Chapter 2: Dyspnea (COPD)

Question 1

Tx for acute COPD exacerbations

Answer 1

Abx, Bronchodilators, ICS

Question 2

Interventions to reduce COPD exacerbations

Answer 2

Smoking cessation
Long-acting bronchodilators
ICS
Influenza and Pneumococcal polysaccharide vaccinations

Question 3

Chronic bronchitis

Answer 3

Cough and sputum production on most days for at least 3 months during at least 2 consecutive years

Question 4

Emphysema

Answer 4

Shortness of breath caused by the enlargement of respiratory bronchial and alveoli caused by destruction of lung tissue

Question 5

Changes in FVC and FEV1 in COPD

Answer 5

Both FVC and FEV1 are reduced and the ratio is less than 70%

Reversibility is defined as an increase in FEV1 of greater than 12% or 200mLq

Question 6

How to measure severity of exacerbation

Answer 6

history (# of previous episodes/hospitalizations, other chronic conditions, current meds, h/o intubation/mech vent, duration/any new sxs)
examination (use of respiratory muscles, worsening/new cyanosis, unstable vitals, AMS, peripheral edema)
pulse ox (target of 88-92%)
PaO2 (around 60 mmHg)

Question 7

Who are hospitalized

Answer 7

Severe symptoms
Comorbidities
AMS
Inability to care for themselves at home
Symptoms fail to respond w/ tx

Question 8

If hospitalized, what should be ordered?

Answer 8

baseline ABG (look for hypercapnia, hypoxemia, and respiratory acidosis)

Consider vent support if conditions continue to deteriorate

Question 9

Tx for acute exacerbations

Answer 9

short-acting bronchodilators (beta-agonist, anticholinergic)

Systemic steroids can shorten the course of exacerbation and may reduce the risk of relapse (40mg prednisolone for 10 to 14 days)

Question 10

When to use abx?

Answer 10

Exacerbations associated with increased sputum or with purulent sputum should be treated with abx

Sputum Cx should also be performed.

Pneumococcus, H. Influ, Moraxella are MC
Klebsiella, Pseudomonas in severe exacerbations

Question 11

relative young pt (<45yo), no smoking hx, PFT shows obstructive process, dx?

Answer 11

alpha1-antitrypsin deficiency

Question 12

Mild COPD (findings and treatment)

Answer 12

FEV1/FVC <70%
FEV1 >80%

Short-acting bronchodilators (albuterol)

Question 13

Moderate COPD (findings and treatment)

Answer 13

FEV1/FVC <70%
FEV1 50-80%

SABA + Long-acting bronchodilators (tiotropium)

Question 14

Severe COPD (findings and treatment)

Answer 14

FEV1/FVC <70%
FEV1 30-50%

SABA + LABA + ICS (fluticasone)

Question 15

Very severe COPD (findings and treatment)

Answer 15

FEV1/FVC <70%
FEV1 <30%
FEV1 <50% with chronic hypoxemia

Long-term oxygen therapy and consider surgical intervetnions

Question 16

Low DLCO with normal PFT

Answer 16

Chronic pulmonary embolism

Question 17

Low DLCO with obstructive pattern on PFT

Answer 17

Emphysema

Question 18

Low DLCO with restrictive pattern on PFT

Answer 18

Interstitial lung disease

Hypersensitivity Pneumonitis

Question 19

Increased DLCO with obstructive pattern on PFT

Answer 19

Asthma - may also show reversibility after bronchodilator administration