COPD Flashcards
Cardinal symptoms that would raise suspicion for COPD
Cardinal symptoms: SOB and activity limitation
SOB is persistent, progressive, worse with exercise
Other symptoms: persistent cough, sputum production
Symptoms of AECOPD
Sustained (>48 hours) worsening SOB and cough beyond day-to-day variance with increased sputum volume with purulence –> leads to increase in maintenance meds and/or additional meds
two most common conditions that contribute to COPD?
emphysema (destruction of alveoli)
chronic bronchitis (chronic inflammation of bronchioles)
What are the major comorbidities leading to hospitalizations and morbidity/mortality in COPD?
mild to moderate: cardiovascular disease is leading cause of hospitalization
severe: resp failure and pneumonia
When should a diagnosis of COPD be considered?
Pt is 40 and older with:
- dyspnea: progressive, persistent and worse with exercise
- chronic cough AND
- increased sputum production
AND
one of following:
- hx of exposure to cigarette smoke
- hx of environmental/occupational exposure to smoke, dust, gas/fumes
- frequent res infections OR
- family hx of COPD
What will CXR show in COPD?
hyperinflation (air trapping)
not used in diagnosis but can determine or rule out other comorbidities (eg HF, TB, pneumonia)
Lung function between symptoms will show ______ in COPD
persistent air flow limitation
FEV1 may improve with therapy but post-bronchodilator FEV1/FVC <0.7 persists
COPD severity is determined by:
- current level of symptoms (dyspnea scale)
- spirometry (FEV1)
- health status (COPD assessment tool)
- risk of exacerbation
- comorbidities
5 A’s for smoking cessation
ask at every visit advise assess readiness assist with quitting arrange f/u
Components of Lifestyle and Self Management of COPD
- smoking
- physical activity
- diet
- pulmonary rehab
- air quality
- smoking: quit
- physical activity: stay active despite symptoms of dyspnea
- diet: maintain BMI 20-25 (low weight and anorexia is risk factor for COPD progression)
- air quality: stay indoors when poor
- pulmonary rehab is moderate to severe COPD
Immunizations recommended in COPD
annual flu vaccine COVID pneumococcal polysaccharide Tdap (if not received in adolescence) shingles
Management of AECOPD
3 components
- short acting bronchodilator
- salbutamol 400-800 mcg MDI
- po prednisone
- 40-50 mg x 5 days
- no tapering needed
- not to exceed 5 days
- antibiotics
- if symptoms and risk factors for bacterial infection
- 5-7 days
Treatment of COPD
Step 1 first line treatment for short term relief of SOB
Step 1: SAMA or SABA for acute short term relief of SOB
• Moderate to severe COPD: SAMA or SABA monotherapy recommended
○ SAMA may reduce risk of AECOPD and improve QoL
If not well controlled on monotherapy, try combo SABA + SABA
SAMA = ipratropium (atrovent) SABA = salbutamol (ventolin)
Treatment of COPD
Step 2 for symptom relief and prevent exacerbations
Add LAMA or LABA
LAMA preferred (tiotropium = Spiriva)
if monotherapy does not control, can try LAMA + LABA combo
(tiotropium + oladaterol = Inspiolto Respimat)
*do not use SAMA and LAMA together (two muscarinic antagonists)
Treatment of COPD
Step 3: to prevent exacerbations
Step 3: Triple therapy of LABA + ICS and LAMA to prevent exacerbations
• Moderate to severe COPD and repeated exacerbations (<50% predicted and 2+ exacerbations in last 12 months)
ICS + LABA = fluticasone + salmeterol (Advair)
Budesonide + formeterol (Symbicort)
Fluticasone + vilanterol (Breo ellipta)
Do not use ICS monotherapy in COPD
