COPD:
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)
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)