COPD Flashcards
COPD
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by airflow limitation; it is usually progressive, not fully reversible, and associated with an abnormal inflammatory response of the lungs.
COPD Risks
Genetic
Socioeconomic
Environmental
Behavior
Smoking is the the biggest risk followed by occupational exposure
COPD Patho
Alveolar wall destruction likely due to increased activated neutrophils that produce enzymes that destroy elastin in the alveoli. End results in destruction of alveoli architecture and the capillary bed within.
COPD Diagnosis
The most common presenting complaints are dyspnea, cough, and/or sputum production. These symptoms are not necessarily noticed by patients until late in the course of this disease, when irreversible changes may have already occurred.
COPD must be considered as a diagnosis in every patient who smokes, even in the absence of respiratory symptoms
Childhood history of bronchitis and history of respiratory problems in childhood is a red flag risk
COPD Diagnosis Spirometry
The presence of a post bronchodilator FEV1/FVC of less than 0.70 and FEV1 of less than 80% predicted confirms airflow limitation that is not fully reversible
COPD Presentations
Increases A-P chest diameter Increased intercostal space Diminished chest excursion Increased resonance Right Ventricle enlargement (late) Spirometry and history are the gold standard for Dx
COPD Classification by Severity
Stage 1 - Mild
Stage 2 - Moderate
Stage 3 - Severe
Stage 4 - Very Severe
Stage 1 COPD
Mild airflow limitation
FEV1/FVC < 70%, FEV >80%
Chronic cough and sputum production may be present
Stage 2 COPD
Progression of symptoms
FEV1 < 80%
SOB with exertion
Stage 3 COPD
FEV < 50%
Repeat exacerbations that affect quality of life
Increased SOB
Stage 4 COPD
FEV1 < 30%
or FEV1 < 50% with chronic respiratory failure
Quality of life significantly impaired
COPD Assessment Test (CAT)
short but comprehensive eight-item measure of health status impairment in patients with COPD
Labs in COPD
Elevated HCT and HGB indicate severity of hypoxia
COPD v. Asthma
COPD is midlife or later with history of smoking / exposure and progressing symptom; spirometry best does not improve usually with SABAs
Asthma is earlier in life, varying symptoms more common in morning / nights; airflow limits are reversible with SABAs and treatment
Oxygen (home) and COPD
PaO2 of 55 or less, SpO2 less than 88% on room air
or
Evidence of right ventricle enlargement or elevated HCT with a PaO2 of 59 or less
Reassess oxygen need every 30 - 90 days
Mainstay of COPD Treatment
Anticholinergics and Long acting beta agonists
Treatment by Stage
Mild
SABA PRN
LABA if needed
Moderate
LAMA
SABA PRN
LABA+LAMA if needed
Severe
LABA+LAMA+ICS
Stop ICS as soon as able
Oxygen
COPD ED Referral
- Sudden, severe worsening of symptoms with resting dyspnea, ↑ respiratory rate, ↓ oxygen level (pulse ox <90%), confusion
- Changing or worsening in peripheral edema, cyanosis
- Failure to respond to treatments
- History of comorbidities under poor control (e.g., HF, arrhythmias, age, DM)
- Lack of home support
COPD Refer to Pulmonology
- Severe disease evidenced by persistent dyspnea with activities of daily living and frequent recurrent exacerbations despite therapy.
- Evaluation for and maintenance of oxygen therapy, including consideration of nocturnal oxygen therapy or transtracheal oxygen therapy.
- Preoperative assessment for any surgery placing the patient at high risk for pulmonary complications
- Failure to respond to treatment for an acute exacerbation
- Consideration of long-term intermittent antibiotic therapy
- Persistent pulmonary infiltrates on chest radiograph with no response to antibiotic therapy
- Evaluation of sleep disturbances, including obstructive sleep apnea
- Management of acute respiratory failure, or if mechanical ventilation is a consideration
- Cor pulmonale with clinical right-sided heart failure unresponsive to usual therapy
- Consideration of α1-antitrypsin augmentation therapy
COPD Complications
Sleep disorders, acute resp. failure, cor pulmonale
GOLD COPD Severity and Symptom Categories
Group A - low symptom severity, low exacerbation risk (LABA or SABA)
Group B - high symptom severity, low exacerbation risk (LABA or LAMA initial or Dual)
Group C - low symptom severity, high exacerbation risk (LAMA or Dual initial, consider LABA+ICS)
Group D - high symptom severity, high exacerbation risk (Dual, add ICS if needed, consider Triple)
