COPD Flashcards
three hallmark symptoms of COPD?
dyspnea, chronic cough, sputum production
cardiopulmonary complications of COPD?
right heart failure
pulmonary HTN
how to confirm COPD?
spirometry with a postbronchodilator FEV1–to– forced vital capacity ratio of <0.7
what is bronchiectasis?
Bronchiectasis is a condition of chronic cough and daily viscid sputum production associated with irreversible airway dilatation and bronchial wall thickening
two classes of puffers for COPD
name one of each
LABA - salmeterol
LAMA - tiotropium
patient with history of COPD presents acutely dyspneic.
common triggers of AECOPD
common - infection or respiratory irritant
What symptoms on history to elicit AECOPD?
What problem do these symptoms suggest?
- changes in volume and color of sputum, especially an increase in purulence
- increase in sputum volume and change in sputum color suggest a bacterial infection and the need for antibiotic therapy
best test for acute evaluation of probable AECOPD?
ABG - help you assess severity and prognosis
With ABG… Normal PaO2? What about VBG?
Normal PaO2 is 80-100 mmHg
- should not be assessing PO2 with VBG!
With ABG.. Normal range of PaCO2?
When PaCO2 is high, what acid base disturbance?
Normal PaCO2 is 35-45
Respiratory acidosis is present if the partial pressure of carbon dioxide (PCO2) is >44 mm Hg.
If the pH is <7.35, there is an acute and uncompensated component of respiratory or metabolic acidosis present.
Respiratory failure at what PaO2?
Respiratory failure typically shows an arterial PaO2 of <60 mm Hg (or an arterial SaO2 <90% in room air)
ED management of AECOPD (10)
- Assess severity of symptoms - ABG
- Administer controlled oxygen (target arterial oxygen saturation of 88%–92%)
- Continuous cardiovascular status monitoring
- Perform arterial blood gas measurement after 20–30 min if arterial oxygen saturation remains <90% or if concerned about symptomatic hypercapnia
- Administer bronchodilators - β2-Agonists and/or anticholinergic agents by nebulization or metered-dose inhaler with spacer
- Add oral or IV corticosteroids
- Consider antibiotics if increased sputum volume, change in sputum color, fever, or suspicion of infectious etiology of exacerbation
- Consider noninvasive mechanical ventilation
- Evaluation may include chest radiograph, CBC with differential, basic metabolic panel, ECG
- Address associated comorbidities - ddx…
What percent of patients with a severe COPD exacerbation with an unclear trigger have a PE?
20-25%
Critical Differential Diagnosis of Chronic Obstructive Pulmonary Disease (COPD) Exacerbations
hint: heart (2), lung (4)
- ACS - trop
- CHF - hx dyspnea with exertion, cardiomegaly on CXR, JVD, BNP
- PE - d-dimer/CTPE
- Pneumothorax - CXR (or PoCUS!)
- Pneumonia - CXR
- Asthma - history
Mainstay of acute medication treatment of AECOPD?
SABA (ventolin) +/- SAMA (ipratropium)
Do not use long-acting inhaled anticholinergics, such as tiotropium, aclidinium, and glycopyrronium, for the acute management of COPD
Should you use steroids in AECOPD?
yes.
A short course (5 to 7 days) of systemic steroids (50 mg) improves lung function and hypoxemia and shortens recovery time in acute COPD exacerbations.
No benefit of IV administration unless unable to take PO
When should you prescribe abx for AECOPD?
Prescribe antibiotics in moderately or severely ill patients if there is evidence of infection, such as change in volume of sputum and increased purulence of sputum.
you check the guidelines for AECOPD, indications for abx, your patient meets criteria…
what are 3 common abx for this?
macrolides (azithromycin),
tetracyclines (doxycycline),
trimethoprim-sulfamethoxazole.
Your AECOPD patient was recently on abx and recently hospitalized. What bug should cross your mind?
Pseudomonas aeruginosa
- if: admission and/or antibiotic course in past
3 months, prior culture showing Pseudomonas infection, or concomitant bronchiectasis
three most common bugs in COPD exacerbation?
most common pathogens associated with COPD exacerbation:
Streptococcus pneumoniae,
Haemophilus influenzae,
Moraxella catarrhalis.
indications for NIPPV with AECOPD patient?
hint: lab (3), clinical (1)
Acidosis (pH <7.36) hypercapnia (PaCO2 >50 mm Hg) oxygenation deficit (PaO2 <60 mm Hg or SaO2 <90%)
Severe dyspnea with clinical signs such as respiratory muscle fatigue or increased work of breathing
Indications for mechanical ventilation (intubation)
4
Use assisted mechanical ventilation when there is evidence of respiratory muscle fatigue, worsening respiratory acidosis, deteriorating mental status, or refractory hypoxemia
Unable to tolerate noninvasive ventilation (NIV) or NIV failure
Respiratory or cardiac arrest
Respiratory failure
Decreased consciousness or increased agitation
Massive aspiration
Persistent inability to remove respiratory secretions Hypotension
Persistent hypoxemia despite optimal respiratory treatment
Hemodynamic instability
