3.COPD and bronchiectasis Year 4 Internal Medicine Notes

3.COPD and bronchiectasis Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / IMED 4.1 / NGUGI -- ● Objectives: ● Definition​ ​of​ ​COPD​ ​and​ ​Bronchiectasis. ● Clinical​ ​and​ ​radiological​ ​diagnosis. ● Differential​ ​diagnosis. ● General​ ​outline​ ​of​ ​management. ● Create​ ​a​ ​link​ ​to​ ​341​ ​clinical​ ​teaching.\n[​ ​Color​ ​index​ ​:​ ​ ​Important​ ​ ​ ​ ​Notes​ ​ ​ ​Extra​ ​]\n[​ ​ ​ ​ ​Editing​ ​file​ ​ ​ ​ ​ ​ ​ ​ ​ ​Feedback​ ​ ​ ​ ​ ​ ​ ​ ​ ​Share​ ​your​ ​notes​ ​ ​ ​ ​ ​ ​ ​ ​ ​Shared​ ​notes​ ​ ​ ​ ​ ​ ​ ​Twitter​ ​ ​ ​ ​] ● Resources: ● 435​ ​slides,​ ​434​ ​&​ ​432​ ​ ​teams,​ ​435​ ​respiratory​ ​block​ ​team.\n\n● Done​ ​by:​ ​Sara​ ​AlKhalifa,​ ​Raghda​ ​Alqassim,​ ​Rawan​ ​alduwaihi ● Team​ ​sub-leader:​ ​Dalal​ ​ ​Al​ ​Huzaimi ● Team​ ​leaders:​ ​Khawla​ ​AlAmmari​ ​&​ ​Fahad​ ​AlAbdullatif ● Revised​ ​by:​ ​Ahmad​ ​alyahya,​ ​Luluh​ ​Alzeghayer \n\n Definition​ ​of​ ​COPD\n\n● COPD: 12​ ​:​ ​18​ ​minutes \n○ Is​ ​a​ ​disease​ ​state​ ​characterized​ ​by​ ​persistent​ ​ ​airflow\nlimitation​ ​that​ ​is​ ​not​ ​fully​ ​reversible​ ​(may​ ​improve​ ​slightly\nwith​ ​salbutamol​ ​but​ ​doesn’t​ ​normalize)​.​ ​The​ ​airflow​ ​limitation​ ​is\nusually​ ​both​ ​progressive​ ​and​ ​associated​ ​with​ ​an​ ​abnormal\ninflammatory​ ​response​ ​of​ ​the​ ​lungs​ ​to​ ​noxious​ ​particles\n(like​ ​smoking,​ ​occupational​ ​gasses,​ ​cooking​ ​gasses)​ ​or​ ​gases​.\n○ COPD​ ​is​ ​classified​ ​under​ ​obstructive​ ​pulmonary​ ​diseases​ ​along\nwith​ ​other​ ​diseases​ ​such​ ​as​ ​asthma​ ​and​ ​bronchiectasis.\n○ Related​ ​diagnoses​ ​include:​ ​emphysema​ ​(pink​ ​puffers)​ ​and\nchronic​ ​bronchitis​ ​(blue​ ​bloaters):\n- They​ ​ ​are​ ​grouped​ ​together​ ​under​ ​COPD​ ​because​ ​they​ ​are​ ​both​ ​mainly​ ​caused​ ​by​ ​smoking​ ​(tobacco\ndestroys​ ​elastin​ ​fibers)1​ ​and​ ​they​ ​usually​ ​present​ ​together.​ 2​\n- Pure​ ​emphysema​ ​or​ ​pure​ ​chronic​ ​bronchitis​ ​are​ ​rare​.\n\n● Epidemiology​ ​and​ ​etiology:\n- The​ ​prevalence​ ​of​ ​COPD​ ​is​ ​directly​ ​related​ ​to​ ​the​ ​prevalence​ ​of​ ​tobacco​ ​smoking3​ ​“​ ​developed\ncountry​ ​causes​ ​90%​ ​of​ ​the​ ​cases”​ ​ ​and,​ ​in​ ​low-​ ​and​ ​middle-​ ​income​ ​countries​ ​“​ d\n​ eveloping​”​ ​,​ ​the​ ​use\nof​ ​biomass​ ​fuels.\n- COPD​ ​is​ ​the​ ​fourth​ ​leading​ ​cause​ ​of​ ​death​ ​in​ ​the​ ​US. \n- by​ ​2020​,​ ​it​ ​is​ ​forecast​ ​to​ ​represent​ ​the​ ​third​ ​most​ ​important​ ​cause​ ​of​ ​death​ ​worldwide​.