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Junior - Pulm Mod 1 > 4 - COPD > Flashcards

4 - COPD Flashcards

1
Q

What is COPD?

A

Progressive airflow obstruction secondary to:

  • chronic bronchitis
  • emphysema

Most COPD have both

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2
Q

What is chronic bronchitis?

A

Excessive secretion of bronchial mucus; daily productive cough x 3 months to 2 yrs

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3
Q

What is emphysema?

A

Abnormal permanent enlargement of airspace distal to terminal bronchiole with wall destruction

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4
Q

Is COPD common?

A

Yeah
15 million in us with another approx 15 million as of yet undiagnosed COPD

COPD + asthma = 4th leading cause of death

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5
Q

What is the most common cause of COPD?

A

Smoking

80% have smoking in hx
20% environmental hx

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6
Q

What is the genetic cause of COPD?

A

Alpha-1 antitripsin deficiency

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7
Q

Smoking effects on airways?

A

Hypertrophy and hyperproliferation of mucus glands
Paralysis of cilia
Bronchioles are most affected
-always leads to bronchitis

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8
Q

What effect does smoking have on the lung parenchyma?

A

Destruction of connective tissue matrix making up alveolar walls

A1-antitrypsin imbalance

Leads to parenchyma

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9
Q

What does a1-antirypsin do in the lungs?

A

It inhibits destruction by inhibiting enzymes of inflammatory cells

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10
Q

What is the life expectancy of 1.5 pack/day smoker?

A

65yrs

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11
Q

What are the hereditary factors of COPD?

A

A1-antitrypsin deficiency (AAT) - allows elastin degradation
1% of COPD

Heterozygous (MZ) and Homozygous (ZZ) affects severity

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12
Q

When does COPD develop in those with a1-antitrypsin deficiency?

A

3rd or 4th decade

Check anyone with a fam hx

AAT + tobacco 32-40yrs
AAT w/o tobacco 48-54 yrs

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13
Q

Chronic bronchitis?

A

Enlargement of mucus glands and proliferation of goblet cells
+
Fibrosis = decreased luminal diameber

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14
Q

All Chronic bronchitis is considered what?

A

Considered Mild COPD

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15
Q

Pathology of emyphsema?

A

Destruction of alveolar walls and enlargement of terminal spaces (air trapping)

Loss of elastic recoil -> driving pressure during exhalation

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16
Q

Panacinar emphysema

A

Diffuse involvement of acinus (bronchiole, alveolar ducts, sacs and alveoli)

Lower lung more than upper

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17
Q

Centrilobular emphysema

A

Proximal acinus (bronchiole)

Destruction more irregular with areas of sparred tissue

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18
Q

SS Of COPD?

A

Typically 5th or 6th decade

Early: SOB, cough, sputum production
— 10 yrs
-pink puffer/blue bloater ss emerge

Late: pneumonia, pulm HTN, cor pulmonale, chronic respiratory failure

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19
Q

Hallmark of COPD?

A

Periodic exacerbations

Often precipitated by infection or environment

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20
Q

Bronchitis CC?

A

Chronic productive cough

Daily for 3+ months - 2+ years

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21
Q

Bronchitis PE?

A 
Cyanotic at rest w no distress
Wheezes, rhonchi
Peripheral edema
Multiple lung infections/yr
Mild dypsnea or exercise limitation
Overweight (frequently)
Blue bloaters (hypoxemia)
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22
Q

Emphysema CC?

A

Severe dypsnea

- slow developing w widespread by the time they come in

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23
Q

Emphysema PE?

A 
Rare cough, non-productive 
Thin pt w wt loss
Apparent respiratory distress
Lung sounds quiet
Nonperipheral edema

Pink puffers - hyperventilation

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24
Q

Chronic bronchitis vs emphysema buzz words

A

Bronchitis:

  • cyanosis
  • obesity
  • high Hb (hypoxemia)
  • cough/lung sounds

Emphysema

  • rubor
  • cachexia
  • Older
  • Quiet lungs
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25
Q

PFTs spirometery?

Early, mid, late

A

Early: decreased mid/small airway flow decreased

Mild: decreased FEV1 and FEV1/FVC ration

Late: very decreased FVC, increased TLC

Increased TLC and RV
Low DLCO

26
Q

COPD staging

A

GOLD 1: mild: FEV1 >80%
GOLD 2: moderate: FEV1 50-79%
GOLD 3: severe: FEV1 30-49%
GOLD 4: very severe: FEV1<30%

27
Q

What does the GOLD guidelines assume?

A

They only look at FEV1 and assume that FEV1/FVC is <70%

28
Q

Do we need areterial blood gas (ABG)study in COPD?

A

Not routinely needed

29
Q

AVG results for COPD?

A

If severe chronic broncitis show respiratory acidosis

30
Q

Sputum analysis/culture in COPD?

