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COPD Flashcards

1
Q

Define COPD

A

Preventable disease state that is characterized by airflow limitation that is not fully reversible.

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2
Q

Name two diseases included in COPD

A

Chronic Bronchitis

Emphysema

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3
Q

Why is asthma not included in definition of COPD?

A

Asthma is reversible

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4
Q

Define Emphysema

A

Pathologically defined as the presence of permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.

Based on the pathology, or the “anatomic alterations of the lung,” associated with the disorder.

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5
Q

Define Chronic Bronchitis

A

Clinically defined as chronic productive cough for 3 months in each of 2 successive years in a patient in whom other causes of productive chronic cough have been excluded.

Based on the major “clinical manifestations” associated with the disease.

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6
Q

How many Americans currently suffer from COPD, chronic bronchitis, and emphysema?

A

appx. 24 million

Estimated 10 t0 15 million people

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7
Q

Two most common risk factors that cause the development of COPD

A

Tobacco smoke

Alpha 1-antitrypsin deficiency (AAT)

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8
Q

The evidence (list 4) linking cigarette smoking to the development of COPD.

A

Chronic cough, phlegm

Impaired lung function with evidence of obstructive pattern

Pathologic changes in airflow obstruction

So called susceptible smokers, who represent approximately 15% of all cigarette smokers experience more rapid rates of decline of lung function than nonsmokers.

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9
Q

What is the other name for Alpha one antitrypsin deficiency?

A

genetic emphysema

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10
Q

What is the treatment for Alpha one antitrypsin deficiency?

A

intravenous augmentation therapy

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11
Q

Describe the protease-antiprotease hypothesis of emphysema

A

When someone has ATT deficiency, neutrophil elastase may go “unchecked”, causing a breakdown of elastin and resulting in dissolution of alveolar walls

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12
Q

What is the protective threshold of Alpha one antitrypsin in the serum?

A

Protective threshold is 11µmol/L, or 57mg/dl

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13
Q

Mechanisms of airflow obstruction in COPD.

A

Inflammation and obstruction of the small airways (<2mm in diameter), loss of elasticity, which keeps small airways open when elastin is destroyed in emphysema and active bronchospasm.

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14
Q

Common symptoms and signs of COPD

A

Cough
Phlegm production
Wheezing
SOB, typicall with exertion

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15
Q

physical examination findings of a patient with COPD

A

Wheezing or diminished breath sounds (early on)
Hyperinflation (later)
Barrel chest
Diaphram flattening
Dimpling inward on the chest wall at the level of the diaphram on inspiration

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16
Q

PaCO2 to changes in FEV1 - “Rule of thumb”

A

In pt with COPD, PaCO2 is usually preserved until airflow obstruction is severe (i.e., FEV1 < 1L), when PaCO2 may increase

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17
Q

Four clinical goals for managing stable COPD

A 
Establish the diagnosis of COPD
Optimize lung function
Maximize the pts functional status
Simplify the medical regimen as much as possible
Prolong survival whenever possible
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18
Q

Features that favor the diagnosis of COPD.

A

Chronic daily phlegm production
Diminished vascularity on chest x-rays
Decrease diffusing capacity

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19
Q

Features that favor the diagnosis of asthma.

A

If the diminished FEV1 obtained on spirometry can be normalized after use of an inhaled bronchodilator.

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20
Q

Is airflow obstruction resulting from emphysema considered to be reversible?

A

Airflow obstruction from emphysema itself is irreversible.

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21
Q

What fraction of patients with stable COPD demonstrate a reversible component to airflow obstruction defined as a 12% (200 ml) rise in the postbronchodilator FEV1

A

2/3 of the patients with stable COPD exhibit a reversible component of airflow obstruction

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22
Q

Why is bronchodilator therapy recommended for patients with COPD?

A

bronchodilators produce smooth muscle relaxation resulting in improved airflow obstruction, improved symptoms and exercise tolerance, and decrease in the frequency and severity of exacerbation.

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23
Q

Both __________________ and ___________________ bronchodilators can improve airflow in patients with COPD.

A

Anticholinergic

Adrenergic

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24
Q

Other treatment options to optimize lung function include administering ______________ and methylxanthines

