COPD

Question 1

What is COPD?

Answer 1

Chronic obstructive pulmonary disease

Question 2

What is COPD characterized?

Answer 2

• Presence of airflow obstruction due to bronchitis or emphysema
• airflow obstruction that gets progressively worse
• may be accompanied by airway hyperreactivity

Question 3

Pink puffer refers to?

Answer 3

Emphysema

Question 4

Does emphysema have a V/Q mismatch?

Answer 4

Minimal V/Q mismatch- both alveoli and capillaries are damaged

Question 5

Which COPD causes muscle wasting?

Answer 5

Emphysema- caused by hyperventilation lowering cardiac output

Question 6

Which COPD is called blue bloater?

Answer 6

Chronic bronchitis

Question 7

Is there a V/Q mismatch in chronic bronchitis?

Answer 7

Yes, capillaries are in tact but airway is restricted

Question 8

If your patient has peripheral edema, which COPD could it be?

Answer 8

Chronic Bronchitis- hypercapnea + acidosis causes lung vasoconstriction leading to cor pulmonale which causes right heart failure and peripheral edema.

Question 9

Explain the pathophysiology of COPD (both emphysema and bronchitis)

Answer 9

Smoking leads to inflammation which can either lead to destruction of alveolar walls + capillaries -> causing large air space, impaired gas exchange, and air trapping (EMPHYSEMA)

or inflammation leads to fibrosis + thickening of bronchiolar walls -> narrow airways -> Bronchitis

Question 10

COPD exacerbations can be triggered by?

Answer 10

Respiratory infections
-Viral
Rhinovirus, respiratory syncytial virus, flu, adenovirus, metapnuemovirus
-Bacterial

Question 11

What is the clinical presentation of a patient with COPD?

Answer 11

Chronic, persistent productive cough + shortness of breath
Dyspnea worsening with exertion
digital clubbing
recurrent exacerbation of symptoms

Question 12

What are all the diagnostic tests you can run for COPD?

Answer 12

ABG, CBC, PFT, Chest X-ray, Chest CT, doppler echocardiogram

Question 13

What would a patient’s pH be with COPD ?

Answer 13

pH= normal unless acute exacerbation

Question 14

What would a patients hemoglobin/hematocrit look like?

Answer 14

Normal or increased

Question 15

What would a COPD patient’s PFT look like?

Answer 15

TLC Increased
FEV1 Decreased 70%
FVC Normal
FEV1/FVC Ratio Decreased

Question 16

What would you see on COPD patient’s x-ray?

Answer 16

Hyperinflation
flattened diaphragm
increased bronchovesicular markings
vertically oriented cardiomegaly
barrel chest
increased retrosternal space

Question 17

What would you see on a COPD patient’s chest CT?

Answer 17

If bronchitis- bronchial wall thickening scarring and increased bronchovesicular markings

Emphysema- alveolar destruction and airspace enlargement

Question 18

What would you see on a doppler echocardiogram of a pt with COPD?

Answer 18

Enlargement of pulmonary arteries
Increased pulmonary pressure

Question 19

What is the gold’s criteria?

Answer 19

Staging of COPD
I= MILD= FEVI => 80%
II=MODERATE= FEVI => 50% < 80%
III=SEVERE= FEVI => 30% < 50%
IV=VERY SEVERE= FEVI < 30$

Question 20

What is the treatment for the stages of gold’s criteria?

Answer 20

I= SAMA or SABA as needed
II= LAMA or LABA
III= ICS + LABA or LAMA
IV= ICS + LABA + LAMA

Question 21

What treatment is the best to improve resting hypoxemia in a patient with COPD?

Answer 21

Oxygen therapy- long term continuous air

Question 22

When do you recommend O2 therapy to a patient with COPD?

Answer 22

PaO2 < 60 mmHg

Question 23

What are the inhaled bronchodilators + anticholinergics used for COPD?

Answer 23

SAMA- Ipratropium bromide
SABA- Albuterol
LAMA- tiotropium
LABA- Salmeterol

Question 24

What are the inhaled corticosteroids used for COPD patients?

Answer 24

Fluticasone
Budesonide
Not first line, and not to be used alone

ICS + LABA -> reduces exacerbations

Question 25

What medicine should be monitored due to it’s narrow therapeutic window?

Answer 25

Theophylline

Question 26

what is the phosphodiesterase inhibitor used for COPD?

Answer 26

Roflumilast

Question 27

Do you prescribe antibiotics to a pt with COPD?

Answer 27

Yes, azithromycin, doxycycline, moxifloxacin/levofloxacin

Question 28

What do you do if you have a pt with COPD exacerbation?

Answer 28

Supplemental O2 -> evaluate for bipap or ventilator
Rule out cardiac etiology
Chest X ray
Labs -> CBC, Chemistry, ABG

Question 29

What medicines do you give a patient with COPD exacerbation?

Answer 29

Albuterol + ipratropium nebulized
systemic steroids- prednisone and methyprednisolone IV
antibiotic- azithromycin
Reevaluate for Bipap

Question 30

What surgery options are available for COPD patients?

Answer 30

Lung Volume reduction
Lung transplant

Question 31

What’s the prognosis for a patient with COPD?

Answer 31

Poor over time
FEVI less than IL = ~4 years