3: COPD Diagnosis Flashcards
In a COPD diagnosis, would you expect the measurement to be increased, decreased, or normal?
FEV1
Decreased
In a COPD diagnosis, would you expect the measurement to be increased, decreased, or normal?
FEV1/FVC Ratio
Decreased
In a COPD diagnosis, would you expect the measurement to be increased, decreased, or normal?
Total Lung Capacity (TLC)
Normal or Increased
In a COPD diagnosis, would you expect the measurement to be increased, decreased, or normal?
Residual Volume (RV)
Increased
In a COPD diagnosis, would you expect the measurement to be increased, decreased, or normal?
Diffusing Capacity (DLCO)
Normal or Decreased
In a COPD diagnosis, what would postbronchodialtor FEV1 be?
≤ 80% predicted
In a COPD diagnosis, what would postbronchodialtor FEV1/FVC ratio be?
< 0.70
What diagnostic is standard for initial diagnosis of COPD?
CXR to see lung hyperinflation
On a CXR, what indicates COPD?
- Visible bullae, decreased parenchymal markings, or hyperlucency (emphysema)
- Increased lung volumes, flattening of diaphragm
- Enlarged heart
T/F CXR is all that is needed for COPD diagnosis.
False. Not stand-alone diagnostic, but can r/o other alternatives.
CXR is seldom diagnostic for COPD without obvious _____.
CXR is seldom diagnostic for COPD without obvious bullous disease.
Though not a 1st-line test, what can be used to r/o malignancy when diagnosing COPD?
CT
Who qualifies for alpha-1 antitrypsin (AAT) deficiency testing?
- <45 yo
- Caucasian descent
- Strong family hx of COPD
What AAT value strongly suggests deficiency?
15-20% below normal
What labs would you order in COPD diagnosis?
- Serum chemistry
- Sodium retention.
- K+ levels lowered by diuretics, B agonsts, and theophylline.
- Renal excretion of Ca and Mg increased by B adrenergic agonists. May be important with hypokalemia.
- CBC
- Hematocrit imbalance (usually mild polycythemia).
- BNP
- May not give straightforward differentiation from CHF.
When is an ABG ordered?
For stable persons with FEV1 less than 50% or with right-sided heart failure (inpatient)
Which differential dx is this?
- Early-life onset
- Positive family hx
- Allergies
- Reversible obstruction
Asthma
Which differential dx is this?
- Older adults
- Basilar crackles
- Cardiomegaly
- Pulmonary edema on CXR
CHF
Which differential dx is this?
- Excessive purulent sputum
- Bacterial pathogen
- Bronchial dilation and thickening on CXR
Bronchiectasis
Which differential dx is this?
- All ages
- Infiltrate, nodular lesions or granuloma on CXR
- High local prevalence
Pulmonary TB
In making a COPD diagnosis, what is looked for on PE?
- Breathlessness test (e.g., 6-minute walk)
- Body mass index (BMI)
- Chest inspection and auscultation
- Vital signs including pulse oximetry
In making a COPD diagnosis, what is looked for on spirometry?
- Baseline test
- Postbronchodilator FEV1 (value less than 70% of predicted indicates COPD)
What are 2 questionnaires administered for COPD?
- COPD Population Screener (COPD-PS)
- Lung Function Questionnaire (LFQ)
How is the 6-minute walk test administered?
- 30 m marked every 3 meters including turnaround points
- Record time/lap before patient must stop for breath
- Monitor pulse oximetry
