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Résidence - FM Learner > 16. MPOC > Flashcards

16. MPOC Flashcards

1
Q

Describe MPOC

A

Persistent respiratory symptoms and airflow limitation due to airway/alveolar abnormalities usually caused by exposure to noxious particles/gases

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2
Q

Describe diagnosis : MPOC (1)

A

Spirometry FEV1/FVC <0.70 post-bronchodilator

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3
Q

Describe grades : MPOC (4)

A
  • Mild = FEV1>80% predicted
  • Moderate = 50-80%
  • Severe = 30 to <50%
  • Very Severe <30%
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4
Q

Name symptoms : MPOC (4)

A
  • Dyspnea
  • Cough
  • Wheeze
  • Sputum production
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5
Q

Name scores/ways to assess symptoms : MPOC (2)

A
  • mMRC
  • COPD assessment test
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6
Q

Describe : mMRC (5)

A
  • Grade 0 = Symptoms on strenuous exercise
  • Grade 1 = Symptoms on hurrying on level or walking up slight hill
  • Grade 2 = Walk slower than people same age because of breathlessness, or stop to breathe when walking at regular pace on level
  • Grade 3 = Stop after 100m or after a few minutes on level
  • Grade 4 = Unable to leave house or breathless when dressing/undressing
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7
Q

Describe : COPD Assessment Test (8)

A

Quantifies impact of COPD symptoms on patients’ overall health.
* Cough
* Phlegm
* Chest tightness
* Breathlessness
* Activities
* Confidence
* Sleep
* Energy

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8
Q

Describe : Alpha-1 antitrypsin deficiency (AATD) (3)

A
  • WHO recommends all patients with COPD should be screened once, especially if high prevalence area
  • Consider if early onset COPD, family history of AATD, <20py smoker, asthma poorly responsive to therapy
  • Classic <45yo with panlobular basal emphysema
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9
Q

Describe tx : MPOC (7)

A
  • Smoking cessation, exercise
  • Yearly influenza vaccine and pneumococcal vaccine (>65yo or risk)
  • Bronchodilators
  • Pulmonary rehabilitation for exercise-limited patients or FEV1<50%
  • Oxygen therapy for severe resting chronic hypoxemia (PaO2 <55mmHg, SaO2<88%)
  • Non-invasive ventilation (CPAP) for OSA or chronic hypercapnia with history hospitalization
  • Bronchoscopic and surgical treatments for advanced COPD
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10
Q

MPOC exacerbation most commonly triggered by what?

A
  • respiratory viral infection (rhinovirus)
  • environment (pollution, temperature)
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11
Q

Treatment of exacerbation MPOC : Mild

A

SABA (eg. 4-8 puffs inhaled q20mins up to 4h then q1-4h PRN)
+/- LAMA

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12
Q

Treatment of exacerbation MPOC : Moderate (2)

A
  • Antibiotics and corticosteroids (Pred 40mg PO daily x5d) indicated if increased sputum purulence with one of: sputum volume or dyspnea (or if requires ventilation)
  • Consider : Procalcitonin, Sputum cultures if recurrent or severe, r/o pseudomonas
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13
Q

In mild MPOC exacerbation, describe ATB tx if simple COPDE (6)

A
  • Amoxicillin 500mg TID x 7d
  • or clarithromycin 500 BID x 7d
  • or azithromycin
  • or cefuroxime
  • or doxycycline
  • or TMP-SMX
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14
Q

In mild MPOC exacerbation, describe ATB tx if complicated COPDE (3)

A

If complicated (FEV1<50%, more than 3 COPDE/y, comorbidity, oxygen needs, chronic inhaled steroid, recent antibiotic use)

  • Moxifloxacin 400mg PO daily x 5d
  • Levofloxacin 500mg PO daily x 7
  • or Clavulin
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15
Q

Treatment of exacerbation MPOC : Severe (2)

A
  • Magnesium sulfate 2g IV over 20 minutes may reduce hospitalizations (NNTB = 7)
  • Hospitalization/ER visit
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16
Q

Describe prevention MPOC (5)

A

Lifestyle

  • Stop smoking
  • Exercise

Vaccine

  • Influenza
  • Pneumococcal 23-valent

Meds

  • LA bronchodilators/anticholinergics
  • Teach inhaler technique
  • Action plan

When to go to Emergency Department

Refer

  • Pulmonary Rehab
  • Resp therapy/Respirology/Specialty clinic
  • Smoking cessation group
17
Q

Décrire risque exacerbation aiguë (2)

A

Le risque d’exacerbation aigüe est élevé si, au cours de la dernière année :
* „ 2 exacerbations aiguës ou plus ont nécessité la prise d’un corticostéroïde oral et/ou d’un antibiotique (c.à.d. ≥ 2 exacerbations modérées) OU
* „ 1 exacerbation aiguë ou plus a nécessité une hospitalisation (c.à.d. ≥ 1 exacerbation sévère)

18
Q

Décrire tx pharmaco initiaux MPOC

A
19
Q

Décrire ajustement du tx pharmacologique du MPOC si : Dyspnée ou limitation à l’exercise

A
20
Q

Décrire ajustement du tx pharmacologique du MPOC si : Risque élevéé d’exacerbaiton aigüe

A

Résidence - FM Learner (26 decks)

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