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Adult Health 1 - Respiratory Disorders - COPD

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Disease state characterized by progressively increased airflow obstruction that is NOT reversible Onset of symptoms is slow Includes diseases that cause airflow obstruction (emphysema - destruction of alveoli, Chronic Bronchitis - inflammation of conducting air tubules) Must be coughing daily for at least 3 months Decreased breath sounds on exhalation *Common feature in all COPD (whether emphysema, chronic bronchitis) = airflow obstruction Pathophyisology of COPD Airflow limitation is progressive, associated with abnormal inflammatory response to noxious agents (eg. smoking) Inflammatory response occurs throughout airways, lung parenchyma (imbalance between proteinase, antiproteinase), inflammatory response and pulmonary vasculature (thicker vessels, inflammatory cells infiltrate, collagen deposit, destruction of capillary beds) Scar tissue and narrowing occur in airways Risk Factors of COPD Tobacco smoke Passive smoking Occupational exposure Ambient air pollution Infections Genetic Abnormalities (Alpha- antitrypsin deficiency = protein that is made in liver, travels to other organs and helps protect, in deficient state, these proteins are the wrong shape and cant get out to the other organs, onset age = 30-40) Childhood lung infection

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Adult Health 1 - Respiratory Disorders - COPD


Use of Steroid with Respiratory Disorder

Reduces airway inflammation



Use of Bronchodilator with Respiratory Disorder

Relax airway muscles

Mild COPD - use short acting bronchodilator

Severe COPD - use long acting bronchodilator

Advair and Symbacor - combination of long and short acting bronchodilators



Severe COPD

FEV1 <60%



2 ppd smoker x 38 yrs = ? pack year history

2 x 38 = 76



COPD and % oxygen

Around 93% is ideal, dont want to have 99% because they need a stimulus (lower O2 level) to have their
body breathe, otherwise they'd become too dependent.



COPD possible orders

Steroids (Prednisone) - reduces airway inflammation

Antibiotic (Azithromycin)

Albuterol (rescue drug to help breathing)

Atrovent (anticholinergic, often given with albuterol)

Vasotec (ACE inhibitor - treats HTN)

*COPD pts often have heart failure, keep tract of fluids

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