Clinical COPD Flashcards
Which patient? cough is rare
pink puffer
Age for COPD
50s and 60s
which patient? weight loss
pink puffer
What scale for severity of Dyspnea of COPD are we using
Medical Research Scale (MRS)
Breathlessness while hurry on ground level or walking up a slight hill
Grade 2
What is the hallmark of COPD
periodic exacerbation of symptoms beyond normal day-to-day variation, often including increased dyspnea, an increased frequency or severity of cough, and increased sputum volume or change in sputum character
the 2 symptom patterns
- pink puffers
- blue bloaters
Needs to stop after 100 yards or a few minutes on level ground
Grade 4
single most important intervention in smokers with COPD?
encourage smoking cessation
Gold 2
FEV1 between 49 and 80 . . . . moderate
too breathless to leave the house or while undressing
Grade 5
Gold 1
FEV1 > 79 . . . mild
Which patient? increased interstitial markings (“dirty lungs”) especially at the bases and diaphragms are not flattened
blue bloater
Breathlessness only with strenuous exercise
Grade 1
Which patient? hyperinflation with flattened diaphragms
pink puffer
which patient? overweight
blue bloater
What is a fourth line agent in patients who do not achieve adequate symptom control with inhaled anticholinergic, beta 2 agonist, and corticosteroids
Theophilline
Which patient? Major complaint is dyspnea
pink puffer
What is required to make a diagnosis of COPD
spirometry
Patients present with
- excessive cough
- sputum production
- shortness of breath
which patient? late 30s and 40s
blue bloater
Which patient?
Major complaint is chronic cough,production of mucopurulent sputum with frequent exacerbations due to chest infection
blue bloater
What is the overall goal when giving Roflumilast
reduce the risk of COPD exacerbations in patients with a history of frequent COPD exacerbations (at least 2 per year or one requiring hospitalization)
Breathlessness walking less than a mile or less than 15 minutes and slower than people their same age
Grade 3
which patient? scant and clear mucoid sputum
pink puffer
What is clearly the most important cause of COPD in North America and Western Europe?
Smoking
Should oxygen therapy be withheld for fear of worsening respiratory acidemia?
NO; hypoxemia is more detrimental than hypercapnia
Patients with a COPD exacerbation associated with increased sputum purulence accompanied by dyspnea or an increase in the quantitiy of sputum are thought to benefit most from what?
antibiotic therapy
Describe the GOLD standard of classification for COPD
evaluation of severity based on FEV1/FVC AFTER bronchodilators
Which patient? chest is noisy
chest is quiet
blue bloater
pink puffer
What characterizes the late stage of COPD
- pneumonia
- pulmonary HTN
- cor pulmonale
- chronic respiratory failure
What is generally preferred to the short-acting beta-2 agonist as a first line agent? and why?
Ipratropium
its longer duration of action and absence of sympathomimetic side effects
Which patient has elevated Hb?
blue bloater
PDE-4 inhibitor that decreases inflammation and my promote airway smooth muscle relaxation
Roflumilast
Which patient? age 50
pink puffer
What given to patients with resting hypoxemia is the only therapy with evidence of improvement in the natural history of COPD
Oxygen therapy
Do bronchodilaters alter lung decline?
No . . they improve symptoms though
is there any advantage of scheduled use of short acting beta 2 agonist compared with as needed administration?
No
Do COPD patients benefit from corticosteroids?
there may be a subset of steroid responsive COPD patients more likely to benefit from long-term oral or inhaled corticosteroids
Gold 4
FEV1 lower than 30 . . . very severe
Gold 3
FEV1 between 29 and 50 . . . severe