A

Corticosteroids

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25
Systemic corticosteroids can produce significant improvements in airflow in a minority (___________) of patients with stable COPD.
6 - 29%
26
Controlled trials do show lessened dyspnea in ___________________ recipients despite lack of measurable increases in airflow.
Methylxanthine
27
Side effects of methylxanthines use.
``` Anxiety Tremulousness Nausea Cardiac arrhythmias Seizures ```
28
To minimize the chance of toxicity, current recommendations suggest maintaining serum theophylline levels at _________________
8 to 10 mcg/ml
29
What does the phrase "acute exacerbation" mean?
Sudden worsening of COPD symptoms (SOB, color of phlegm)
30
List strategies used to improve lung function during an acute exacerbation of COPD.
``` inhaled bronchodilators (especially beta-2 agonist) antibiotics systemic corticosteroid ```
31
Criteria defining the candidacy for noninvasive ventilation
Acute respiratory acidosis (without frank respiratory arrest) Hemodynamic stability Ability to tolerate the interface needed for noninvasive ventilation.
32
Describe what can be done to maximize the ability of a stable COPD patient to perform the activities of of daily living.
Pharmacologic treatments to maximize functional status include administration of bronchodilators to enhance lung function as much as possible and consideration of methylxanthine therapy.
33
What therapy has been proven to prolong the survival of COPD patients?
Smoking cessation program
34
Indications for long-term oxygen therapy
Continuous CO2 resting PaO2 ≤ 55mmHg resting PaO2 56-59 mmHg or SaO2 89% in the presence of any of the following: 1. Dependent edema, suggesting CHF 2. P. pulmonale on the electrocardiogram (P wave >3 mm in standard lead II, III, or aVf) 3. Erythrocytosis (hematocrit >56%) Noncontinuous O2 flow rate and # of hours per day must be specified 1. during exercise: PaO2 ≤55 mmHg or SaO2 ≤ 88% with low level of exertion 2. during sleep: PaO2 ≤ 55 mmHg or SaO2 ≤ 88% with associated complications, such as pulmonary hypertension, daytime somnolence, or cardiac arrhythmias
35
Why should patients receive optimal bronchodilator therapy before being assessed for supplemental long-term continuous oxygen?
1/3 of potential O2 candidates experience sufficient improvemetn with aggressive bronchodilation to avoid the need for long-term supplemental O2.
36
What can be done to prevent the progression of COPD?
Breath cleaner air | Quit smoking
37
Why are annual influenza vaccinations and pneumococcal vaccinations indicated for patients with COPD?
COPD pt are considered a high risk in contacting flu and pneumonia
38
Panlobular emphysema (Slide #5)
Slide has two pictures. A-Normal aveoli for comparison purposes. B- Panlobular emphysema (aveoli is enlarged and open with holes)
39
Chronic bronchitis (Slide #4)
Most common airway diseases | Picture of bronchiole shows green goo flowing from it
40
Centrilobular emphysema (Slide #6)
Slide shows alveoli enlarged, swollen, and closed. Looks like it is about to burst.
41
What is Chronic Obstructive Pulmonary Disease?
preventable and treatable disease state characterized by airflow limitation that is not fully reversible.
42
What is airflow limitation?
usually progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking.
43
What does COPD affect?
Lungs | Produces significant systemic consequences
44
COPD
A preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.
45
T/F The pulmonary component of COPD is fully reversible.
(False) Its pulmonary component is characterized by airflow limitation that is NOT fully reversible.
46
T/F The airflow limitation of COPD is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases.
True
47
Anatomic alterations of the lungs - Chronic Bronchitis
Chronic inflammation and swelling of the peripheral airways Excessive mucus production and accumulation Partial or total mucus plugging of the airways Smooth muscle constriction of bronchial airways (bronchospasm) Air trapping and hyperinflation of alveoli—occasionally in the late stages
48
Anatomic Alteration of Lungs - Emphysema
Permanent enlargement and deterioration of the air spaces distal to the terminal bronchioles Destruction of pulmonary capillaries Weakening of the distal airways, primarily the respiratory bronchioles Air trapping and hyperinflation of alveoli (air-trapping)
49
Risk Factors of COPD
Tobacco Smoke Occupational dusts and chemicals Indoor air pollution Outdoor air pollution Conditions that affect normal lung growth Genetic predisposition (Alpha 1-antitrypsin deficiency)
50
Diagnosis of COPD
Dysypnea Chronic cough Chronic sputum production History of exposure to risk factors
51
3 main spirometry tests for COPD
FVC FEV1 FEV1/FVC ratio
52
Which tracing indicates airflow obstruction? (Slide #23)
curved dotted line - normal FVC curved dotted line/solid line intersects straight dotted line - FEV1 (normal/COPD) solid line - COPD FVC
53
Pulmonary Function Study in COPD diagnosis
The presence of COPD is confirmed when both the FEV1 and FEV1/FVC ratio are decreased.
54
Stage 1: Mild COPD
FEV1>=80%
55
Stage II: Moderate COPD
FEV1 50% to <80% of predicted | Complains of shortness of breath upon exertion
56
Stage III: Severe COPD
FEV1 30% to s quality of life.
57
Stage IV: Very severe COPD
FEV1 < 30% predicted, or FEV1 < 50% predicted | Chronic ventilatory failure
