Pathophysiology
How does smoking cause an obstructive rather than a restrictive lung disease?
smoking causes inflammation and destruction of airways and alveoli, leading to airflow obstruction, which is the hallmark of obstructive disease
What is the single most important diagnostic tool for confirming COPD?
Spirometry
Which two types of medications are used for immediate bronchodilation during an exacerbation?
Short-acting beta-agonists (SABAs) and short-acting muscarinic antagonists (SAMAs).
How do long-acting bronchodilators like tiotropium and olodaterol differ in their mechanisms?
Tiotropium (a LAMA) blocks acetylcholine's constricting effects, while olodaterol (a LABA) stimulates beta-2 receptors to relax airway muscles.
What is the primary cause of a COPD exacerbation?
A viral or bacterial infection, or an environmental irritant, that causes an acute increase in airway inflammation and mucus
What FEV1/FVC ratio is diagnostic for COPD?
A post-bronchodilator FEV1/FVC ratio of less than 0.70.
Name one oral or IV medication that is used to reduce inflammation during a COPD exacerbation.
Prednisone or another systemic corticosteroid
At what GOLD stage are inhaled corticosteroids (ICS) typically added to long-term therapy?
GOLD D (Severe to Very Severe) to reduce exacerbation frequency.
Describe the physical exam finding of pursed-lip breathing and explain how it relates to COPD pathophysiology.
It's a breathing technique used to increase back-pressure in the airways, which prevents their collapse during exhalation in patients with emphysema.
A patient's FEV1 is 65% of predicted. According to the GOLD criteria, what is their stage of disease?
GOLD 2 (Moderate)
When are antibiotics indicated during a COPD exacerbation?
When the patient has at least two of the three cardinal symptoms: increased dyspnea, increased sputum volume, and increased sputum purulence.
What is the primary benefit of pulmonary rehabilitation for a patient with COPD?
It improves exercise capacity, quality of life, and reduces symptoms and hospitalizations through a structured program of exercise, education, and support.
What osteopathic structural exam findings are correlated with COPD?
Bilateral Inhalation SD
Diaphragm Restric.
Paravertebral HT at T2-T7
(TRUELEARN)
How do spirometry and chest radiology findings correlate with COPD pathophysiology?
Spirometry shows a low FEV1/FVC ratio due to airflow obstruction, while radiology may show hyperinflation and flattened diaphragms, both of which are direct results of air trapping and lung destruction.
What two clinical findings, other than a history of smoking, are essential for a suspected COPD diagnosis?
Chronic cough and dyspnea.
In a patient with severe dyspnea, why would a nebulizer machine be preferred over a metered-dose inhaler?
A nebulizer delivers a continuous mist of medication that is easier for a severely dyspneic or uncoordinated patient to inhale.
How do nicotine patches and oral medications like varenicline assist in smoking cessation?
Nicotine patches replace the nicotine from cigarettes to reduce withdrawal symptoms, while varenicline reduces the pleasure of smoking and withdrawal symptoms by affecting nicotine receptors in the brain.
What is the physiological mechanism behind the development of a barrel chest in a patient with advanced COPD?
Chronic air trapping and hyperinflation cause the lungs to push the ribs outward, increasing the anterior-posterior diameter of the chest.
What specific chest X-ray finding is indicative of severe COPD?
A flattened diaphragm.
Other than medication, what is a crucial non-pharmacological treatment for managing a severe COPD exacerbation?
Oxygen therapy, and potentially non-invasive or invasive ventilation
What are two key components of a nutritional approach for COPD?
Consuming foods rich in omega-3 fatty acids and antioxidants to reduce inflammation and oxidative stress.