00:00:00.510 --> 00:00:04.080 Welcome to another MedCram lecture. 00:00:04.080 --> 00:00:13.200 We're going to talk about emphysema today, otherwise known as C.O.P.D. 00:00:13.200 --> 00:00:18.660 It seems as all these diseases have abbreviations in medicine. 00:00:18.660 --> 00:00:22.660 This one is "chronic obstructive pulmonary disease." 00:00:22.660 --> 00:00:24.250 What is C.O.P.D.? 00:00:24.250 --> 00:00:32.369 It's a common preventable and treatable lung disease and the typical symptoms that you'll 00:00:32.369 --> 00:00:46.879 see in patients with emphysema C.O.P.D. is shortness of breath, and you'll also see cough, 00:00:46.879 --> 00:00:50.909 and if it's wet you'll have sputum as well. 00:00:50.909 --> 00:00:56.629 These are very nonspecific symptoms, but they're very typical of what you see in C.O.P.D. 00:00:56.629 --> 00:00:59.039 How important of a disease is this? 00:00:59.039 --> 00:01:12.670 Couple of statistics that you should know is it's the third most common cause of death 00:01:12.670 --> 00:01:15.310 in the US; pretty significant. 00:01:15.310 --> 00:01:23.910 There's a number 2 and there's a number 1 above it and that's heart disease and cancer 00:01:23.910 --> 00:01:27.610 and sometimes these, depending on how you survey, will flip spots. 00:01:27.610 --> 00:01:29.280 There's also number 4 and number 5. 00:01:29.280 --> 00:01:35.510 The key here is that this is the only cause of death in the United States out of these 00:01:35.510 --> 00:01:45.000 5 that have actually gone up from about 2007 to 2010 all the others have gone down in frequency 00:01:45.000 --> 00:01:46.070 except for this one. 00:01:46.070 --> 00:01:51.260 This is a pretty significant disease that we've got to be concerned about. 00:01:51.260 --> 00:02:02.530 In addition to all of this, it's also the second leading cause of disability. 00:02:02.530 --> 00:02:09.090 Okay, so the bottom line here is that this is a very important disease to know about. 00:02:09.090 --> 00:02:14.579 In case of course, you're wondering how much of this costs the US healthcare system in 00:02:14.579 --> 00:02:23.099 the United States every year, the answer is about 50 B with a billion; 50 billion with 00:02:23.099 --> 00:02:31.489 a B. That's quite a lot of money As I mentioned, C.O.P.D or emphysema is a 00:02:31.489 --> 00:02:33.620 disease that affects the lungs. 00:02:33.620 --> 00:02:42.029 Specifically, if you were to take a look your lungs, you of course know that your lungs 00:02:42.029 --> 00:02:47.610 have 2 sides and that there's a major airway call the trachea and it branches off into 00:02:47.610 --> 00:02:50.529 the right and left main-stem bronchus. 00:02:50.529 --> 00:02:54.599 From there it just goes down to smaller and smaller branches, without getting into too 00:02:54.599 --> 00:02:55.599 much anatomy. 00:02:55.599 --> 00:03:01.069 If we were to take these very small bronchioles or respiratory bronchioles they would eventually 00:03:01.069 --> 00:03:09.840 end in a grape like cluster called a alveolus. 00:03:09.840 --> 00:03:13.260 This essentially increases the surface area. 00:03:13.260 --> 00:03:17.299 This is what a normal respiratory bronchioles would look like. 00:03:17.299 --> 00:03:22.709 If you were to take all these alveoli in the entire lung and spread it out it would be 00:03:22.709 --> 00:03:29.349 about the size of a tennis court. 00:03:29.349 --> 00:03:36.439 It's pretty big. 00:03:36.439 --> 00:03:42.040 These bronchioles of course allow the air that you breathe in to go down and cause gas 00:03:42.040 --> 00:03:43.040 exchange. 00:03:43.040 --> 00:03:46.359 Now C.O.P.D. affects 2 main areas. 00:03:46.359 --> 00:03:52.930 It affects this bronchus, the small bronchial and it also affects the alveolus in a bad 00:03:52.930 --> 00:03:54.810 way. 00:03:54.810 --> 00:03:59.659 What happens, is because the elastic fibers are destroyed, we'll get into that later, 00:03:59.659 --> 00:04:05.370 is that that airway becomes very collapsible and essentially it becomes very small, and 00:04:05.370 --> 00:04:08.799 that's where the obstruction in C.O.P.D. comes from. 00:04:08.799 --> 00:04:15.579 Furthermore, you're also going to get destruction of the alveoli and you lose a lot of surface 00:04:15.579 --> 00:04:21.440 area, so instead of having a nice tennis court you end up with maybe a badminton court or 00:04:21.440 --> 00:04:25.660 even a table tennis court here that you're working with. 00:04:25.660 --> 00:04:31.420 The surface area becomes much smaller and all these changes happen throughout the lung, 00:04:31.420 --> 00:04:34.640 but mostly in the upper regions of the lung. 00:04:34.640 --> 00:04:37.340 As a result of that it's hard to get the air out. 00:04:37.340 --> 00:04:42.850 There's an obstruction, that's the key point there is that air cannot get out of the lungs. 