\n- Usually​ ​after​ ​the​ ​age​ ​of​ ​40,​ ​unlike​ ​asthma​ ​which​ ​can​ ​develop​ ​at​ ​any​ ​age.\n\n ● Chronic​ ​bronchitis:​ ​“​ ​defined​ ​by​ ​clinical​ ​features”\n​ ​Chronic​ ​or​ ​recurrent​ ​expectoration​ ​(cough​ ​up​ ​lots​ ​of​ ​sputum4)\nwhich​ ​is​ ​present​ ​on​ ​most​ ​days​ ​for​ ​a​ ​minimum​ ​of​ ​3​ ​months​ ​a​ ​year​ ​for\nat​ ​least​ ​2​ ​successive​ ​years​.​ ​(this​ ​is​ ​a​ ​warning) .\n (it​ ​is​ ​a​ ​clinical​ ​syndrome​ ​in​ ​which​ ​Ct​ ​scan​ ​can​ ​be​ ​normal​ ​,​ ​spirometry​ ​can​ ​be\nnormal​ ​ ​but​ ​there’s​ ​cough​ ​because​ ​irritation​ ​of​ ​small​ ​bronchi​ ​“​ ​which​ ​is​ ​called\nsimple​ ​chronic​ ​bronchitis​ ​“​ ​,later​ ​on​ ​develop​ ​to​ ​COPD​ ​or​ ​sometimes​ ​become\ndyspneic​ ​without​ ​going​ ​through​ ​Chronic​ ​bronchitis​ ​(but​ ​the​ ​majority​ ​develop\nCOPD)​ ​.\n​ ​8:46​ ​minutes\n\n 1\n​ ​Loss​ ​of​ ​elastic​ ​recoil​ ​of​ ​the​ ​lung​ ​leads​ ​to​ ​SOB..\n2\n​ ​“​ ​In​ ​practice,​ ​these​ ​phenotypes​ ​often​ ​overlap”\n3\n​ ​The​ ​development​ ​of​ ​COPD​ ​is​ ​proportional​ ​to​ ​the​ ​number​ ​of​ ​cigarettes​ ​smoked​ ​per​ ​day​ ​“​ ​30​ ​C/day​ ​➝​ ​↑​ ​20​ ​time​ ​than​ ​non\nsmoker”.​ ​But​ ​not​ ​all​ ​smokers​ ​develop​ ​the​ ​condition​,​ ​suggesting​ ​that​ ​individual​ ​susceptibility​ ​factors​ ​are​ ​important.\n4\n​m\n​ ucus​ ​plugs​ ​cause​ ​obstruction​ ​of​ ​bronchioles→​ ​COPD \n\n ● Emphysema:​ ​“defined​ ​by​ ​structural​ ​changes”\nIt​ ​is​ ​a​ ​pathologic​ ​diagnosis​ ​of​ ​Permanent​ ​destructive\nenlargement​ ​of​ ​airspaces​ ​ ​distal​ ​to​ ​the​ ​terminal\nbronchioles​(ALVEOLI)​ ​without​ ​obvious​ ​fibrosis.\n-​ ​ ​Secondary​ ​to​ ​inflammation​ ​destruction​ ​of​ ​alveolar​ ​walls.\n-​ ​emphysema​ ​classified​ ​according​ ​to​ ​the​ ​site​ ​of​ ​damage:\n\n ​ ​ ​10:07​ ​minutes\n\n centri-acinar​ ​emphysema ​ ​ ​ ​ ​Pan-acinar​ ​emphysema ​ ​Irregular​ ​emphysema ​ ​extremely​ ​common​:​ ​ ​ ​(in​ ​smoker) less​ ​common: There​ ​is​ ​scarring​ ​and​ ​damage •​ ​Distension​ ​and​ ​damage​ ​of​ ​lung​ ​tissue​ ​is •​ ​ ​Distension​ ​and​ ​destruction​ ​appear​ ​to affecting​ ​the​ ​lung​ ​parenchyma concentrated​ ​around​ ​the​ ​respiratory involve​ ​the​ ​whole​ ​of​ ​the​ ​acinus patchily​ ​without​ ​particular bronchioles​ ​(proximal​ ​acini)​ ​,​ ​whilst​ ​the (both​ ​proximal​ ​and​ ​distal​ ​acini) regard​ ​for​ ​acinar​ ​structure. more​ ​distal​ ​alveolar​ ​ducts​ ​and​ ​alveoli​ ​tend •Predilection​ ​for​ ​lung​ ​bases​. to​ ​be​ ​well​ ​preserved •​ ​ ​inherited​ ​defic