2 - COPD Flashcards
COPD is umbrella term for
Emhysema
Chronic bronchitis
Refractory asthma
Severe bronchiectasis
3 defining characteristics of COPD
(3 P’s)
- Preventable and treatable
- Persistent airflow limitation
- Progressive
Chronic Bronchitis
Daily producive cough for three months or more in at leaast two consecutive years
Emphysema
Permanent enlargement and destruction of airspaces distal to the terminal bronchiole
CXR in emphesema
Enlarged air space and flattened diahragm
COPD aka
COLD
CLRD
Mechanisms underlying COPD
Small airway disease ****
Parenchymal destruction ****
Risk factors for COPD
- Smoking
- Occupation
- Environmental tobacco smoke
- Pollution
Genes, Infections, Socioeconomic status
gene for COPD
alpha 1 antitrypsin
Dx of COPD
- Symptoms (Cough, SOB, Sputum)
- Exposure to risk factors
- Spirometry***
**required for Dx!
Spirometry measures
volume of air inhaled/exhaled, rate of air movement
FVC
forced vital capacity
(from full inhale, breathe all the way out)
FEV1
First second volume
4L is normal
Important ratio in diagnosis of Obstructive Lung Disease
FEV1 / FVC
Low = obstructive
Ratio is normal = not obstructive, even if FVC low
Normal FEV1 / FVC
0.8
Obstructive disease has greater change in…
FEV1
Restrictive lung disease has change in
FEV1 and FVC
–> ratio stays the same
TLC change in obstructive/restrictive
DOWN = restrictive
UP = Obstructive
Assessents for COPD
- COPD assessment test (CAT)
- Clinical COPD Questionnaire (CCQ)
- mMRC Breathlessness Scale
Most validated assessment tool for COPD
CAT
COPD assessment test
GOLD critera catergorizes based on…
FEV1:FVC must be below 70%
If FEV1 more than 80% of predicted value = Mild
if less than 50% = Severe
Normal spirometry varies based on
Height, age, gender, ethnicity
FEV1 is Severe if
<35%
Indicators of high risk COPD
- Two or more exacerbations within the last year, or an FEV1 <50%
- One or more hospitalizations for COPD exacerbataions
COPD patients are at increased risk for:
- Cardiovascular disease
- Osteoporosis
- Resp infections, lung cancer, bronchiectasis
- Diabetes
- Depression/anxiety
Occurs at any age
asthma
(COPD is older than 35 yrs)
Variable Smoking/dyspnea associations
asthma
(COPD is typical, progressive)
Family history, Atopy, and diurnal symptoms are more common in
Asthma
Additional Investigation measures
- CXR
- Lung volumes
- Oximetry and ABG
- a1AT deficiency screening
- Exercise testing (self paced/incremental)
- Composite Scores
COPD meds
- Beta2 agonists (first for asthma)
- Anticholinergics (first for COPD)
- Methylxanthines, Inhaled corticosteroids, PDE4 inhibitors
TRIPLE THERAPY eventually needed for most pts ( BrA, Antichol, Steroid)
Management for MILD COPD
(FEV1/FVC <70% with or without Sx)
Short acting bronchidilator
mngmt of Moderate COPD
FEV1 between 50-80%
- Regular Tx with one or more bronchodilators
- REHAB
- Inhaled CS’s if significant Sx and lung function response
Mngmt of Very Severe COPD
FEV1 less than 30%
- Regular bronchodilator
- Inhaled CS
- Treatment of complications
- Rehab
- Long term O2
- Surgery possible
Always offer this to COPD patients
Rehabilitation
Increases survivla in pts with severe, resting hypoxemia
O2 therapy
(long-term, >15hrs per day)
Surgical options for COPD
- LVRS (lung volume reduction surgery)
(costly relative to health care programs that dont involve surgery)
- Lung transplantation
Two patient types that respond to Non-invasive ventilatory support (NIV)
COPD
Pulmonary Edema
LTOT indications – If someone has 90% CO2 and PO2 >60mmHg
None except with qualifier
7 Causes of COPD exacerbation
- Infection
- PEdema
- PEmbolism
- Pneumothorax
- Arrhyth.
- Exposure
- Non-compliance
ABG
PaO2 < 8.0kPa
with or without
PaCO2 >6,7 kPa
Useful to exclude alterntive diagnoses
CXR
Target saturation with O2 Therapy
88-92%
Hypoxic patient given too much oxygen causes
remove hypoxia in lungs
dilation of pulm vessels
blood goes to healthy AND damaged lung
Causes V/Q mismatch (blood doesn’t get oxygenated) –> causes CO2 to increase
Preferred bronchidilators
Short acting inhaled B2 agonists with or without short acting anticholinergics
Anthonisen criteria
increased dyspnea
increased sputum volume
increased sputum purulence
Anibiotics indicated for whom?
Those with three cardinal (Anthonisen) symptoms
Those who are on mechanical ventilation
_______ for pts hospitalized for acute exacerbations of COPD
NIV
- Improves resp acidosis
- Decreases RR and mortality
5A’s
Ask
Assess
Advise
Assist
Arrange
Intervention plans for smoking
Behavioral (self help, advice, counseling, exercise)
Pharmacologic (Nicotine replacement, bupropion, varenicline, Ecig)
In one year of smoking cessation
50% Cardiac disease risk
