21.22.23. COPD Flashcards
What is COPD?
COPD is characterized by persistent respiratory symptoms and airflow limitation that is due to airway / alveolar abnormalities usually caused by significant exposure to noxious particles or gases.
What are the most common respiratory symptoms of COPD?
The most common respiratory symptoms of COPD are dyspnea, cough, and/or sputum production.
What are the risk factors for COPD?
- tobacco smoking (main risk),
- environmental exposures such as biomass fuel exposure and air pollution,
- host factors such as genetic abnormalities, abnormal lung development, and accelerated aging.
What is the pathology of COPD?
The pathology of COPD includes chronic inflammation and structural changes (tissue destruction).
What is the pathogenesis of COPD?
- oxidative stress leading to protease-antiprotease imbalance,
- that causes inflammatory cells (neutrophils, lymphocytes) to produce inflammatory mediators,
- leading to peribronchiolar and interstitial fibrosis.
What is the difference between centriacinar and panacinar emphysema?
Centriacinar emphysema affects respiratory bronchioles and is associated with smoking, while panacinar emphysema affects the entire acinus and is associated with alpha1-antitrypsin deficiency.
What is paraseptal emphysema?
Paraseptal emphysema affects distal airspaces and is associated with scarring from previous infections.
What is the diagnostic test required to make a diagnosis of COPD?
Spirometry.
What is the criteria for confirming the presence of persistent airflow limitation in COPD, using spirometry?
The presence of a post-bronchodilator FEV1/FVC < 0.7.
What are some clinical symptoms of COPD? (aka think of what you can notice in phys exam)
- Barrel chest,
- peripheral edema,
- hyper-resonant lungs on percussion,
- decreased breath sounds on auscultation.
What are some other symptoms of COPD?(less specific)
- Fatigue,
- weight loss,
- anorexia,
- syncope,
- rib fractures,
- ankle swelling,
- depression
- anxiety.
What is the pathophysiology of COPD?
- Airflow limitation and gas trapping,
- gas exchange abnormalities,
- mucus hypersecretion
- secondary pulmonary hypertension
What is the key factor in the diagnosis of COPD?
The presence of dyspnea, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease.
What should be the key finding in spirometry after bronchodilation inhalation?
FEV 1/FVC <70%.
What are the two methods for symptoms assessment in COPD?
- COPD assessment test (CAT),
- medical research council (mMRC) questionnaire - dyspnea scale
What is the pathophysiology of emphysema?
- Chronic inflammation leads to an increase in proteases.
- Nicotine use (or other noxious stimuli) inactivates protease inhibitors (especially alpha1-antitrypsin),
- it all leads to an imbalance of protease and antiprotease, which increases elastase activity.
- This results in the loss of elastic tissue and lung parenchyma via destruction of alveolar walls.
What are the clinical features of pink puffers in emphysema?
- dyspnea accompanied by hyperventilation, which leads to adequate blood exchange, proper oxygenation, and a pink appearance.
- barrel chest,
- sit forward in a hunched-over position.
- Weight loss and pursed-lip breathing are common
- they have a normal FVC, but decreased FEV1, resulting in a reduced FEV1/FVC ratio.
What are the clinical features of blue bloaters in emphysema?
- Blue bloaters may have coughing or wheezing as their first sign.
- They have less prominent dyspnea and respiratory drive, leading to CO2 retention, hypoxia, and cyanosis, resulting in a blue appearance.
- They have peripheral edema
- They have an increased FVC, but decreased FEV1, resulting in a normal or increased FEV1/FVC ratio.
What is the ABCD assessment tool used for?
The ABCD assessment tool is used to classify COPD patients based on their symptoms and exacerbation history to determine the appropriate treatment plan.
What is the first step in prevention and maintenance therapy for COPD?
Smoking cessation is the first step in prevention and maintenance therapy for COPD.
How does pulmonary rehabilitation help in COPD?
Pulmonary rehabilitation improves symptoms, quality of life, and physical and emotional participation in everyday activities for COPD patients.
When is long term 02 therapy recommended? When is it not?
- In patients with severe resting chronic hypoxemia.
- It is not recommended for patients with stable COPD and exercise-induced desaturation
What is the benefit of long-term non-invasive ventilation in patients with severe chronic hypercapnia and a history of hospitalization for acute respiratory failure?
It may decrease mortality and prevent re-hospitalization.
What is the goal of palliative approaches in advanced COPD?
They are effective in controlling symptoms.
What is an exacerbation of COPD?
It is an acute worsening of respiratory symptoms that results in additional therapy.
What is the most common cause of exacerbations of COPD?
Respiratory tract infections such as influenza, strep, and COVID.
What is the goal for treatment of COPD?
To minimize the negative impact of the current exacerbation and prevent subsequent events.
What is the recommended initial bronchodilator for treating an acute exacerbation of COPD?
- If mild : short-acting inhaled beta-2 agonists (SABA), with or without short acting anticholinergics
- Can also use antibiotics and / or oral corticosteroids
What are the benefits of systemic corticosteroids for COPD patients during an exacerbation?
They can improve lung function (FEV1), oxygenation, and shorten recovery time and hospitalization duration.
What is the recommended duration of systemic corticosteroid therapy for COPD patients during an exacerbation?
Not more than 5-7 days.
What is the benefit of antibiotics for COPD patients during an exacerbation?
They can shorten recovery time, reduce the risk of early relapse, treatment failure, and hospitalization duration.
What are the two types of leukotriene modifiers?
- 5-LO inhibitors (Zileuton)
- CysLT1 antagonists (Montelukast).
What are the two types of long-acting bronchodilators?
Long-acting beta-2 agonists (LABA) and Theophyllines (per os).
What are the main classes of medications used in COPD treatment?
Bronchodilators and corticosteroids.
How do bronchodilators improve COPD symptoms?
They relax the muscles around the airways, making it easier to breathe.
What is the difference between short-acting and long-acting bronchodilators?
Short-acting bronchodilators provide quick relief of symptoms, while long-acting bronchodilators provide sustained relief over a longer period.
What is the mechanism of action of corticosteroids in COPD treatment?
They reduce inflammation in the airways.
What is the role of oxygen therapy in COPD management?
It can improve survival and quality of life in patients with severe COPD and low oxygen levels.
