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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

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

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

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

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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