286 - Chronic Obstructive Pulmonary Disease Flashcards
COPD is defined by ___ respiratory symptoms and chronic ___ limitation that is not fully ___
persistent
airflow
reversible
Emphysema is defined by a ___ of the lung’s ___ with air space ___
destruction
alveoli
enlargement
Chronic bronchitis is defined by chronic ___ and ___
cough
phlegm
In small airway disease- small ___are ___ and ___ in number
bronchioles
narrowed
reduced
What is the genetic deficiency contributing to emphysema?
Alpha 1 antitrypsin (Alpha1AT)
Changes in large airways lead to ___ and ___ production
Cough
sputum
Changes in small airways cause ____ alterations
Physiological
What does GOLD stand for?
Global initiative for chronic Obstructive Lung Disease
What won’t we see in GOLD 1 and 2?
emphysema
What are the 3 categories of emphysema?
- Centrilobular
- Panlobular
- Paraseptal
Which emphysema is most associated with smoking?
Centrilobular- Enlarged air spaces. Usually in the upper lobes and the upper parts of the lower lobes
Which genetic defect is common among panlubular emphysema patients?
Alpha1ATD
In COPD there is a continues decrease in ____- it is the most common finding. Also, FEV1/FVC is chronically __. Unlike asthma- ___ do not have a significant effect
FEV1 (Forced expiratory flow)
Low
Bronchodilators
PaO2 is mostly normal until ___ is under __%. PaCO2 does not increase until ___ goes under ___%
FEV1 (Forced expiratory volume in one second)
50
FEV1
25
Cor pulmonale and right HF start when ___ goes under ___
FEV1
25%
What are the main risk factors for COPD (5)?
- Cigarette smoking/passive smoking
- Asthma
- Infections
- Occupational exposure
- Air pollution
What are the most common symptoms of CPOD? (3)
- Cough
- Phlegm
- Exertional dyspnea
In COPD there is a decrease in ___ and ___.
There is an increase in ___, ___, ___
FEV1
FEV1/FVC
TLC
FRC (Functional residual capacity)
RV
What is FRC?
Functional residual capacity is the volume remaining in the lungs after a normal, passive exhalation.
What are the characteristics of COPD severity assessment? A, B, C, D
A- Low symptoms, low risk
B- High symptoms, low risk
C- Low symptoms, high risk
D- High symptoms, high risk
What is common to groups A and B?
0 or 1 exacerbation history without hospital admission
What is common to groups C and D?
> = 2 exacerbation history, or >=1 with hospital admission
What is the treatment for group A?
Bronchodilator->evaluate effect->continue, stop, or try alternative class of bronchodilator
What is the treatment for group B?
LAMA or LABA
What is the treatment for group C?
LAMA->further exacerbation(s)->(LAMA+LABA)or (LABA +ICS)
What is the treatment for group D?
LAMA->LAMA+LABA->LABA +ICS->LAMA+LABA+ICS-> with further exacerbations-> if smoker- macrolide, or, if FEV1<50%+chronic bronchitis than roflumilast
COPD patients should receive yearly ____ vaccine, and ___ together with ___ vaccines
Flu
Pneumococcal
Bordetella pertussis
LVRS (Lung Volume Reduction Surgery) is recommended to a select group of ___ patients. The most suitable are patient with ___ lobe spread and low exertional capability after proper lung ___
Emphysema
Upper
rehabilitation
The best predictor for COPD exacerbation is a former ___ and the biggest risk factor for hospital admission is a former ____
exacerbation
admission
In all GOLD criteria the FEV1/FVC will be < ___
0.7
Mild GOLD criteria is defined by
FEV1>= 80%
Moderate GOLD criteria is defined by
FEV1>= 50% but <80%
Severe GOLD criteria is defined by
FEV1>= 30% but <50%
Very severe GOLD criteria is defined by
FEV1< 30%
