COPD
Chronic Bronchitis-Emphysema
General description:
Chronic airflow obstruction from chronic bronchitis and or/ emphysema signifies
chronic obstructive Pulmonary disease.
Causes: cigarette smoking, air pollution, occupational exposure to dust and gasses, airway infection,
genetic and familial factors.
Pathophysiology:
Chronic Bronchitis- excessive bronchial mucus secretion( increased goblet cells), productive cough lasting 3
or more months in 2 consecutive years, narrowing of small airways, impaired cilliary function, recurrent
infections, Pulmonary hypertension- leading to right sided heart failure(Cor Pulmonae). Altered function of
alveolar macrophages, narrowing of small airways
Manifestations:
Productive cough with copious thick tenacious sputum, cyanosis, evidence of r-sided heart failure: neck vein
distension, edema liver engorgement, enlarged heart, Auscultation: loud ronchi, possible wheezes.
bronchospasms, hypoxemia hypercapnia,
Pathophysiology:
Emphysema- characterized by destruction f alveolar walls with enlargement of abnormal air space, enlarged
spaces cause loss of portions of pulmonary capillary bed decreasing gas exchange; loss of support tissue causes
airways to collapse during expiration leading to trapped air.
Ppt. deffinition- destruction of alveolar walls w/o fibrosis
Manifestations:
Insidious onset: initially dyspnea on exertion; progresses to severe dyspnea occurring at rest, minimal coughing
barrel chest -due to air trapping, hyperinflation, often thin, tachypnic, uses accessory muscles to breathe and
leans forward while sitting to ease breathing, prolonged expiration; diminished breath sounds, percussion tone is
hyper resonant. Hypercapnia- developes late possible CO2 narcosis
ABG’s- hypoxic drive to breathe, w/normal or low CO2 tension, resp. alkalosis due to increased resp. rate.
DX:
Ineffective Airway Clearance: Prepare for intubation and mechanical ventilation
TX: smoking abstinence is the KEY prevent, slow progression, avoid pollutants, hydrate, effective cough
“huffing” between relaxed breathing, percussion , postural drainage, avoid cough suppressants and sedation,
Physical exercise, breathing exercise(pursed lip /abdominal), O2: caution low flow continuous or intermittent
Commonly used drugs:
Immunizations against Pneumococcal pneumonia, antibiotics, Bronchodilators: adrenergic stimulants,
anticholenergic, methylxanthine, corticosteroids: if asthma, Alpha1-antitrypson replacement therapy: genetic
component; given weekly
Nursing interventions: above in DX
Major Complications:
Pulmonary hypertension- leading to right sided heart failure(Cor Pulmonae).
Surgery: Lung transplantation, if medical therapy ineffective
Other:
Diagnostic tests: (Book pg. 1116 Lemone) Pulmonary function tests, ventilation perfusion scan(dead space, or
shunting), Serumalph antitrypson level(family hx, early onset women), ABG’s, above, CBC, chest x-ray