, maybe some altered mental status, impaired gas exchange. masqueraders: pulmonary embolism, CHF |
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Term
treatment for acute COPD exacerbations |
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Definition
bronchodilators, corticosteroids, maybe antibiotics, beta blockers probably underprescribed (have to be careful about which ones you use but can be useful with heart failure) |
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Term
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Definition
reduce symptoms, palliative care, damage is irreversible, most pts don't receive optimal palliative care |
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Term
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Definition
midwest, northern, not the south |
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Term
definition of asthma, what you see, what happens, type of disease |
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Definition
chronic inflammatory disorder of the airway in which many cells and cellular elements play a role (mast cells, eosinophils, T lymphs, neutrophils, epithelial cells) variable and reversible airflow obstruction- spontaneously or due to medication. get recurrent episodes of wheezing, breathlessness, chest tightness, cough, esp early morning hrsl. airway inflammation contributes to airway hyperresponsiveness to stimuli. atopic disease, body develops IgE in response to environmental allergens |
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Term
diseases related to asthma |
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Definition
allergic rhinitis, asthma, hay fever, eczema |
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Term
3 major pathophysiology components to asthma |
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Definition
-inflammation (inc eos, mast cells, lymphs) -persistent changes in the airway structure (fibrosis, mucus hypersecretion, smooth muscle hypertrophy) -airflow obstruction (variable and responsive to bronchodilators) |
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Term
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Definition
turbulent airflow due to bronchoconstriction and inflammation |
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Term
inflammatory remodeling in asthma |
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Definition
acute response -> bronchoconstriction, edema, inc secretions, mucus production, cough. chronic inflammation -> inc cell recruitment, epithelial damage, some early structural damage -> airway remodeling -> smooth muscle hypertrophy/proliferation, mucus, inc protein, basement membrane thickening -> fibrosis |
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Term
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Definition
treat the obstruction, hyperresponsiveness, inflammation. use steroids and beta agonists to open the airway, inc airflow, dec obstruction, dec inflammation. inflammation ect could have been going on 6-8 weeks before symptoms of asthma attack |
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Term
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Definition
genetic predisposition, exposure to allergens/smoke/pollution/microbes, stress, diet, obesity, inactivity, sudden temp changes, respiratory infection, strenuous exercise |
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Term
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Definition
recurrent episodes of wheezing, troublesome cough at night, cough or wheezing after exercise, chest tightness after exposure. lung function and FEV1 might not be that bad, variable symptoms |
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Term
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Definition
FEV1, look for improvement after bronchodilator, spirometry (obstructive pattern but not always). may need to repeat testing. fractional exhaled nitrous oxide- measures the nitrous oxide released by damaged epis (inflammometer), check IgE levels or specific Ags, CBC looking at eos, radiographic imaging, bronchoprovocation- trigger airway hyperactivity |
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Term
determining severity of asthma |
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Definition
look at current impairment (frequency/intensity) and functional limitations |
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Term
to be classified as persistent asthma have to have |
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Definition
any one of the following: albuterol use greater than 2 days per week, not daily, asthma symptoms greater than 2 days per week ,not daily, nighttime awakenings >2x/month, minor limitations to activity, FEV1 >80% predicted |
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Term
quick relief asthma medicaxtions |
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Definition
short acting beta 2 agonists, albuterol or anticholinergics -ipatropium |
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Term
treatment for acute exacerbations in the ER |
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Definition
systemic corticosteroids and short-acting beta 2 agonists |
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Term
for long term asthma treatment |
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Definition
daily inhaled corticosteroids, leukotriene modifiers, long-acting beta 2 agonists, cromolyn (mast cell stabilizers- only good for allergy induced), methylxanthines (theophylline) |
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Term
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Definition
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Term
asthma intermittent vs mild vs mod vs severe chart |
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Definition
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Term
order of adding meds for asthma |
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Definition
short term beta 2 agonists, low dose inhaled corticosteroid, long term beta 2 agonists, medium dose inhaled corticosteroids, high dose inhaled corticosteroids, oral steroids, prednisone |
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Term
how do inhaled beta agonists work |
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Definition
bind the beta-2 cells on smooth muscle leading to vasodilation and opening up the airways |
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Term
asthma exacerbation treatment |
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Definition
beta agonists- nebulizer, every 2 hrs if needed, O2, steroids, ipatropium, corticosteroids a couple hrs after 1st albuterol, may have to do continuous inhaled albuterol, IV magnesium sulfate can help (reduces hospitalization but can cause hypotension so give fluids), IV terbutaline (cardiac SE) if albuterol fails, IV epinephrine if anaphylaxis , IV fluids for dehydration (also restores lactic acidosis, tachypnea and distress due to rapid breathing) |
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Term
side effects of beta agonists |
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Definition
tachycardia, superventricular tachycardia, hypokalemia, prolong QT intervals (avoid macrolides or antibiotics to avoid arrhythmia), IV administration can lead to systolic hypertension or diastolic hypotension |
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Term
antibiotic for asthmatic with mass on CXR |
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Definition
azithromycin (has anti-inflammatory effects). chlmaydia and mycoplasma are implicated in severe asthma and macrolides or tetracyclines can be used to treat those |
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Term
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Definition
unrelenting, unremitting asthma with rapidly increasing severity due to diffuse bronchiole obstruction leading to hypoxia and respiratory muscle fatigue, get chest tightness, SOB, cough, tachycardia, tachypnea, cyanosis, use accessory muscles, intercostal retractions, no wheezing (no airflow). may be hypoxic, hypercapnic. CXR may show hyperinflation due to air trapping. Treat w O2. bronchodilaters every 2 hrs or continuous. high dose IV corticosteroids. mechanically ventilate if they get too tired to breathe, |
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