NRS 525-Module 7: Respiratory Exam A+ Graded
chronic obstructive pulmonary disease (COPD) - ANSWER A common, preventable and
treatable disease characterized by persistent respiratory symptoms and airflow
limitation that is due to airway and/or alveolar abnormalities usually caused by
significant exposure to noxious particles or gases and influenced by host factors
including abnormal lung development. A combination of chronic bronchitis and
emphysema.
COPD symptoms - ANSWER -Dyspnea
-Poor Exercise Intolerance
-Frequent infections
-Fatigue (chronic, but worse during exacerbations)
The individual with COPD... is often thin, has tachypnea with prolonged expiration, and
must use accessory muscles for ventilation. The anteroposterior diameter of the chest
is increased (barrel chest), and the chest has a hyperresonant sound with percussion.
The individual often leans forward with arms extended and braced on knees when sitting
and exhales through pursed lips (helps prevent expiratory airway collapse).
COPD diagnosis requires... - ANSWER -Increased mucus production
-Mucosal edema
-Impaired or lost ciliary function
-A chronic cough lasting at least 3 months each year for 2 years
COPD risk factors - ANSWER -Tobacco smoke (primary etiology is cigarette smoking in
>85% of cases)
-Occupational dust and chemicals (vapors, irritants, and fumes)
-Indoor air pollution from biomass fuel used for cooking and heating (in poorly vented
dwellings)
-Outdoor air pollution
-Any factor that affects lung growth during gestation and childhood
-Genetic susceptibilities: alpha-1 antitrypsin deficiency
COPD therapeutic management - ANSWER Prevention is key!! Don't smoke!!
- Initial treatment --> LAMA (e.g., tiotropium or revefenacin)
, - Breathing exercises: to slow exhalation and minimize air trapping
- Bronchodilators
- Mucolytics (medications that break up mucus)
- Inhaled corticosteroids (are associated with an increased risk of pneumonia and
should not be used alone)
- Oxygen therapy (high-flow nasal cannula or noninvasive ventilation are indicated)
*COPD is a chronic condition, but can (and will) have acute exacerbations, typically
caused by respiratory infections (viral and/or bacterial) or less commonly, significant
exposure to a respiratory irritant (air pollution and/or allergen).
Emphysema - ANSWER An abnormal permanent enlargement of the gas-exchange
airways accompanied by the destruction of the alveolar walls without obvious fibrosis.
*Results in dyspnea due to loss of surface area for gas exchange.
Emphysema Pathophysiology changes - ANSWER - Breakdown of elastin in the alveolar
septa (or respiratory bronchioles) destroys lung tissue
- Alveolar and respiratory bronchiole integrity is destroyed
- Pulmonary capillaries destroyed
- Loss of passive elastic recoil → airway collapse
- Gas cannot flow during expiration
- Air trapping occurs
Emphysema Phenotypes - ANSWER Both phenotypes are associated with an enhanced
chronic inflammatory response in the airways to noxious particles or gases.
Centriacinar (Centrilobar):
- Septal destruction occurs in the respiratory bronchioles and alveolar ducts, usually in
the upper lobes.
- Alveolar sac (alveoli distal to the respiratory bronchiole) remains intact.
- Tends to occur in smokers with chronic bronchitis.
Emphysema Phenotypes - ANSWER Both phenotypes are associated with an enhanced
chronic inflammatory response in the airways to noxious particles or gases.
Panacinar (Panlobular):
- Involves the entire acinus.
chronic obstructive pulmonary disease (COPD) - ANSWER A common, preventable and
treatable disease characterized by persistent respiratory symptoms and airflow
limitation that is due to airway and/or alveolar abnormalities usually caused by
significant exposure to noxious particles or gases and influenced by host factors
including abnormal lung development. A combination of chronic bronchitis and
emphysema.
COPD symptoms - ANSWER -Dyspnea
-Poor Exercise Intolerance
-Frequent infections
-Fatigue (chronic, but worse during exacerbations)
The individual with COPD... is often thin, has tachypnea with prolonged expiration, and
must use accessory muscles for ventilation. The anteroposterior diameter of the chest
is increased (barrel chest), and the chest has a hyperresonant sound with percussion.
The individual often leans forward with arms extended and braced on knees when sitting
and exhales through pursed lips (helps prevent expiratory airway collapse).
COPD diagnosis requires... - ANSWER -Increased mucus production
-Mucosal edema
-Impaired or lost ciliary function
-A chronic cough lasting at least 3 months each year for 2 years
COPD risk factors - ANSWER -Tobacco smoke (primary etiology is cigarette smoking in
>85% of cases)
-Occupational dust and chemicals (vapors, irritants, and fumes)
-Indoor air pollution from biomass fuel used for cooking and heating (in poorly vented
dwellings)
-Outdoor air pollution
-Any factor that affects lung growth during gestation and childhood
-Genetic susceptibilities: alpha-1 antitrypsin deficiency
COPD therapeutic management - ANSWER Prevention is key!! Don't smoke!!
- Initial treatment --> LAMA (e.g., tiotropium or revefenacin)
, - Breathing exercises: to slow exhalation and minimize air trapping
- Bronchodilators
- Mucolytics (medications that break up mucus)
- Inhaled corticosteroids (are associated with an increased risk of pneumonia and
should not be used alone)
- Oxygen therapy (high-flow nasal cannula or noninvasive ventilation are indicated)
*COPD is a chronic condition, but can (and will) have acute exacerbations, typically
caused by respiratory infections (viral and/or bacterial) or less commonly, significant
exposure to a respiratory irritant (air pollution and/or allergen).
Emphysema - ANSWER An abnormal permanent enlargement of the gas-exchange
airways accompanied by the destruction of the alveolar walls without obvious fibrosis.
*Results in dyspnea due to loss of surface area for gas exchange.
Emphysema Pathophysiology changes - ANSWER - Breakdown of elastin in the alveolar
septa (or respiratory bronchioles) destroys lung tissue
- Alveolar and respiratory bronchiole integrity is destroyed
- Pulmonary capillaries destroyed
- Loss of passive elastic recoil → airway collapse
- Gas cannot flow during expiration
- Air trapping occurs
Emphysema Phenotypes - ANSWER Both phenotypes are associated with an enhanced
chronic inflammatory response in the airways to noxious particles or gases.
Centriacinar (Centrilobar):
- Septal destruction occurs in the respiratory bronchioles and alveolar ducts, usually in
the upper lobes.
- Alveolar sac (alveoli distal to the respiratory bronchiole) remains intact.
- Tends to occur in smokers with chronic bronchitis.
Emphysema Phenotypes - ANSWER Both phenotypes are associated with an enhanced
chronic inflammatory response in the airways to noxious particles or gases.
Panacinar (Panlobular):
- Involves the entire acinus.
