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Clinical Medicine II > chronic obstructive diseases > Flashcards

chronic obstructive diseases Flashcards

1
Q

When does lung function decline in COPD?

A

after age 40 with presence in the 50s and 60s and progressing

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2
Q

What do these symptoms characterize: cough, sputum production, SOB that starts w/ exertion, common to see blue bloaters and pink puffers?

A

COPD

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3
Q

What are risk factors for COPD?

A

History of smoking or biomass fuel cooking, air pollution, airway infection, environmental factors, allergy, hereditary factors, reactive airway disease
Exposures early in life → poor lung growth in childhood + expiratory flow limitation (may not manifest clinically until mid-life)

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4
Q

Is COPD reversible?

A

no

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5
Q

How are COPD exacerbations precipitated?

A

infection or exposure

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6
Q

What do late stages of COPD look like?

A

pneumonia, pulmonary HTN, RHF, chronic respiratory failure

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7
Q

What deficiency can predispose someone to emphysemic dysfunction and COPD and is common in 20yo with early unexplained disease that may be misdiagnosed as asthma with no improvement upon treatment + unexplained pannicultis + antiproteinase-3 vasculitis?

A

alpha 1 antitrypsin deficiency

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8
Q

What is the treatment for alpha 1 antitrypsin deficiency?

A

augmentation therapy

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9
Q

What would this PE indicate:
barrel chest -> lungs fill w/ air + unable to fully breathe out
- use of resp muscles
- pursed lip breathing
- reduced chest expansion
- reduced breath sounds
- wheezing
- hyperresonance
- expiratory time >4s
- reduced expiratory flow, airflow obstruction, air trapping + hyperinflation?

A

COPD

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10
Q

What is the basis of COPD diagnosis?

A

spirometry

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11
Q

What on an early PFT would indicate COPD?

A

abnormal closing volume

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12
Q

What on FEV1 and FEV1/vital capacity indicate COPD?

A

reduced –> airflow obstruction
severe = significant FVC reduction

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13
Q

What does an increase in residual volume + total lung capacity or elevation of RV/TLC ratio mean?

A

COPD – air trapping + hyperinflation

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14
Q

What tests do you need to indicate COPD?

A

DLCO (effectiveness), 6 minute walk test, ABGs (w/ hypoxemia or hypercapnia), FEV1 or DLCO <40% of predicted for severe COPD and <70% meaning obstruction

early sign could be increased alveolar-arterial gradient
respiratory acidosis
sinus tachy
chest xray to differentiate chronic bronchitis and emphyema

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15
Q

What’s the first line for COPD?

A

smoking cessation and vaccination

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16
Q

How do you identify a high risk patient?

A

1) FEV1<50% of predicted
2) 2+ exacerbations in past year
3) 1+ hospitalizations for COPD exacerbations in the past year

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17
Q

What’s the gold criteria?

A

FEV1 measurement
Gold 1 - >80 - mild
Gold 2 - 50-79 - moderate
Gold 3 - 30-49 - severe
Gold 4 - <30 - very severe
<70 needs treatment
Group A/B- 1 or 2
Group E - 3 or 4

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18
Q

What group of medications do you give for a patient with more than 2 moderate exacerbations or more than 1 leading to a hospitalization?

A

Group E- (LAMA + LABA for highly symptomatic or ICS + LABA + LAMA for eos >300) + SAMA or SABA

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19
Q

What group of medications do you give for 0-1 exacerbations with no hospital admission?

A

Group A (bronchodilator) or B (long acting bronchodilator)

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20
Q

Group A

A

bronchodilator (SAMA or SABA) short acting

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21
Q

Group B

A

LABA AND LAMA

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22
Q

Group E

A

LAMA+LABA (highly symptomatic) or ICS + LABA + LAMA (eos>300) + SABA/SAMA

23
Q

How do you treat COPD outpatient?

A

O2 for at least 15 hours a day and only treatment to lengthen life

24
Q

What medications can you use to improve symptoms in COPD?

A

inhaled bronchodilators but stop if doesn’t help

25
Q

What helps COPD in severe exacerbations with eos>300?

