Question

1. A 64-year-old man with a 40 pack/year history of cigarette smoking has been diagnosed with emphysema. He asks the APRN if this means he has COPD. Question 2 of 2: Explain the pathophysiology of chronic bronchitis and how it relates to COPD.

Answer 1

1. The APRN ( Advanced Practice Registered Nurse) would Response this by saying , Yes this is COPD as COPD is refers to a group of diseases that cause airflow blockage and breathing-related problems.

COPD includes:

• Emphysema – It is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter. This lung disease causes destruction of the fragile walls and elastic fibers of the alveoli. Small airways collapse when you exhale, impairing airflow out of your lungs.
• Chronic Bronchitis – long-term inflammation of the airways due to repeated infections in the lungs.

Various Risk factors for Emphysema-

• Smoking. Emphysema is most likely to develop in cigarette smokers, but cigar and pipe smokers also are susceptible. The risk for all types of smokers increases with the number of years and amount of tobacco smoked.
• Age. Although the lung damage that occurs in emphysema develops gradually, most people with tobacco-related emphysema begin to experience symptoms of the disease between the ages of 40 and 60.
• Exposure to secondhand smoke. Secondhand smoke, also known as passive or environmental tobacco smoke, is smoke that you inadvertently inhale from someone else's cigarette, pipe or cigar. Being around secondhand smoke increases your risk of emphysema.
• Occupational exposure to fumes or dust. If you breathe fumes from certain chemicals or dust from grain, cotton, wood or mining products, you're more likely to develop emphysema. This risk is even greater if you smoke.
• Exposure to indoor and outdoor pollution. Breathing indoor pollutants, such as fumes from heating fuel, as well as outdoor pollutants — car exhaust, for instance — increases your risk of emphysema.

2. Pathophysiology of Chronic Bronchitis and it's Relation to COPD-

The pathological foundation for Chronic Bronchitis is due to the over-production of mucus in response to the inflammatory signals, this is known as mucous metaplasia. In COPD patients this overproduction and hypersecretion due to the goblet cells and decreased the elimination of mucus.

The mechanisms responsible for mucous metaplasia in COPD patients is associated with the function of the T cells, although it is still poorly understood. It is believed to be linked to end production of the Th2 inflammation cells while the cellular response is thought to be attributed to the Th1 inflammation cells, both produce cytokines that have an influence on mucus production associated with COPD patients.

Mucus metaplasia causes airflow obstruction by several mechanisms: it causes luminal occlusion; the thickening of the epithelial layer intrudes on the airway lumen, and the mucus alters the airway surface tension. These all leave the airway at a greater risk for collapsing and decreases the capacity for airflow and gas exchange.

Mucus hypersecretion is one of the risks associated with cigarette smoke exposure, viral infections, bacterial infections, or inflammatory cell activation. When combined with poor ciliary function, distal airway occlusion, ineffective cough, respiratory muscle weakness, and reduced peak expiratory flow clearing secretions is extremely difficult and requires high energy consumption.