Chronic Obstructive

Pulmonary Disease

COPD
The most common chronic pulmonary disorder
Fourth-leading cause of morbidity and mortality in the
United States
Characterized by airflow limitation that is not fully
reversible and usually progressive
Associated with an abnormal inflammatory response of
the lung to noxious particles or gases

COPD
Risk Factors

Environmental Factors

Cigarette smoking
Occupational exposures
Indoor pollutants
Outdoor pollutants

Increased
neutrophils,
macrophages, T
lymphocytes

Chronic
inflammation1

Damage of the
endothelial
lining of the
airways

Hypertrophy of
glands and
goblet cells2

Airway
remodeling

Airway repair

Excessive
secretions

Partial or
complete
obstruction of
airway3

Hyperinflation
during
expiration4

COPD
Clinical Presentation
Chronic cough
Expectoration
Exertional dyspnea
Thorax appears enlarged
Chest A-P diameter increased
Hypertrophy of (m)s of ventilation

Diaphragm is flatter and less domed

Breath and heart sounds difficult to hear
Wheezing and crackles
Pursed lip breathing, cyanosis, digital clubbing (advanced stages)

COPD
Prognostic indicators for mortality:
Advanced age
Need for supplemental oxygen
Exercise capacity
Disease distribution within the thorax

Asthma

Asthma
Characterized by chronic airway inflammation
associated with airway hyperresponsiveness
(hyperreactivity) resulting in bronchospasm
Wheezing, breathlessness, coughing with sputum
production
Usually diagnosed with a history of episodic wheezing,
shortness of breath (SOB), tightness in the chest, and/or
coughing, which may be worse at night in the absence
of any other obvious cause.

Asthma
Etiology
Allergic (Extrinsic)
Immunologic (IgE-mediated) response to envtal triggers

Nonallergic (Intrinsic)
Exposure to irritants

Exposure to
environmental
triggers and
irritants

Increased
resistance to
airflow

Inflammation,
bronchospasm,
increased
bronchial
secretions

Narrowing of
airways

Air is trapped,
leading to
hyperinflation

Abnormal
distribution of
ventilation to
alveoli

Asthma
Clinical Presentation
Cough
Dyspnea on exertion or at rest
Wheezing
Chest is usually held in an expanded position

Crackles may be present

Mild to moderate hypoxemia (ABG analysis)
More pronounced hypoxemia and hypercapnea

Cystic Fibrosis

Cystic Fibrosis
a chronic disease that affects the excretory glands of
the body
secretions are thicker, more viscous than usual, and can
affect a number of systems of the body: pulmonary,
pancreatic, hepatic, sinus, and reproductive
Pulmonary system dysfunction common cause of
morbidity and mortality

Cystic Fibrosis
Etiology
Genetic transmission (autosomal recessive trait)
CF gene dysfunction (cystic fibrosis transmembrane
conductance regulator [CFTR])
Long arm of chromosome 7
CFTR functions to transport electrolytes and water in and out
of the epithelial cells of many organs in the body, including
lungs, pancreas, and digestive and reproductive tracts.

Abnormal and
altered
secretions

Impaired
mucociliary
transport
system

Airway
obstruction
and
hyperinflation;
infection

Reduced
ventilation to
the alveolar
units

Ventilation and
perfusion are
not matched

Fibrosis of the
lung
parenchyma

Cystic Fibrosis
Diagnosis
CF may be suspected if:
(+) family Hx of the dse
Recurrent respiratory infections from S. aureus and P.
aeruginosa
Dx of malnutrition and failure to thrive

A chloride concentration of greater than or equal to

60 mEq/L found in the sweat of children is a positive
test for the diagnosis of CF.

Cystic Fibrosis
Clinical Presentation
Failure to thrive
Diabetes
Frequent resp. infections
Chronic cough
Thick bronchial secretions
Increased A-P dimension of chest
Increased dorsal kyphosis
Decreased thoracic excursion
Crackles and wheezes
Hypertrophy of accessory (m)
Pursed-lip breathing
Cyanosis
Digital clubbing
Hypoxemia and hypercapnea
Pulmonary HTN and cor pulmonale