Chronic obstructive pulmonary disease -- chronic bronchitis & emphysema

1)      Chronic bronchitis: clinical diagnosis; chronic productive cough (3+ months/yr for at least 2 consecutive years)

2)      Emphysema: pathologic diagnosis; alveolar walls damaged à permanent enlargement of air spaces distal to terminal bronchioles.

 

-tobacco smoke à increases # of activated macropahages and PMNs, inhibits a1-antitripsin, increases oxidative stress à destruction of alveolar walls.

 

-pink puffers (emphysema) vs. blue bloaters (chronic bronchitis)

-see article on reading flow volume loops

 

Treatment: 

1)      stop the smoking

2)      B2 agonists (short acting – albuterol and long acting – salmeterol).

3)      Anticholinergics (inhaled) – ipratropium bromide (slower onset but longer lasting)

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4)      Corticosteroids (inhaled) – for patients who are not controlled on brochodilators. Are anti-inflammatory.

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5)      Theophylline?

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6)      Oxygen – can prevent pulmonary hypterension and cor pulmonale. (for severe disease)

7)      Vaccination – against strep pneumo every 5 years.

8)      Surgery: resection & transplantation.

 

Complications:

1)      Acute exacerbations (from infection, noncompliance, cardiac disease)

2)      Secondary polycythemia (Hct>55% in men or >47% in women) from chronic hypoxemia

3)      Pulmonary HTN and cor pulmonale

 

For acute exacerbations: use the above medications but do not use inhaled corticosteroids (have to use Oral and then taper off with oral prednisone once symptoms improve). Antibiotics – azithromycin & levofloxacin. Oxygen. Noninvasive positive-pressure ventilation (such as CPAP & BIPAP)