A

corticosteroids
stable for 2 years = discontinue

26
Q

What med is used in COPD for patients who don’t improve with anything else and require monitoring?

A

theophylline

27
Q

What COPD med is used only for
1) acute exacerbation (increased sputum, purulence, dyspnea)
2) acute bronchitis
3) prophylaxis for bronchitis?

A

abx

28
Q

What med is for COPD for moderate/severe + chronic bronchitis and frequent exacerbations with taking LABA/ICS and/or LAMA?

A

roflumilast (phosphodiesterase type 4 inhibitor)

29
Q

What are these symptoms indicative of: cough and sputum production for >3 months/year for >2 years w/ absence of other conditions?

A

chronic bronchitis

30
Q

blue bloaters

A

high BMI, metabolic comorbidity, increased exacerbation

31
Q

pink puffer

A

lower BMI, low muscle mass, hyperinflation, dyspnea, decreased exercise capacity, worse health status from smoking

32
Q

How do you differentiate from chronic bronchitis and emphysema?

A

Chest XR and CT
emphyesma has a dry cough and is a structural change — chronic bronchitis has a productive cough

33
Q

When do you admit a COPD patient?

A

severe symptoms, worsening, hypoxemia, hypercapnia, edema, AMS, inadequate home care, inability to sleep or maintain nutrition, high risk comorbid conditions

34
Q

How do you manage an inpatient COPD patient?

A

O2 90-94%, inhaled beta 2 agonists w/ or w/o ipatropium (SAMA), steroids, broad spectrum antibiotics

35
Q

What is characterized by a chronic cough, purulent sputum, dyspnea, hemoptysis, chest pain, wheezing, rhinosinusitis, fatigue, weight loss, and failure to thrive?

A

bronchiectasis

36
Q

What can predispose you to bronchiectasis?

A

CF!
severe infections, immunodef, autoimmune, inhaling objects, idiopathic, radiation
middle age

37
Q

What is bronchiectasis?

A

widening + scarring of airways –> progressive, suppurative lung disease

38
Q

What would you see on a CT for bronchiectasis?

A

dilation >.8 children, >1-1.5 in adults, mucus impaction
xray = bronchi dilation

39
Q

How can you diagnose bronchiectasis?

A

PFTs or respiratory status testing, sputum culture, XR with tram track markings, dilated bronchi

40
Q

How do you treat bronchiectasis?

A

airway clearance techniques w/ pretreatment of bronchodilators, expectorants, humidifiers

41
Q

How do you treat severe bronchiectasis?

A

long term abx for 3+ exacerbations/year.. may need lung resection/transplant

42
Q

What do these xray findings indicate:
-enlarged lung fields, flattened diaphragms, trapped air, decreased vascular markings, and bullae?

A

emphysema

43
Q

What do these xray findings indicate:
increased vascular markings, normal diaphragms, pulmonary HTN, right heart enlargement?

A

chronic bronchitis

44
Q

How would a patient differ whether they have emphysema or chronic bronchitis?

A

emphysema – hyperresonance on percussion, low breath sounds, LOW fremitus (air trapping) barrel chest, and generally would be breathing through pursed lips and not displaying signs of cyanosis

chronic bronchitis – may be obese, cyanotic, and have crackles, rales, rhonci, wheezing upon auscultation

45
Q

Which COPD med is considered the strongest long acting and thus is the recommendation of Group C?

A

LAMA - tiotropium

46
Q

LAMA

A

tiotropium

47
Q

LABA

A

salmeterol

48
Q

SABA

A

albuterol

49
Q

SAMA

A

ipatropium

50
Q

Could you add on a long acting on top of short acting muscarinic antagonist/beta agonist in Group B to make it stronger?

A

yes

51
Q

What are the new guidelines for COPD Group A?

A

LABA or LAMA if cost permits unless in very mild cases, SABA/SAMA are an option otherwise and recommended for mild disease on a PRN basis

52
Q

What are the new guidelines for COPD Group B?

A

LAMA+LABA +/- SABA/SAMA

53
Q

What are the new guidelines for COPD Group E?

A

LAMA + LABA
LAMA + LABA + ICS w/ eos>300, +/- SABA

Clinical Medicine II (15 decks)

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