# COPD --- **COPD** stands for **Chronic Obstructive Pulmonary Disease** It is a group of related [[respiratory system|respiratory system]] that cause airflow blockage and breathing-related problems. It is a chronic, progressive and terminal disease that causes irreversible damage to the lung tissue. The increase in work from the lungs can also lead to [[heart failure|cor pulmonale]]. Patients with COPD are unable to expel [[carbon dioxide|CO2]], which puts them in a state of chronic [[acidosis|respiratory acidosis]]. This acidosis develops slowly over time so it's often fully compensated by the kidneys. Unfortunately this overloads the [[pulmonary ventilation#Breathing Regulation|central chemoreceptors]], so the breathing drive is fully controlled by the [[pulmonary ventilation#Breathing Regulation|peripheral chemoreceptors]]. This is fine, except since the peripheral chemoreceptors monitor O2 levels, keeping those too high will tell the brain it's okay to stop breathing--not good. >[!science] Normal Values The normal SpO2 values for someone with COPD is **88%–92%** ## Emphysema & Chronic Bronchitis The two common [[respiratory system]] diseases that contribute to COPD are [[emphysema]] and [[chronic bronchitis]]. Although these are two technically separate conditions, they often occur together. - [[chronic bronchitis]] - mucus production - cyanosis - peripheral edema - crackles/wheezes - [[emphysema]] - structural changes - pursed-lip breathing - wasting/cataxia ## Risk Factors - [[smoking]] - smoking accounts for 90% of COPD cases - air polution - occupational exposures - genetics - alphal-antitrypsin deficiency - is a breakdown of elastin ## Signs & Symptoms - [[dyspnea]] - tripod position - pursed lip breathing - [[cyanosis]] - wheezing and crackles [[lung sounds]] - chronic cough ## Diagnostic Tests - [[complete blood count|CBC]] with differential - looking for [[polycythemia]] - Chest X-ray - can see a hyperinflation of lungs and flattened diaphragm - [[pulmonary function tests]] - particularly the FEV1 can estimate the degree of compromise (80% for adults) - sputum analysis - respiratory infection common - this is what ends patients in the hospital a lot of the time - Arterial blood gases - looking for - compensated [[acidosis|respiratory acidosis]] (i.e. compensatory H2CO3-) - Decreased Pa02 - Decreased Sp02 - ECG - looking for right sided heart failure (cor pulmonale) ## Treatment Treatment for COPD usually revolves around reducing risk factors and managing symptoms. COPD is ultimately fatal, and once damage has been done it's perminant. - Medicine - bronchodilators - like [[albuterol]] - corticosteriods - for long term help, not as a rescue - alpha protease inhibitor replacement therapy - if it's genetic Surgery can be used for palliative care to relieve the worst of the symptoms, but it does does not cure anything. - Lung volume reduction surgery - the surgeons come in and take the worst of the lung out - [[lung transplant]] - There is a **2 year survival** rate of 75% - There is a **5 year survival** rate of 55% ## Nursing Considerations [[ineffective airway clearance]] [[ineffective gas exchange]] [[activity intolerance]] Generally can do things to help clear the airways such as: - encourage fluids - vaporizer/humidifier - postural drainage - suction - controlled coughing ___