A

S. Pneumonia,
H. influenzae,
M. Catarrhalis

Doesnt correlate w exacerbations

31
Q

ECG for COPD?

A 
Sinus tach
Chronic pulmonary HTN/cor pulmonale
Arrhythmias
-MAT
-A flutter
-A fib
32
Q

CXR for COPD?

A

Not for diagnosis only to r/o alternatives/comorbidities

33
Q

Chronic bronchitis x ray results?

A

Nonspecific peribronchial/perivascular markings

Cardiomegaly

Increased AP diameter

34
Q

Emphysema CXR results?

A

Flattening of diaphragms
Bullae
Peripheral vascular deficiency
Relatively small cardiac silhouette

Increased AP diameter

35
Q

HRCT for COPD?

A

High resolution CT

Not routinely used

Can characterize extent of damage in pts - considered in lobectomy

36
Q

DDx of COPD?

A

Asthma
Bronchiectasis
CF
Alpha 1 antitrypsin deficiency

37
Q

Complications of stable COPD?

A 
Acute bronchitis
Pneumonia
Pulmonary thromboembolism
Atrial dysrhythmias 
LV failure
38
Q

Complications of advanced COPD?

A

Pulmonary HTN

Cor pulmonale

39
Q

rare COPD complications?

A

Spontaneous pneumothroax

40
Q

Hemoptysis?

A

Can be copd (chronic bronchitis)

Also may be bronchogenic carcinoma

41
Q

What do COPD pts need to do?

A

Tobacco cessation
Vaccination
- influenza
- pneumococcal

42
Q

Single most important intervention for COPD?

A

Smoking

Slows the decline in FEV1

43
Q

Resting hypoxemia <90%?

A

-only therapy w evidence of improvement in natural progression of COPD

Longer survival
Reduced hospitalizations
Improved QOL

44
Q

O2 distribution and rate?

A

Nasal cannula x 15hrs/day

Typically 1-3L/min

45
Q

O2 for COPD with normal/low-normal resting O2 but low O2 w exertion

A

O2 improves exercise intolerance
Shortens recovery from dypsnea
NO evidence of mortality benefit

46
Q

What will improve s/s, excercise tolerance and overal health but not the inevitable decline into lung death?

A

Bronchodilators

47
Q

What inhaled bronchodilators are used?

A

Short acting:

  • ipratropium (anticholinergic)
  • albuterol, metaproterenol (SABAs)

Long acting:
- tiotropium (LAMA)
- Formoterol, salmeterol (LABA)
—often combined with ICS

48
Q

What other meds do COPDers get?

A

corticosteroids

  • ICS daily for moderate - severe COPD, often combined w LABA
  • systemic for acute

Phosphodiesterase 4 inhibitors
- roflumilast - decreased inflammation and increased bronchodilation

49
Q

Who gets ABX?

A

Most benefit with:
-increasted sputum purulence or quantity + dypsnea (think bacterial infection)

Pt hx of: 
Age > 65
FEV1 <50%
3+ exacerbations/yr
Comorbitdities (cardiac/DM)
50
Q

ABX for COPD exacerbations?

A 
Doxycycline 100mg
Trimethoprium-sulfamethozazole 160/800mg
Cephpodoximine 200mg
Azithromycin 500mg
Ciprofolaxacin or levofloxacin 500mg
Amoxicillin-clavulanate 875/125mg
51
Q

What else can help COPD?

A

Exercise rehab
Chest physiotherapy chest wall percussion and drainiage)
Supplemental a1-antitrypsin

52
Q

What meds are not helpful for COPD?

A

Cough suppressants and sedatives

Expectorants/mucolytics

53
Q

When to admit COPD pts?

A

Acute or worsening symptoms
Inadequate home care
Inability to sleep/maintain nutrition
High risk comorbid conditions

54
Q

Meds the hospital will give to COPD inpatient?

A 
O2 titrated 90-94%
Ipatropium + SABA
Corticosteroids (prednisone 7-10 days)
Broad-spectrum abx
Chest physiotherapy in selected cases
55
Q

Surgical options for COPD?

A

Lung transplant
Lung volume reduction
Bullectomy (severe bullous emphysema)

56
Q

Opiates for COPD?

A

Small amount of opiates can reduce symptoms of air hunger

57
Q

How is the BODE index calculated?

A

Points accumulated from the following categories:

BMI
FEV1
Exercise
Dypsnea with ___

58
Q

BODE index 4 yr survival rate?

A

0-2 pts 80%
3-4 pts 67%
5-6 pts 57%
7-10 pts 18%

59
Q

Who gets referred?

A 
COPD before age 40
>2 exacerbations/yr on max therapy
Severe/rapidly progression
S/s disproportionate to severity of airflow obstruction
Need for long-term O2 therapy
Onset of comorbidities
60
Q

Does surgery for COPD extend life?

A

Nope only palliative, doesnt extend life only improve symptoms

Junior - Pulm Mod 1 (4 decks)

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