COPD can develop with intense or prolonged exposure to:oDusts, vapours, irritants, or fumes *wear mask around inhalants oHigh levels of air pollutionoFumes from indoor heating or cooking with fossil fuels COPD – InfectionRecurring infections impair normal defense mechanisms Risk factor for COPDIntensify pathological destruction of lung tissue *ex. PneumoniaCOPD – Heredity-Antitrypsin (AAT) deficiencyoGenetic risk factor for COPDoAccounts for 3% of COPD*For genetic testing, you need genetic counselling •Pt. has risk factors You need to look at what the pt. will dowith that result (ex. Might be worried about it all the time) COPD – AgingSome degree of emphysema is common because ofphysiological changes of aging lung tissue.Img: Public Health Agency of Canada, 2007 (Does not includeinfluenza, pneumonia, bronchiolitis, RDS)COPD -Clinical Manifestations*important (NEED TO KNOW)Develops slowlyDiagnosisis considered with:oCoughoSputum productionoDyspnea (shortness of breath) *due to damaged lungs oExposure to risk factors*note:Waking up consistently in the morning with thick sputum + persistent cough and then the shortness of breath Dyspnea usually prompts medical attentionoOccurs with exertion in early stagesoPresent at rest with advanced diseaseCauses chest breathingoUse of accessory and intercostal muscles
oInefficient *Q. Why is coughing prominent in the morning? A: b/c they’ve beenlaying down(as the day goes on, lose up and expel it) Characteristically underweight with adequate caloric intakeChronic fatigue*Vicious cycle (less activities weaker muscles etc…); Pt may showup malnourished Physical examination findingsoProlonged expiratory phaseQ.why do we have prolonged expiratory phase? (instead of 1 to 2)A: air is trapped (trying to get all the air out) oWheezesoDecreased breath soundsQ.Why dec. breath sounds? A: b/c of secretions, inflammations, mucus productiono↑ Anterior-posterior diameterQ. Why ↑ Anterior-posterior diameter? A: air trapping=barrel chestSkin discoloration (Bluish-red)CB vs EmphysemaChronic BronchitisEmphysema Intermittent dyspnea *(coughing gets worse at times) – laying down is worse unlike emphysema where they have it at all timesSymptoms onset >35 yrsCopious purulent sputum *b/c we know it increases mucus production Stocky, obeseChest AP diameter normalChest Percussion dull/normalHematocrit elevated *Q. Why is hematocrit elevated ?