00:01
Now, the cardinal signs and symptoms of COPD
is dyspnea, shortness of breath. This dyspnea
is usually worsened upon exertion. As the
disease progresses, the patient becomes even
dyspneic at rest. Doesn’t this kind of sound
like angina? Same concept. And so therefore,
if that pain occurs even at rest, we are in
the realm of unstable angina and so therefore,
the patient is at imminent deathly
risk. Patients with chronic bronchitis will
have a cough and this cough is productive.
We will talk about the definition of chronic
bronchitis in detail.
00:36
Physical examination. If it’s obstructive,
you are having a hard time with airflow limitation
and by this, we mean you are having a hard
time with exhalation. So therefore, you will
have more air that is stuck in your lungs.
So therefore, you can expect there to be
hyperinflation. If it is emphysema, that you
are all too familiar with, you can only imagine
that there the diaphragm then becomes
depressed and there is the barrel chest that
we are referring to is the fact that you have
an increased in PA diameter. The cyanosis,
this is something that you are going to
then see immediately, in the nails or perhaps
in the lips because of lack of proper oxygen,
decreased air entry on auscultation, distant
breath sounds, scattered wheezes or rhonchi
on auscultation referring to the fact that
you have issues down the alveoli. Sounds like
cor pulmonale and that is a problem. At some
point in time, if the disease process in general
with COPD is severe enough then there might
be a right ventricular dysfunction, welcome
to cor pulmonale.
01:40
Now, what is COPD? Classically divided into
three main categories. We’ll take a look
at the emphysema. You will understand why
these patients are called pink puffers when
the time is right. Chronic bronchitis,
these individuals are blue bloaters, mean
to say that the cyanosis is taking place quite
early. And then asthma. And these are the
three major classifications we will take a
look at. What we will do with bronchiectasis
actually which is traditionally part of the
four types of COPD's is truly understand that
in the setting of infections. Bronchiectasis,
the three major ones that you want to focus
upon with COPD and current day practice are
these three.
02:27
We will be spending quite a bit of time with
these huge symptomatic circles. We will walk
through each one of the numbers. I will show
you as to what it means to be within this
dashed box that we have here in which the
three conditions of chronic bronchitis, emphysema
and asthma is going to fall into play. Now,
the area that you see shaded in green represents
actual definition of COPD. If you have missed
or you have neglected your definition of COPD,
I highly recommend that this will be the time
you go back and review your definition. At
some point in time, this could be preventable,
but understand that comorbidities may exist
and so therefore, your patient is at risk
of severity and secondary issues including
cor pulmonale. The area in green here, as
we go through, you will see the overlapping
issues and which one of these numbers you
want to pay attention to specifically. Let
us now begin our discussion.
03:39
What is this? This is a Venn diagram in which,
once again, the three major COPDs are listed.
03:44
The areas defined in green represent the COPD,
chronic bronchitis, a symptom that you want
to pay attention to here, by definition. It’s
three months of chronic productive cough for
two consecutive years. History.
“Hey, doc, I have had cough. Are you bringing
up anything?” “Matter of fact, I am. How
long has it been going on?” “Oh, couple
of months.” “And for how long?” “Well,
duration? I don’t know, it seems like it’s
been a long time.” Understand from your
patient how they will express themselves will
be rather layman in terms, but you have to be
astute enough where you are picking up on
the fact that this is a pattern, chronic bronchitis.
What about emphysema? Emphysema, most notably,
you are looking for a patient that has a history
of smoking and upon exposure to smoke,
we will walk through the two major patterns
of emphysema, two major ones. One will be
centrilobular, the other one is called panacinar
type of emphysema. Ultimately, it’s a fact
that your lung is being destroyed, the parenchyma.
And so, therefore, you lose your surface area
and hence, your diffusion capacity of carbon
monoxide is going to be decreased. Let’s