Adult Chronic Airway Diseases

Question 1

What information to gather for stable suspected COPD

Answer 1

Peripheral edema
CXR
Bedside spirometry (STABLE COPD ONLY)
ABG
CBC
BNP

Question 2

Stable COPD treatment/decision making

Answer 2

Smoking cessation
Disease management education
Pulmonary rehab
Avoidance of triggers
Dietary counseling
Immunizations
Antibiotics if inspected infection

Question 3

COPD stage 1 values and stepped up tx

Answer 3

FEV1/FVC < 70%
FEV1 80% predicated
SABA or anticholinergic

Question 4

COPD stage 2 values and stepped up tx

Answer 4

FEV1/FVC <70%
FEV1 50-80% predicted
SOB on exertion
LABA and/or long acting Anticholinergic

Question 5

COPD stage 3 values and stepped up tx

Answer 5

FEV1/FVC <70%
FEV1 30-49%
SOB on exertion/frequent exacerbations
LABA and/or steroids

Question 6

COPD stage 4 values and stepped up tx

Answer 6

FEV1 <30% or FEV1<50% + chronic respiratory failure
Add long term O2

Question 7

stable COPD disease management

Answer 7

Smoking cessation
Preventive care
Pt education
Action plans
Stepped up

Question 8

Acute exacerbation of COPD key signs and symptoms

Answer 8

Dyspnea at rest
Cyanosis
RR > 25
HR > 110
Accessory muscle use

Question 9

Acute COPD exacerbation information gathering

Answer 9

peripheral edema
CXR
ABG
sputum c&s
BNP

Question 10

Acute COPD exacerbation tx/decision making

Answer 10

Supplemental O2 (SpO2 88-92%)
Increasing SABA/LABA dose
Add inhaled Anticholinergic
Systemic steroids
Antibiotic/antiviral tx (if secretions suck)

Question 11

IncreAse tidal volume and ventilation on BiPAP?

Answer 11

Increase IPAP

Question 12

Airtrapping/auto peep in BiPAP with Normal pH?

Answer 12

Raise IPAP and EPAP equally

Question 13

pH < 7.25?

Answer 13

Intubate