COPD Flashcards
What is COPD?
Chronic obstructive pulmonary disease (COPD) is a respiratory disease that causes obstructed airflow from the lungs
What are the symptoms of COPD?
Symptoms include chronic and progressive dyspnea (shortness of breath), chronic cough, sputum, production and wheezing
What are some common causes of COPD?
COPD is most commonly caused by tobacco smoke, but can be caused by other air pollutants (e.g. noxious particles, smoke from fires, cigars, pipes and marijuana). Long-term exposure to these gases or particles causes chronic inflammation in t eh lungs, eventually resulting in emphysema and/or bronchitis
What is emphysema?
Emphysema is the destruction of the small passages in the lungs, called alveoli
What is bronchitis?
Bronchitis is inflammation and narrowing of the bronchial tubes and results in mucus production and a chronic cough
What deficiency creates a higher risk of developing COPD?
Individuals with alpha-1 antitrypsin (AAT) deficiency are at a higher risk of developing COPD because AAT helps to protect the lungs from damage caused by inflammation
When should COPD be suspected?
COPD should be suspected in any patient with symptoms and a history of exposure to risk facts. Other common reasons for shortness of breath and cough should be ruled out
What is one difference between asthma and COPD?
The limitation of airflow in asthma is reversible with medication. In COPD, the limitation of airflow is not fully reversible and progresses over time, leading to a gradual loss of lung function
What is required for the diagnosis of COPD?
Spirometry is required to assess lung function and make a diagnosis of COPD
How does spirometry confirm the diagnosis of COPD?
Spirometry measures the total amount of air a person can breathe out (forced vital capacity) and the amount of air exhaled in one second. A post-bronchodilator FEV1/FVC < 0.70 confirms a diagnosis of COPD
What are some key differences between COPD and asthma?
- Age of onset is usually > 40 years in COPD
- Smoking history is usually > 10 years in COPD whereas it is uncommon in asthma
- Symptoms are persistent in COPD
- First line treatment of COPD is bronchodilators whereas inhaled corticosteroids are first line treatment for asthma
What are the four aspects of COPD assessment?
Degree of airflow limitation (disease severity), symptoms, risk of exacerbations, presence of comorbidities
How is degree of airflow limitation measured?
The post-bronchodilator FEV1 is assessed using spirometry and helps determine disease severity
*The GOLD guidelines use a grading system of 1-4 to classify patients based on spirometry results
What is considered mild severity in the GOLD guidelines?
GOLD 1: FEV1 > 80% predicted
What is considered moderate severity in the GOLD guidelines?
GOLD 2: 50% < FEV1 < 80% predicted
What is considered severe severity in the GOLD guidelines?
GOLD 3: 30% < FEV1 < 50% predicted
What is considered very severe severity in the GOLD guidelines?
GOLD 4: FEV1 < 30% predicted
What are the most commonly used scoring systems for symptoms assesment?
Modified British Medical Research Council (mMRC) dyspnea scale, COPD Assessment Test
Describe the mMRC dyspnea scale.
The mMRC dyspnea scale assesses breathlessness. Scores range from 0 (only breathless with strenuous exercise) to 4 (too breathless to leave the house or breathless with normal daily activities)
Describe the CAT.
The CAT is a comprehensive assessment of symptoms (e.g. cough, mucus production, chest tightness, energy level, breathlessness, sleep patterns, limitations to normal activity), with possible scores ranging from 0-40 with higher scores indicating worse symptoms
What is a COPD exacerbation?
A COPD exacerbation is an acute worsening of respiratory symptoms beyond normal day-to-day variation
What is a frequent exacerbator?
If a patient has two or more exacerbations per year, they are considered to be frequent exacerbators
Why is preventing and quickly treating exacerbations necessary in the management of COPD?
The risk of exacerbations increases as airflow limitations worsens. Hospitalization for an exacerbation is associated with an increased risk of death.
*Poor control of comorbid conditions can independently influence mortality and hospitalizations
What should be assessed at each COPD follow up visit?
At each follow up visit, symptoms should be assessed using the mMRC or CAT system, and history of exacerbations should be documented. The patient is then assigned to a group (ABCD), which determines the initial treatment warranted
What is the only management strategy proven to slow the progression of COPD?
Smoking cessation is the only management strategy proven to slow the progression of COPD. Healthcare providers should encourage all tobacco users to quit using proven strategies
What is the role of vaccines in the management of COPD?
Vaccinations reduce the risk of hospitalizations due to serious respiratory illness and the risk of death. Patients with COPD should receive an annual influenza vaccine, pneumococcal vaccinations per ACIP recommendations and Tdap if not received as part of childhood vaccinations
What do medications used in COPD do for patients?
The medications used in COPD do not modify the long-term decline in lung function or reduce mortality. They decrease symptoms and/or prevent complications, such as exacerbations and hospitalizations
What is considered first-line treatment for COPD?
Bronchodilators are the first-line treatment for all patients. A short-acting beta-2 agonist (SABA) and/or short-acting muscarinic antagonist (SAMA) can be used as needed
*If regular use is required, LABAs and/or LAMAs are preferred. Combination treatment is often required with two bronchodilators preferred
