COPD Flashcards
What is COPD?
Chronic obstructive pulmonary disease
What is COPD characterized?
- Presence of airflow obstruction due to bronchitis or emphysema
- airflow obstruction that gets progressively worse
- may be accompanied by airway hyperreactivity
Pink puffer refers to?
Emphysema
Does emphysema have a V/Q mismatch?
Minimal V/Q mismatch- both alveoli and capillaries are damaged
Which COPD causes muscle wasting?
Emphysema- caused by hyperventilation lowering cardiac output
Which COPD is called blue bloater?
Chronic bronchitis
Is there a V/Q mismatch in chronic bronchitis?
Yes, capillaries are in tact but airway is restricted
If your patient has peripheral edema, which COPD could it be?
Chronic Bronchitis- hypercapnea + acidosis causes lung vasoconstriction leading to cor pulmonale which causes right heart failure and peripheral edema.
Explain the pathophysiology of COPD (both emphysema and bronchitis)
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
COPD exacerbations can be triggered by?
Respiratory infections
-Viral
Rhinovirus, respiratory syncytial virus, flu, adenovirus, metapnuemovirus
-Bacterial
What is the clinical presentation of a patient with COPD?
Chronic, persistent productive cough + shortness of breath
Dyspnea worsening with exertion
digital clubbing
recurrent exacerbation of symptoms
What are all the diagnostic tests you can run for COPD?
ABG, CBC, PFT, Chest X-ray, Chest CT, doppler echocardiogram
What would a patient’s pH be with COPD ?
pH= normal unless acute exacerbation
What would a patients hemoglobin/hematocrit look like?
Normal or increased
What would a COPD patient’s PFT look like?
TLC Increased
FEV1 Decreased 70%
FVC Normal
FEV1/FVC Ratio Decreased
What would you see on COPD patient’s x-ray?
Hyperinflation
flattened diaphragm
increased bronchovesicular markings
vertically oriented cardiomegaly
barrel chest
increased retrosternal space
What would you see on a COPD patient’s chest CT?
If bronchitis- bronchial wall thickening scarring and increased bronchovesicular markings
Emphysema- alveolar destruction and airspace enlargement
What would you see on a doppler echocardiogram of a pt with COPD?
Enlargement of pulmonary arteries
Increased pulmonary pressure
What is the gold’s criteria?
Staging of COPD
I= MILD= FEVI => 80%
II=MODERATE= FEVI => 50% < 80%
III=SEVERE= FEVI => 30% < 50%
IV=VERY SEVERE= FEVI < 30$
What is the treatment for the stages of gold’s criteria?
I= SAMA or SABA as needed
II= LAMA or LABA
III= ICS + LABA or LAMA
IV= ICS + LABA + LAMA
What treatment is the best to improve resting hypoxemia in a patient with COPD?
Oxygen therapy- long term continuous air
When do you recommend O2 therapy to a patient with COPD?
PaO2 < 60 mmHg
What are the inhaled bronchodilators + anticholinergics used for COPD?
SAMA- Ipratropium bromide
SABA- Albuterol
LAMA- tiotropium
LABA- Salmeterol
What are the inhaled corticosteroids used for COPD patients?
Fluticasone
Budesonide
Not first line, and not to be used alone
ICS + LABA -> reduces exacerbations
What medicine should be monitored due to it’s narrow therapeutic window?
Theophylline
what is the phosphodiesterase inhibitor used for COPD?
Roflumilast
Do you prescribe antibiotics to a pt with COPD?
Yes, azithromycin, doxycycline, moxifloxacin/levofloxacin
What do you do if you have a pt with COPD exacerbation?
Supplemental O2 -> evaluate for bipap or ventilator
Rule out cardiac etiology
Chest X ray
Labs -> CBC, Chemistry, ABG
What medicines do you give a patient with COPD exacerbation?
Albuterol + ipratropium nebulized
systemic steroids- prednisone and methyprednisolone IV
antibiotic- azithromycin
Reevaluate for Bipap
What surgery options are available for COPD patients?
Lung Volume reduction
Lung transplant
What’s the prognosis for a patient with COPD?
Poor over time
FEVI less than IL = ~4 years
