Chapter 70: Chronic Obstructive Pulmonary Disease Flashcards
COPD definition encompasses of
- Chronic bronchitis
- Emphysema
- Bronchiectasis
- Asthma
True or False
Men are at high risk of developing COPD?
False
Major risk factor for developing COPD
Smoking
What is the pathophysiology of COPD?
Mucus-secreting cells replace cells that normally secrete surfactant and protease inhibitors
The central element of chronic lower airway obstruction is?
Impedance to expiratory airflow due to increased resistance or decreased caliber of the small bronchi and bronchioles
What are the classifications of COPD severity?
Mild COPD - FEV1 ≥80% predicted
Moderate COPD - FEV1 between 50% and 79% predicted
Severe COPD - FEV1 between 30% and 49% predicted
Very severe COPD - FEV1 <30% predicted
What are the hallmark symptoms of COPD?
Chronic and progressive dyspnea, cough, and sputum production
COPD that is expansion of the thorax, impeded diaphragmatic motion, and global diminution of breath sounds
Empysema
At what level of FEV1 will COPD has hypoxemia and hypercapnia?
FEV1 falls below 1L
Best way to diagnose COPD?
Spirometry with a postbronchodilator FEV1 to forced vital capacity ratio of <0.7
Chest xray showed hyperaeration, seen as increased anteroposterior chest diameter, flattened diaphragms, increased parenchymal lucency, and attenuation of pulmonary arterial vascular shadows. What COPD is this?
Empysema
Chest xray show normal. What COPD is this?
Chronic bronchitis
Used to distinguish COPD to acute heart failure?
B-type natriuretic peptide
Treatment for COPD
- Oxygen
- Pharmacotherapy, measures to decrease mucus secretion
- Smoking cessation
- Pulmonary rehabilitation.
Goal of oxygenation in COPD patient?
Partial pressure of arterial oxygen (Pao2) to ≥60 mm Hg or the arterial oxygen saturation (Sao2) to ≥90% at rest.
A most preferred group of medication for COPD
LABA
Bronchodilators often improve FEV1 by how many percent?
10%
Medications that are best for patients at high risk of exacerbation of COPD
Combination inhalers with long-acting β2-agonists plus cor- ticosteroids
Other medications that decrease the exacerbation of COPD
- Simvastatin
- Azithromycin (elder and mild)
Key to dampen acute infection in COPD patient
Vaccination
Important triggers for exacerbations of COPD
- Infection
- Hypoxia
- Cold weather
- B-blocker
- Opioids or sedative-hypnotics
Acute exacerbations of COPD are primarily due to
Ventilation–perfusion mismatch
Acute exacerbations of Asthma are primarily due to
Expiratory airflow limitation
The most life-threatening feature of an acute exacerbation is
Hypoxemia
The best tool in acute
evaluation for assessing oxygenation, ventilation, and acid-base disturbances
ABG
What is the changes in ABG in acute respiratory acidoses in COPD patient?
Serum bicarbonate rises by 1 mEq/L for each 10-mm Hg increase in Pco2, and the pH will change by 0.008 × (40 – Pco2)
What is the changes in ABG in chronic respiratory acidoses in COPD patient?
Serum bicarbonate rises by 3.5 mEq/L for each 10-mm Hg increase in Pco2, and the pH will change by 0.03 × (40 – Pco2)
True or False
Administer oxygen to achieve a Pao2 of 60 to 70 mm Hg or an Sao2 between 88% and 92%
True
Administer oxygen to achieve a Pao2 of 60 to 70 mm Hg or an Sao2 between 88% and 92%
First-line therapies in the management of acute, severe COPD
SABA
An anticholinergic drug that is the agent of choice for COPD
Ipratropium bromide given as a single dose by metered-dose inhaler with a spacer or as an inhalant solution by nebulization (0.5 milligram or 2.5 mL of the 0.02% inhalant solution)
The most common pathogen of pneumonia in COPD
- Streptococcus pneumonia
- Haemophilus influenzae
- Moraxella catarrhalis
The goals of assisted mechanical ventilation in COPD pateint are what?
The goals of assisted mechanical ventilation are to rest ventilatory muscles and to restore adequate gas exchange
When to use assisted mechanical ventilation in COPD patient?
- Respiratory muscle fatigue
- Worsening respiratory acidosis
- Deterioating mental status
- Refractory hypoxemia