00:04:42.850 --> 00:04:46.520 That's why it's called chronic obstructive pulmonary disease. 00:04:46.520 --> 00:04:52.780 In addition to that because these alveoli are all destroyed and become areas of large 00:04:52.780 --> 00:04:59.160 balloons if you will, the long actually increases in size and as a result of that you get these 00:04:59.160 --> 00:05:04.150 patients with large lungs but they're full of air and they can't get the air out and 00:05:04.150 --> 00:05:07.030 that's basically C.O.P.D.. 00:05:07.030 --> 00:05:13.210 The way that we diagnose C.O.P.D. is based on this obstruction. 00:05:13.210 --> 00:05:17.270 We set them down in front of a spirometer, that's basically a machine where you breathe 00:05:17.270 --> 00:05:20.150 into it and it measures how much you breathe 00:05:20.150 --> 00:05:29.740 We asked them to basically breathe out after taking a deep breath in, breathe out as much 00:05:29.740 --> 00:05:41.560 air as they possibly can and we measure it. 00:05:41.560 --> 00:05:46.880 This represents how much air they can blow out given enough time to blow it out, so we 00:05:46.880 --> 00:05:50.571 give them 6 to 10 seconds to blow it out enough time that they need to blow everything that 00:05:50.571 --> 00:05:53.110 they possibly can out in the lung. 00:05:53.110 --> 00:06:01.810 We call that, by the way, the forced vital capacity. 00:06:01.810 --> 00:06:04.270 Otherwise known as the FVC. 00:06:04.270 --> 00:06:07.320 That's how much air they can blow out completely. 00:06:07.320 --> 00:06:11.460 We said that C.O.P.D. is an obstructive lung disease so what we're really looking for is 00:06:11.460 --> 00:06:15.390 how fast can they get that air out, because if there's an obstruction that's going to 00:06:15.390 --> 00:06:20.950 impede their ability to get that air out as fast as they possibly can. 00:06:20.950 --> 00:06:24.830 The next thing that we do is that we have them do the same maneuver, but we measure 00:06:24.830 --> 00:06:35.720 how much comes out in 1 second, so there's kind of a timed proportion to this. 00:06:35.720 --> 00:06:40.090 How much can you blown out given an infinite amount of time? 00:06:40.090 --> 00:06:45.240 And how much can you blow out in just 1 second? 00:06:45.240 --> 00:06:49.280 There's a little bit of a velocity factor involved there. 00:06:49.280 --> 00:07:02.250 What we do is, we call that by the way, the forced expiratory volume in 1 second. 00:07:02.250 --> 00:07:04.970 This is otherwise known as the FEV1. 00:07:04.970 --> 00:07:15.310 Then we do a very simple calculation, we measure and we see. 00:07:15.310 --> 00:07:21.060 We take this number, the forced expiratory volume and we divide it by the forced vital 00:07:21.060 --> 00:07:24.190 capacity number and we come up with a fraction. 00:07:24.190 --> 00:07:33.160 This is known as the FEV1 divided by the FVC ratio. 00:07:33.160 --> 00:07:42.460 The definition that's come up in the literature is that .70, 0.70 is the cutoff. 00:07:42.460 --> 00:07:53.050 If the FEV1 divided by the FVC ratio is less than .70 that means that you could get less 00:07:53.050 --> 00:07:57.530 than 70% of the air that you could normally get out, given an infinite amount of time, 00:07:57.530 --> 00:07:59.730 out in the first second. 00:07:59.730 --> 00:08:03.150 That means you've got obstructive lung disease. 00:08:03.150 --> 00:08:07.980 If you can get more than .7 out that means you don't have obstructive lung disease. 00:08:07.980 --> 00:08:13.620 The question here is, can you get out at least 70% of the air that you could normally blowout 00:08:13.620 --> 00:08:18.580 in the first second, and if the answer is yes then you don't have obstructive lung disease. 00:08:18.580 --> 00:08:24.770 If the answer is no and it's less than .7, then you have obstructive lung disease. 00:08:24.770 --> 00:08:35.210 Of course, the lower this number is, the FEV1, the worse your C.O.P.D. is going to be. 00:08:35.210 --> 00:08:37.409 Let's review. 00:08:37.409 --> 00:08:51.640 C.O.P.D. is 1) common, it costs a lot; 2) it's the third leading cause of death and 00:08:51.640 --> 00:09:00.320 is the only 1 of the 5 that are actually increasing in frequency; 3) causes difficulty with breathing 00:09:00.320 --> 00:09:09.250 out, that's obstruction; 4) reduces the cross-sectional surface area, causes drops in oxygen; 5) you 00:09:09.250 --> 00:09:19.920 diagnose it by spirometry, and then finally 6) the diagnosis is the FEV1 divided by the 00:09:19.920 --> 00:09:24.550 FVC is less than .7 Thank you for joining us.
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