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Pathophysiology of COPD
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[Music]
hello and welcome to pathophysiology of
copd my name is david woodruff
i'm the editor of critical care nursing
made incredibly easy i hope to make this
incredibly easy for you too
so today we're going to talk a little
bit about what copd is
and the pathophysiology so let's start
back a little bit kind of backing up a
little bit into our anatomy and physiology
physiology
and let's take a look at the picture on
the left which is demonstrating our
upper and lower airways
so we have our upper airway the air is
going down obviously through the trachea
and into the bronchi down into the lungs
notice the
location of the organs in relationship
to the lungs so we have our lungs there
we have our heart
in the middle and then we have our
abdomen below the diaphragm
this is important because with some of
the changes that occur with copd
we're also going to see some impact on
both the heart
and the abdomen and in fact if the patient
patient
also has some underlying conditions such
as maybe obesity
that is pressing up on the diaphragm
that could also be impacting how well
that patient is able to breathe with
their copd
okay over on the left hand side at the
top we see the trachea now moving down
into the bronchi finally into the bronchioles
bronchioles
and then down all the way to the alveoli
and the alveoli we see our capillary
network going around the alveolus
and now we've got our blood flow around
the alveolus so we have two different
mechanisms that are happening here in
the lung we have
perfusion and we have ventilation the
ventilation is the air part so that's
the part that's going down the airways
trachea bronchi bronchioles and alveolus
and then we have the perfusion part
which is the capillary network
so two separate processes we have the
little picture over to
the right in the middle there of the
alveolus and you can see there's
one alveolus with its blood flow around it
it
and it's exchanges co2 and oxygen
so let's blow this up a little bit and
just take a look at that alveolus itself
and we can see these little clusters of
alveoli they're supposed to look like
that they're supposed to look like
little grape-like clusters
that we're seeing in the picture on the
left and each one of them has its own
little capillary
network that's going around the alveolus
this gives it a really
big surface area for gas exchange to
take place
over on the right hand side again we've
got that individual alveolus
and we see the air coming in and we see
the gas exchange occurring and then the
air going back
out one thing to keep in mind that we're
getting when we're getting down to this
level when we're talking about the
alveoli whether that's this
cluster of alveoli or the bronchial but
down here in the distal parts of the airway
airway
the air is being circulated it is not
being exchanged so in other words when
you're looking at the picture on the
right and you see the air coming in
and the air going out that's really kind
of what happens here is that air is just
circulating through that alveolus
rather than the patient taking your
breath in and the alveolus filling and then
then
the alveola is collapsing when the
patient exhales if we did that every time
time
you took a breath in you'd have to
re-recruit all of those millions of alveoli
alveoli
which would be nearly impossible to do so
so
instead we're just circulating the air
that's in those alveoli
okay now let's talk about what copd is
technically there are three different
types of diseases that can cause airway obstruction
obstruction
we have emphysema which is the
destruction of the lung tissue
we have asthma which is a narrowing of
the airways caused
usually by an allergic response that's
causing inflammation
and then we have chronic bronchitis
which is a chronic
mucus production and usually associated
with emphysema so emphysema chronic
bronchitis those two things usually
now the inflammation that occurs is
going to cause a number of things to happen
happen
remember from inflammation that three major
major
categories of things happen with
inflammation we have vasodilation
we have capillary permeability and we
have clotting
the vasodilation part is going to get
more blood flow going through those alveoli
alveoli
so that hopefully we're maintaining our
perfusion however we're
also going to have capillary
permeability when that occurs we're
going to have
fluid moving out into the interstitial
spaces and the fluid will interfere with
our gas exchange
eventually that fluid again remember its
inflammatory fluid
it's going to be thick and full of
inflammatory debris
and some dead cells etc so it's going to
be thick like
pus and that's what causes all of these
secretions that your copder is coughing up
up
is because we have this capillary
permeability and this inflammation
that is occurring not just in the
airways but in the alveolus too
then we have clotting occurring so this
can cause some additional destruction to
that lung tissue as a result of having
inflammation and having some of those
inflammatory mediators
going to the sites of this inflammation
we will have what's called oxidative stress
stress
oxidative stress is the result of having
free radicals
those are oxygen molecules that have
become unstable
so you see the pictures on the bottom of
the screen to the right
the normal cell and then the normal cell
that's being attacked by free radicals
free radicals are normally produced in
the body by the inflammatory and immune process
process
as a response to killing bacteria so
this is a normal process
and it's designed to kill bacteria however
however
what happens in copd is we have inflammation
inflammation
that's out of control and that isn't
supposed to be there
so this could be an autoimmune response
this could be a response to
cigarette smoke or to some other kind of
irritant to the lung
but we have inflammation occurring and
inflammation causes
these inflammatory mediators to be
present and they are going to cause the
production of oxygen free radicals
now since there isn't any bacteria to
kill there's just cigarette smoke or
whatever the
the mediator is that
free radical is now going to start to
attack healthy tissue
so we see the free radicals are
attacking the tissue here
and then we end up having this severe
what's called oxidative stress
because it's an oxygen free radical so
it's an oxidative
type of process it's going to cause cell death
death
and unfortunately these are going to be
the cells of the lung
itself so the alveolus and the lung tissue
tissue
so when you take a look at this picture
here over on the right you see a
detailed view
of copd now instead of having those nice
grape-like clusters you can see
that the walls of the alveoli have
become destroyed
so because of oxidative stress and
inflammation the walls of the cells
or of the alveoli have become destroyed
and now it's forming these
big kind of bulbous type alveoli
the problem with those is that big
alveoli don't have as much surface area
as all those teeny little ones
have so we lose some of our surface area
we lose some of our gas exchange capability
capability
and this is why your patient with cob pd
is eventually going to start to
build up their co2 and decrease their
oxygen levels
because they don't have the surface area
to be able to do the gas exchange that
they could
when those alveoli were normal we also
have the production of
sputum so there's two main things that
are happening here in copd and
most of the time you may have a patient
who is diagnosed with
emphysema for example or maybe they're
diagnosed with chronic bronchitis
patients who have copd have both of
these processes going on there's lung
destruction that's the emphysema part
and there's chronic bronchitis which is
the chronic mucus production part
so there's both of those processes going on
on
the patient may have been diagnosed with
one over the other because maybe one
is a little bit more prominent than the
other one is in this
particular patient but they're going to
have both they're going to have the
sputum production
the tissue destruction and those things
are going to lead to air trapping
hyperinflated lungs which is going to
start to press on the heart
and you're going to see some cardiac
involvement as well
a lot of our patients who have copd also
and that's the reason why you can't
separate out the heart and the lungs
they're in the same
cavity if you want to learn more about
nursing emergencies check out our
nursing emergencies program
at thenursingprof.com and help you to
decrease complications
rapidly detect problems and implement
prop action
in your patients well thank you for
joining me today for pathophysiology of copd
copd
my name is david woodruff until next [Music]
[Music] time
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