COPD Flashcards
Dx if someone has reversible airflow obstruction, is a smoker, and they start to devlop irreversible component to their obstruction
Asthma/COPD overlap Syndrome
What Three tests should you get for a patient who you suspect has COPD
PFTs to make the diagnosis
Sleep study because Cpap if they have sleep apnea will decrease mortality and hospitalizations
(Can screen with STOP BANG)
Alpha 1 Antitrypsin
What are the criteria to test for/ be suspicious of OSA
Snoring Tired during the day Observed Apnea Pressure (being treated for HTN) BMI >35 Age ?50 Neck ?40 cm Gender Male
Risks for COPD other than smoking
Alpha 1 antitrypsin Second hand smoke Immigrant patients living in enclosed places with burning biofuels Female Air pollution Occupational Exposures Childhood infections
What two scores can you use to grade COPD severity
mMRC
COPD Assessment Test
What is the mMRC
Grade 0=Symptoms with strenuous exercise
Grade 1= Symptoms going quickly or up hill
Grade 2=Walk slower than people of your age because of symptoms
Grade 3=Cant go more than 100 m on flat ground
Grade 4=Unable to leave the house
What categories are on the CAT
Sleep, energy, ADLS
Cough, Home confidence, Exercise (1 flight of stairs), sputum, Tightness in the chest,
SEA CHEST
0-5 for each
Symptoms of COPD
Dyspnes
Cough
Sputum production
Wheeze
What factors make it more likely that you will have future exacerbations of COPD
Past exacerbations
High eosinophil count
Non pharm management (List 5)
Smoking cessation Accupuncture Active mind-body therapy Yoga Tai Chi Pulmonary rehab
O2-but this doesn’t change hospitalization or time to death (? can have survival advantage if PaO2 <55)
Important preventative measures in COPD patients
Smoking cessation
Influenza vaccine
Pneumonia vaccine
How to treat someone with COPD
MMRC and CAT and how many exacerbations
Ventolin (Short Acting Beta 2 Agonist) if low symptoms and no exacerbations
Spiriva (Long Acting Muscarinic Antagonist) if low symptoms but some exacerbations
Spiriva (LAMA) if higher symptoms but no exacerbations
Spiriva (LAMA) Or Onbreze (Long Acting Beta 2 Agonist) OR Anoro (Combo LAMA/LABA)
Add ICS IF High eosinophils (300)
When should you use an ICS in COPD
Eosinophils >300
When should you avoid an ICS in COPD
Eosinophils <100
Frequent pneumonias
History of mycobacterium
What could you consider if someone has frequent exacerbations
Adding daily macrolide (azithromycin)
What could you consider if someone has frequent hospitalizations
Create action plan
Use SABA
Initiate Pred 40 mg po daily x 5 days
Start Amox if simple or Moxifloxacin if complicated
Who can you refer to
Pulmonary rehab
Resp therapy
Smoking cessation
Palliative care
What ABX to use in exacerbation
Simple:
Amoxicillin 500 mg tid x 7 days if simple
Doxycycline
2nd line=Azithromycin
Complicated:
Amoxi/clav
2nd line=Moxifloxacin 400 mg po x 5 days if (on ICS, recent antibiotic use, on oxygen, >3 COPDE in the past year, or FEV1 <50%)
Pseudomonas (If on ICS think about this)
Cipro
TREAT PER LOCAL RESISTANCE PATTERNS
When to use moxifloxacin (quinolone) for COPDE
ABX recently On ICS On O2 More than 3 COPDE in the past year FEV1 <50%
List two benefits and one risk of adding triple therapy in COPD
Mortality benefit
Fewer exacerbations
More pneumonia
When to give abx.
Winnepeg criteria 2/3 of 1. Sputum purulence 2. Sputum volume 3. Dyspnea
OR
CRP>40
What bacteria are likely to cause a COPDE
H. Influenza
S. Pneumoniae
M. Catarrhalis
Klebsiella
Pseudomonas
Criteria for diagnosing COPD
FEV1/FVC <0.7
