NURS 8250-Chronic Obstructive Pulmonary Disease Discussion

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Patients have difficulty exhaling all the air from the lungs

Exhaled air comes out more slowly than normal

At the end of full exhalation, an abnormal amount of air may still linger in the lungs

Obstructive lung diseases

The most common causes of obstructive lung disease are:

Chronic Obstructive Pulmonary Disease (COPD), which can have two components:

Bronchitis and Emphysema

Asthma

Bronchiectasis

Cystic Fibrosis

Chronic obstructive pulmonary disease – Definition

When chronic bronchitis and emphysema appear together

Preventable and treatable, but not able to be cured

Characterized by airflow limitation that is not fully reversible

Progressive disease associated with abnormal inflammatory response of the lung to noxious particles or gases

Chronic bronchitis and emphysema can each develop alone; however, they often occur together as one disease complex. COPD refers to two lung diseases, chronic bronchitis and emphysema, which occurs simultaneously. Patients demonstrate a variety of clinical manifestations associated with both disorders and the relative contribution of each respiratory disorder is difficult to acertain.

COPD – Chronic bronchitis

Anatomic Alterations

Chronic inflammation and swelling of the walls of the peripheral airways

Excessive mucous production and accumulation

Partial or total mucous plugging of the airways

Smooth muscle constriction of the bronchial airways (bronchospasm)

Air trapping and hyperinflation of alveoli (in the later stages)

Chronic Bronchitis Chronic Obstructive Pulmonary Disease Discussion

Diagnosed based on symptoms

Cough with excessive sputum for at least three months for two consecutive years

Emphysema

Anatomic Alterations

Permanent enlargement and destruction of the air spaces distal to the terminal bronchioles (alveoli)

Destruction of pulmonary capillaries

Weakening of the distal airways, primarily the respiratory bronchioles

Air trapping and hyperinflation

Emphysema

Diagnosed definitively only by lung biopsy or post-mortem exam

Two types

Centrilobular

Panlobular

Normal anatomy

Acinus: A grouping of alveoli distal to a terminal bronchiole.

Normal Acinus

Centrilobular Emphysema

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Centrilobular (centriacinar) emphysema is characterized by enlargement and destruction of the central part of the acinus (the respiratory bronchioles) with the more distal parts (the alveoli) remaining intact.

The respiratory bronchioles enlarge, become confluent, and are then destroyed.

Most common form of emphysema.

Associated with cigarette smoking

Panlobular Emphysema

In panlobular emphysema, the entire acinus is involved.

The normal structure of the alveoli and alveolar ducts are lost along with the loss of pulmonary parenchyma.

Bullae (emphysematous spaces greater than one cm) are often present in this type of emphysema.

Emphysema

Panulobular Emphysema

Panulobular emphysema can also be genetic.

Caused by Alpha 1 Antitrypsin Deficiency

Protein that protects lung elastin from neutrophil elastase

Neutrophil elastase breaks down elastin during an inflammatory response, resulting in destruction of the alveolar walls

Alpha 1 Antitrypsin lab test

Normal range is 200-400 mg/dl

COPD

Precise incidence of COPD is not known.

10-15 million people have chronic bronchitis, emphysema, or a combination of both.

In 2004, the annual cost related to COPD was about $37.2 billion

4th leading cause of death

Since 2000, more women than men have died of COPD

The number one cause of COPD is cigarette smoking.

Mucocillary Escalator is damaged.

Paralyzed

Cilia

Excessive

mucus

Damaged Tissues