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2.2: A Nasty Cough, Investigations, Bronchodilators (SABAs) not very…

- - - - SOBOE
        
        Unable to walk to bathroom (mMRC dyspnoea scale Grade 4)
- - - - Emphysema
        
        Hyperinflation
- - - - Obstructive lung disease
        
        Symptoms for 3 months or longer
        
        COPD
        
        Pharmacotherapy
        
        Bronchodilators
        
        Antimuscarinics
        
        2 more items...
        
        Beta2 agonists typically not very helpful in COPD
        
        3 more items...
        
        Vaccinations - prevent viral infections (triggers of acute exacerbations)
        
        Preventers
        
        ICS
        
        2 more items...
        
        Acute exacerbations of COPD
        
        Antibiotics
        
        3 more items...
        
        Oral CS
        
        1 more item...
        
        IV CS
        
        1 more item...
        
        Macrolides (erythromycin, azithromycin) either daily or 3x a week
        
        May reduce frequency of exacerbations in severe COPD
        
        1 more item...
        
        Non-pharmacotherapy
        
        Pulmonary rehabilitation
        
        Smoking cessation
        
        Check inhaler technique
        
        Oxygen therapy
        
        Non-invasive ventilation
        
        Palliative Tx
- - - - Increased risk and length of infection
        
        Increased risk of COPD exacerbations
        
        Predictor of future exacerbations
        
        Sore throat
        
        Coryzal (rhinitis)
  - - - Coughing up small amount of clear mucus and SOB for 3/12 for 2 consecutive years
        
        Chronic bronchitis
  - - - Release of TNFa and IL-8
        
        Neutrophil recruitment
        
        Release of proteases
      - Release of CXCL9, CXCL10, CXCL11
        
        Th1 release IFN-g and TNF-a, CD8 T cells release granzyme and perforin
  - - - Lung parenchyma destruction
        
        Loss of alveolar walls
        
        Decreased elastic recoil tension
        
        Airway obstruction
        
        Air trapping
        
        Decreased gas exchange between alveoli and arterial blood
        
        2 more items...
        
        Static + Dynamic hyperinflation
        
        Increased FRC
        
        Increased RV
        
        Large, uneven alveoli
        
        Patchy lung destruction
        
        Ventilation/perfusion mismatch
        
        Decreased ventilation
        
        1 more item...
        
        Initiation of repair by M2 macrophages
        
        Epithelial cells produce TGFbeta
        
        Fibroblasts produce collagen
        
        Fibrosis (small airways)
- - - - Increased gas trapping
        
        Dynamic hyperinflation
        
        increases expiratory flow
        
        at the expense of reduced inspiratory volume