58
Distinguish the body build.
Emphysema - Thin, underweight (Pink Puffer) Chronic Bronchitis - Stocky, overweight (Blue bloater)
59
Barrel Chest
Emphysema - Common - classic sign Chronic Bronchitis - Normal
60
Respiratory Pattern
Emphysema - Hyperventilation & marked dyspnea; often occurs at rest Late stage: diminished respiratory drive & hypoventilation Chronic Bronchitis - Diminished respiratory drive Hypoventilation common, with resultant hypoxia and hypercapnia
61
Pursed-Lip Breathing
Emphysema - Common Chronic Bronchitis - Uncommon
62
Cough
Emphysema - Uncommon during mild and moderate stage; Some coughing during sever-stage with infection Chronic Bronchitis - Common (classic sign) More severe in the mornings
63
Sputum
Emphysema - Uncommon; little, mucoid Chronic Bronchitis - Common (classic sign) Copious amounts, purulent
64
Cyanosis
Emphysema - Uncommon (reddish skin) Chronic Bronchitis - Common
65
Peripheral edema
Emphysema - Uncommon Chronic Bronchitis - Common (Right heart failure)
66
Neck vein distention
Emphysema - Uncommon Chronic Bronchitis - Common (Right heart failure)
67
Use of accessory muscles
Emphysema - Common, especially during exacerbations Chronic Bronchitis - Uncommon, end-stage in some
68
Auscultation
Emphysema - Diminished breath sounds, diminished heart sounds; prolonged expiration Chronic Bronchitis - Wheezes, crackles, rhonchi, depending on the severity of disease
69
Percussion
Emphysema - Hyperresonance; deverased diaphragmatic excursion Chronic Bronchitis - Normal
70
Laboratory tests
Emphysema - Hyperresonance Chronic Bronchitis - Normal
71
Chest x-ray
Emphysema - Hyperinflation, narrow mediastinum, normal or small vertical heart, low flat diagphragm, presence of blebs or bullae Chronic Bronchitis - Congested lung fields, densities, increased bronchial vascular markings, enlarged horizontal heart
72
Polycythemia
Emphysema - Uncommon Chronic Bronchitis - Common
73
Infections
Emphysema - Occasionally Chronic Bronchitis - Common
74
Pulmonary Hypertension
Emphysema - Uncommon Chronic Bronchitis - Common
75
Cor pulmonale
Emphysema - Uncommon Chronic Bronchitis - Common (right heart failure)
76
Diffudion Capacity (DLCO) and DLCO/VA
Emphysema - Decreased; decreased DLCO is a classic diagnostic sign of emphysema Chronic Bronchitis - Often Normal
77
Heart rate and respiratory rate
Stable patients: normal vital signs Exacerbations: Usually acute increase in heart rate and respiratory rate (Tachypnea) Classic sign of hypoxemia
78
Altered Sensorium - anxiety, irritability
Emphysema - Common—severe stage Classic sign of hypoxemia Chronic Bronchitis - Common—during moderate and severe stage Classic sign of hypoxemia
79
Digital Clubbing
Emphysema - Late- Stage Chronic Bronchitis - Common
80
Peripheral edema and venous distention
Emphysema - End-stage Chronic Bronchitis - Common—Because polycythemia & cor pulmonale are common, the following are often seen: Distended neck veins Pitting edema Enlarged & tender liver
81
Define Hoover's Sign
Inward movement of the lower lateral chest wall during each inspiration Indicated severe hyperinflation
82
Hoover's Sign
Emphysema - Common, Severe stage Chronic Bronchitis - Uncommon
83
Palpation of the Chest
Emphysema - Decreased tactile fremitus, decreased chest expansion, PMI often shifts to the epigastric area Chronic Bronchitis - Normal
84
Label slide #53
x- axis - Time and progression of disease y-axis - PaO2 or PaCO2 Left box of chart - Disease onset Right box of chart - Alveolar hyperventilation Line at bottom of graph (starting at 40) - PaCO2 Line at top of graph (starting under 100) - PaO2
85
At what point are the peripheral chemo receptor stimulated? (Slide #53)
Point where vertical line intersects PaO2 line - this indicated the point at which PaO2 declines enough to stimulate peripheral Oxygen receptors
86
Describe the blood gas that would occur at the 4 right edge of the drawing. (Slide #53)
acute alveolar hyperventilation on top of chronic ventilatory failure. pH7.51, SaO2 78%, PaOc38 They breathe faster/quicker/deeper and hyperventilate- blow off acid- Co2 moves to 39 and their driving ventilatory force is hypoxemia
87
Describe the blood gas that would occur at the centerline of the chart. (Slide #53)
Compensated Respiratory Acidosis | pH 7.38. PaCO2 66, PaO2 60, HCO3 35
88
Name 2 surgeries that can be used in extreme cases for patients with end stage COPD
Lung transplant | Lung volume reduction
89
LVRS
Lung Volume Reduction Surgery
90
Can all patients benefit from LVRS surgery?
Lung transplantation is a consideration for patients with severe airflow obstruction who are younger than 65 years old, who lack major dysfunction of other organs, and who are psychologically and motivationally suitable.
91
What are the benefits and difficulties of IV augmentation with Alpha one antitrypsin therapy
benefit would be that weekly augmentation therapy may be associated with a slower rate of decline of lung function and improved survival. Difficulties with intravenous augmentation therapy include the substantial expense ($100,000 per year), inconvenience of frequent intravenous infusions for life, and the infusion itself.
92
According to actuarial survival studies, what % of patients can be expected to live for 5 years after receiving a lung transplant surgery?
approximately 54%

Cardiology (6 decks)

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