Chapter 13 COPD
FEV1
forced expiratory volume in 1 second (air blow out in 1 second)
FVC
forced vital capacity (all the air a person could blow out)
Chronic bronchitis
is defined clinically as chronic productive cough for 3 months in each of 2 successive years in a patient in whom other causes of productive chronic cough have been excluded.
Which of the following is true of the diffusing capacity test (DLCO) findings in a patient with COPD? a. Normal in all cases b. Decreased in emphysema c. Decreased in chronic bronchitis d. Increased in all cases
Decreased in emphysema
According to the GOLD report, which of the following is the greatest worldwide risk factor for COPD? a. Exposure to fungal spores in the soil b. Genetic predisposition c. Exposure to influenza viruses d. Exposure to environmental tobacco smoke
Exposure to environmental tobacco smoke
Stage III: Severe COPD
FEV1 30%-49% predicted
Stage II: Moderate COPD
FEV1 50%-79% predicted
Stage IV: Very severe COPD
FEV1 ≤29% or less than predicted
Stage I: Mild COPD
FEV1 ≥80% predicted
What is the term for the inward movement of the lateral chest wall during inspiration? a. Truman's sign b. Burton's sign c. Carr's sign d. Hoover's sign
Hoover's sign
Alpha-1 antitrypsin deficiency screening
When a younger patient (<45 years old) presents with a history and clinical indicators associated with COPD, an AATD screen should be considered.
Arterial blood gas measurement
When the peripheral arterial oxygen saturation (SpO2) is <92%, an ABG should be assessed. We can see if the patient is a retainer of CO2.
Chest x-ray
rarely diagnostic for COPD, but it may be valuable in ruling out other diagnosis. We may also see lungs that are overdistended, hyperinflated, flatten diaphragm, and air accumulation.
In the United States, the primary factor leading to the development of COPD is: a. α1-antitrypsin deficiency. b. recurrent respiratory infections. c. socioeconomic status. d. tobacco smoking.
tobacco smoking.
Which of the following statements accurately describe(s) emphysema? 1. It is characterized by alveolar wall destruction. 2. It is most closely associated with cystic fibrosis. 3. It is reversible and preventable. 4. It is characterized by thick secretions and mucus plugging. a. 1 only b. 3 only c. 1, 3 d. 1, 2, 4
1 only
Which of the following are used to confirm the diagnosis of COPD? 1. Presence of a chronic cough 2. Chronic exposure to environmental smoke 3. FEV1/FVC ratio greater than 0.70 4. FEV1 <80% a. 1, 2 b. 3, 4 c. 1, 2, 3 d. 1, 3, 4
1, 2, 3
The management of COPD may include: 1. annual influenza immunization. 2. bronchopulmonary hygiene procedures. 3. bronchodilators. 4. smoking cessation. a. 1, 2 b. 2, 3 c. 2, 3, 4 d. 1, 2, 3, 4
1, 2, 3, 4
Which of the following are clinical findings associated with chronic bronchitis? 1. Cyanosis 2. Purulent sputum 3. Right heart failure 4. Elevated CO2 level a. 1, 2 b. 3, 4 c. 1, 3 d. 1, 2, 3, 4
1, 2, 3, 4
Which of the following clinical manifestations are associated with late- stage chronic bronchitis? 1. Rhonchi 2. Cor pulmonale 3. Digital clubbing 4. Stocky, overweight build a. 1, 2 b. 2, 3 c. 1, 3, 4 d. 1, 2, 3, 4
1, 2, 3, 4
Which of the following terms is (are) commonly applied to a patient with emphysema? 1. Pink puffer 2. Blue bloater 3. Type A COPD 4. Type B COPD a. 1 b. 2 c. 1, 3 d. 2, 4
1, 3
Which of the following are anatomic alterations found with chronic bronchitis? 1. Increased size of submucosal bronchial glands 2. Destruction of pulmonary capillaries 3. Chronic bronchial wall inflammation and thickening 4. Bronchospasm a. 2, 3 b. 3, 4 c. 1, 2, 3 d. 1, 3, 4
1, 3, 4
Which of the following are pathologic alterations found with emphysema? 1. Air trapping and hyperinflation 2. Mucus plugs 3. Decreased surface area for gas exchange 4. Weakened respiratory bronchioles a. 1, 2 b. 2, 4 c. 1, 3, 4 d. 1, 2, 3, 4
1, 3, 4
Which of the following clinical manifestations would be expected in a patient with emphysema? 1. Polycythemia 2. Barrel chest 3. Pursed-lip breathing 4. Normal percussion note a. 1, 4 b. 2, 3 c. 2, 3, 4 d. 1, 2, 3, 4
2, 3
According to GOLD, at what age can the initial diagnosis of COPD be made? a. 35 years b. 40 years c. 45 years d. 50 years
40 years
FEV1/FVC ratio
Air blow out in 1 second All the air a person could blow out
The genetic reference to a person with a normal level of α1-antitrypsin is _____ phenotype. a. Z b. MZ c. MM d. ZZ
MM
Bronchodilator reversibility testing
helps rule out a diagnosis of asthma.
Emphysema may be caused by all of the following EXCEPT: a. inhaling asbestos fibers. b. α1-antitrypsin deficiency. c. secondhand cigarette smoke. d. air pollution.
inhaling asbestos fibers.
Chronic obstructive pulmonary disease (COPD)
is a preventable and treatable disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking. Although COPD affects the lungs, it also produces significant systemic consequences.
Emphysema
is defined pathologically as the presence of permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis. Destruction of the gas-exchanging surfaces of the lung (alveoli).
List the anatomic alterations of the lungs caused by Chronic bronchitis
· Chronic inflammation and swelling of the peripheral airways · Excessive mucus production and accumulation (submucosal bronchial glands to enlarge and the number of goblet cells to increase) · Partial or total mucus plugging of the airways · Smooth muscle constriction of bronchial airways (bronchospasm) · Air trapping and hyperinflation of alveoli- occasionally in the late stages
Epidemiology
· It is estimated that 25 million people in the United States either have chronic bronchitis, emphysema, or a combination of both. · Most authorities agree that COPD is under diagnosed · We have diagnosed about half, 12 million people. The other half don't know, or have not been diagnosed yet. · It is the third leading cause of death in the United States.
List the anatomic alterations of the lungs caused by Emphysema
· Permanent enlargement and deterioration of the air spaces distal to the terminal bronchioles (blown up/damage) · Destruction of pulmonary capillaries (decrease surface area for gas exchange) · Weakening of the distal airways, primarily the respiratory bronchioles (traps gas in the alveoli) · Air trapping and hyperinflation of alveoli (air-trapping)
Risk Factors
· Tobacco smoke (90%) · Occupational dusts and chemicals (factory, construction) · Indoor air pollution (second hand smoke) · Outdoor air pollution · Conditions that affect normal lung growth (low birth weight, respiratory infections) · Genetic predisposition - Alpha 1-antitrypsin deficiency (elastase is free to attack and destroy the elastic tissue of the lungs. Super rare)
A genetically linked cause of panlobular emphysema is: a. bronchiectasis. b. α1-antitrypsin deficiency. c. cystic fibrosis. d. bronchial asthma.
α1-antitrypsin deficiency.
