COPD

Question 1

Chronic Bronchitis

Answer 1

chronic productive cough for more than 3 months

mucous hypersecretion and ciliary dysfunction

Question 2

emphysema

Answer 2

destruction of alveoli

lung hyperinflation

impaired gas exchange

Question 3

asthma

Answer 3

intermittent productive cough and airway obstruction with full reversibility

long standing persistent- hard to differentiate-mixed disease

Question 4

spirometry interpretation

Answer 4

1. look at FEV1 FVC ratio
   low= obstructing disease
   less 0.7 per gold criteria
   normal no disease
2. Look at FVC
   low= restrictive disease
   normal= no disease
3. look at FEV1
   severity of obstruction
4. look at reversibility of post bronchodilator
   reversibility =asthma
   modest reversibility = asthma or copd overlap

Question 5

Severity of obstruction

Answer 5

FEV1 %of predicted

mild More 80
moderate 50-79
severe 30-49
very severe less 30

Question 6

Severity of Airflow Limitation Severity of Restriction

Answer 6

FVC% of predicted
Mild65 to 80
Moderate50 to 65
Severe< 50

Question 7

Managing Exacerbations Key Points

Answer 7

Short acting beta antagonists with or without short acting anticholinergics
Systemic Steroids – Prednisone 40mg qd X 5 days
Antibiotics (dyspnea, increased sputum, purulent sputum)
Reduces risk of relapse and hospitalization
Common pathogens – H.flu, S.pneumonia, M.catarrhalis
Bactrim, Amox/Augmentin, macrolide.

Question 8

Pulmonary Fibrosis

Answer 8

Occurs when the lung tissue becomes damaged and scarred
This thickened stiff tissue makes it difficult for the lungs to work properly.
Usually cannot pinpoint what the exact cause is. Irreversible

Question 9

Sarcoidosis

Answer 9

An inflammatory disease that affects multiple organs in the body, but mostly the lungs. Abnormal nodules(called granulomas) consist of inflamed tissue form in certain organs.

Question 10

Common Lung Terms

Answer 10

Atelectasis – collapse or closure of the lung resulting in reduced or absent gas exchange. (partial lung collapse)
Pleural effusion – excess fluid that accumulates in the pleural cavity
Pneumothorax – abnormal collection of air in the pleural space (total lung collapse)
Pulmonary consolidation – region of the lung tissue that has filled with liquid instead of air.
Consolidation must be present to diagnosis pneumonia

Question 11

Pneumonia

Answer 11

Community-Acquired Pneumonia
Community setting – not hospital, NH or other healthcare setting
Hospital-Acquired Pneumonia
Hospital-acquired pneumonia (HAP) or nosocomial pneumonia refers to any pneumonia contracted by a patient in a hospital at least 48–72 hours after being admitted. It is thus distinguished from community-acquired pneumonia. It is usually caused by a bacterial infection, rather than a virus.
Ventilator-Associated Pneumonia – defined as pneumonia that presents > 48 hours after intubation

Question 12

Screening for Lung Cancer

Answer 12

Low Dose CT Chest for Lung Cancer Screening
• Low-dose CT is recommended annually for asymptomatic adults 55 to 77 years of age who have smoked at least 30 pack years, and who continue to smoke or have quit within the past 15 years.
• Low-dose CT screening is not recommended in patients who do not meet the age and smoking criteria, even if they are considered high risk by clinical risk prediction calculators.
• Evidence-based tobacco cessation treatments should be provided to current smokers undergoing low-dose CT screening for lung cancer.

Question 13

Evaluation of Cough

Answer 13

Onset – rapid (PE, CHF, Infection) – slow (COPD, Asthma, Restrictive Lung Disease.
Location – Triggers? (cold air, exercise, irritants, seasonal)
Duration - < 2 months –vs- years
Character – intermittent –vs- progressive, worsening
Associated Symptoms – CP, SOB, Fevers, Edema, Weight loss, hemoptysis
Relieving – Rest, Medications
Treatments – things tried in the past, medications.