COPD for NP
Chronic obstructive pulmonary disease for the Nurse Practitioner Licensing Exam
Pathophysiology
- Chronic Inflammation:
- COPD is driven by chronic inflammation of the airways and alveoli, typically due to long-term exposure to irritants, such as cigarette smoke.
- Inflammatory cells (neutrophils, macrophages, CD8+ T cells) release proteases that degrade lung tissue, causing airflow limitation.
- Airflow Limitation:
- COPD involves two main mechanisms:
- Chronic bronchitis: Inflammation and mucus hypersecretion lead to narrowing of small airways.
- Emphysema: Destruction of alveolar walls leads to loss of lung elasticity and air trapping.
- Oxidative Stress:
- Smoking and pollutants increase oxidative stress, leading to further inflammation and tissue damage.
Clinical Features
- Chronic Cough and Sputum Production:
- Often the earliest symptoms of COPD, especially prominent in the morning.
- Dyspnea:
- Progressive shortness of breath with exertion, becoming more severe over time.
- Wheezing and Chest Tightness:
- These symptoms are common, particularly during exacerbations.
Diagnosis
- Spirometry:
- Key diagnostic tool showing:
- FEV1/FVC Ratio <0.70: Confirms airflow limitation.
- FEV1: Decreases as disease severity increases.
- Chest X-ray:
- May show hyperinflation and flattened diaphragms in advanced COPD.
Management
- Smoking Cessation:
- Most effective intervention to halt disease progression.
- Bronchodilators:
- Short-acting beta-agonists (SABAs): Used for symptom relief during exacerbations.
- Long-acting bronchodilators (LABAs, LAMAs): Maintenance therapy for symptom control and exacerbation reduction.
- Inhaled Corticosteroids (ICS):
- Often used in combination with LABAs in patients with frequent exacerbations.
- Pulmonary Rehabilitation:
- Improves exercise tolerance and quality of life in patients with moderate-to-severe COPD.
Key Points
- COPD is a progressive disease primarily caused by smoking, leading to airflow limitation due to chronic bronchitis and emphysema.
- Spirometry confirms the diagnosis, with an FEV1/FVC ratio <0.70 after bronchodilator use.
- Smoking cessation is the most critical intervention, with bronchodilators and inhaled corticosteroids used for symptom control.
- Exacerbations are managed with bronchodilators, corticosteroids, and, when necessary, antibiotics.
- Pulmonary rehabilitation is a valuable tool for improving patient outcomes in moderate-to-severe COPD.