Chronic Obstructive Airway Disease Quiz

COPD is airflow limitation caused by an inflammatory response to inhaled toxins, often cigarette smoke. Occupational and genetic factors may also contribute.
Symptoms include a productive cough and dyspnea (shortness of breath) that develop over years.
Signs include decreased breath sounds, prolonged expiratory phase, and wheezing.
Complications include weight loss, pneumothorax (collapsed lung), frequent exacerbations (worsening of symptoms), and right heart failure, or acute/chronic respiratory failure.
Diagnosis involves a patient history, physical exam, CXR (chest X-ray), and pulmonary function tests.
Treatment may include bronchodilators, steroids, oxygen, antibiotics, corticosteroids (a type of steroid), lung transplant or lung volume reduction surgery.

Chronic bronchitis is a chronic inflammation of the airways.
It involves airflow limitation, a productive cough (coughing up mucus) most days of the week for at least 3 months in two consecutive years.

Chronic asthmatic bronchitis is characterized by a productive cough, wheezing, and partially reversible airflow obstruction.
It occurs when asthma coexists with chronic bronchitis in the same patient.
Treatment should follow asthma guidelines.

COPD patients exhibit increased airway resistance due to edema, secretions, bronchospasm, and collapse.
Pulmonary hyper-insufflation (over-inflation of the lungs) and a large physiological dead space are observed.
If ventilatory demand exceeds the respiratory muscle capacity, acute respiratory failure can result.

Emphysema involves lung tissue destruction, leading to loss of elastic recoil and alveolar septal destruction.
This causes radial airway traction to decrease, increasing the tendency for airway collapse.
Airflow limitation, and lung hyperinflation result.
Pathophysiology includes increased airway resistance, pulmonary hyperinflation, and elevated pulmonary dead spaces, impacting breathing.

Mechanical ventilation aims to improve pulmonary gas exchange and allow for rest of compromised respiratory muscles to recover.
It's essential to avoid increasing PaCO2 (partial pressure of carbon dioxide) and resultant hypercapnic narcosis, ensuring SaO2 (arterial blood oxygen saturation) stays below 90%.
Differential diagnosis should be established for possible respiratory failure causes (e.g., pulmonary thromboembolism, pneumothorax, and upper airway obstruction).

In severe COPD exacerbation, non-invasive ventilation (NIV) is generally preferred initially to reduce intubation rates, length of ICU stay, and mortality.
Treatment includes bronchodilators, steroids, antibiotics, and, in some cases, mechanical ventilation.
Other potential causes of acute exacerbation include infection, environmental factors (e.g., pollutants, cold temperatures), and cardiac conditions.

Asthma is characterized by airway inflammation, hypertrophy of the airway walls, lesser airway collapse (despite decreased airway caliber) and generally reversible obstruction, which may be minimal or lacking in long-term asthma.

COPD patients often require bronchodilators, steroids or antibiotics. Also, mechanical ventilation might be an option for extensive cases.
In COPD, bronchodilators are an important treatment, often the first choice.
Many COPD patients exhibit high bacterial colonization in the lower airways and/or microaspirations from gastroesophageal reflux which might be the cause of some complications.

The initial response to treatment in asthma serves as an important prognostic factor. If clinical, physiological, and mechanical improvement doesn't occur within 1-2 hours, ventilation assistance is often considered.
In COPD, the response to treatment is slower than in asthma and the prognostic significance isn't as clear cut, but some general treatments apply either way.

Intubation in COPD is often a last resort, if noninvasive mechanical ventilation fails after a time.
If needed in acute cases, appropriate procedures ensure patient safety during intubation and reduce complications like aspiration or lung collapse.

Stratification assesses patient severity based on clinical findings and can predict outcomes.
Signs such as lethargy, obnubilation, auscultation silence, bradycardia and hypotension are warning signs of potential respiratory failure or arrest.
Initial treatment response in asthma is commonly a significant prognostic factor. Clinical and physiological improvement, specifically in blood gases and PEFR(Peak Expiratory Flow Rate), are evaluated for proper intervention.