Chronic Obstructive Pulmonary Disease

Question 1

• Pathological and radiographic term that describes structural changes associated with COPD
• abnormal and permanent enlargement of airspaces distal to terminal bronchioles (respiratory bronchiole, alveolar ducts, alveolar sacs and alveoli) that is accompanied by destruction of the airspace walls
• this results in ariway collapse due to loss of tethering of the airways open as the alveoli are destroyed

Answer 1

Emphysema

Question 2

risk factors for COPD?

Answer 2

tobacco use

• cigarette smokin is leading environmental risk, however even for heavy smokers < 50% develop COPD

E-cigarrettes
genetic risk factors
gender differences
occupational/ environmental exposures

Question 3

what are some things to note about women and COPD?

Answer 3

• COPD is leading cause of death among female smokers ahead of lung cancer and cardiovascular disease
• often more delayed diagnosis than in men- depression and fatigue mae distract from underlying lung disease
• more likely to have coexisting anxiety, depression, heart failure, osteoporosis

Question 4

symptoms and physical exam findings in COPD?

Answer 4

Symptoms

• Dyspnea
• cough
• sputum production
• wheezing and chest pain

PE:

• prolonged expiration or wheezing with forced exhalation
• more advanced disease: hyperinfation- barrel shaped chest (increased AP diameter) depressed diaphragm
• wheezing
• distant heart sounds

Question 5

what are some end-stage physical exam finding in COPD?

Answer 5

• Tripod positioning
• use of accessory respiratory muscles of neck and shoulder girdle
• pursed lip breathing
• cyanosis
• muscle wasting

Question 6

diagnosis of COPD?

Answer 6

• all pts newly diagnosed with COPD should be screened for a1at deficiency
• PFT are required to make the diagnosis of COPD
• spirometry is used to idenify obstruction and to grade severity of disease
• diffusion capacity (DLCO) is often reduced, particularly in patients with extensive emphysema
• expiratory limb of the flow-volumve curve will have scooping

Question 7

Prognostic factors of COPD

Answer 7

• FEV1
• ongoing tobacco use
• BMI- less than 21 is asscoiated with increased mortality
• age
• frequency of exacerbations and severity exacerbations
• chronic hypercapnia
• presence of comorbid conditions- lung cancer, cardiovascular disease, sleep-related breathing, diabetes, osteoporosis, cognitive dysfunction, psychiatric illness

Question 8

• only therapeutic intervention that impats mortality in COPD long term
• never withold due to CO2 concerns
• Pa02 < 55mmg or SaO2 < 88%
• consistenly improves exrecise capacit in lab-based exercise tests, but effects on dyspnea were variable
• if patients are started in the setting of hospitalization or exacerbation, re-evaluate in 4-8 weeks for ongoing needs

Answer 8

oxygen therapy

Question 9

• acute change (< 14 days of symptoms) in baseline respiratory status
• one or more of the following cardinal symptoms:
• cough increases in frequency and severity
• sputum production increases in volume and/or changes character
• increase in dyspnea

Answer 9

acute exacerbation of COPD

Question 10

risk factors for exacerbations in COPD?

Answer 10

• Advanced age
• severity of FEV1 impairment
• chronic sputum production
• frequent prior exacerbations
• hospitalization w/in past year
• comorbidities (CAD, CHF, DM)

Question 11

Diagnsotic studies for exacerbation of COPD?

Answer 11

• chest radiograph (for eD or hospital admits)
• spriometry-
• ABG
• pulse oximetry
• sputum cultures
• +/- respiratory viral PCR panel
• BNP
• d-dimer
• procalcitonin

Question 12

etiology/trigger of AECOPD?

Answer 12

Infectious (80%)

• bacterial
• viral
• co infection
• atypical bacteria

noninfectious

• environmental exposures (NO2, SO2, ozone, particulates)
• nonadherence to medications