COPD

Question 1

emphysema

Answer 1

a type of COPD that has abnormal permanent enlargement of the terminal airspaces with no obvious fibrosis

Question 2

types of emphysema

Answer 2

centrilobar (proximal alveoli) - MC and seen w smoking
Panacinar - associated w alpha 1 antitrypsin deficiency
Paraseptal (distal alveoli) - seen w the above 2 or spontaneous pneumothorax

Question 3

sx emphysema

Answer 3

dyspnea (hallmark)
chronic cough - often mild; not as much sputum as chronic bronchitis
weight loss due to increased energy from breathing through pursed lips —> pink puffer

Question 4

nickname for emphysema

Answer 4

pink puffer

Question 5

PE for emphysema

Answer 5

hyperinflation - decreased breath sounds, increased AP diameter, hyperresonance to percussion

obstruction - end-expiratory wheezing and/or prolonged expiration

cachectic and non-cyanotic = pink puffer

pursed lip expiration

Question 6

chest XR for emphysema

Answer 6

hyperinflation - flattened diaphragm, increased AP diameter, decreased vascular markings; bullae and/or blebs

Question 7

what imaging modality can be used to differentiate btwn different types of emphysema

Answer 7

computed tomography (CT)

Question 8

what is the cornerstone of diagnostic evaluation in emphysema

Answer 8

pulmonary function testing - especially spirometry

Question 9

PFTs in COPD

Answer 9

airway obstruction - normal or decreased forced vital capacity (max amount you can exhale); post bronchodilator decreased FEV1/FVC < 70% predicted (incompletely reversible); decreased FEV1

hyperinflation - increased volumes (residual volume; total lung capacity; RV/TLC; functional residual capacity)

decreased diffusing capacity of the lung for carbon monoxide (DLCO) – this is normal in chronic bronchitis

Question 10

GOLD classifications for emphysema

Answer 10

mild > 80%
moderate 50-79%
severe 30-49%
very severe < 30%

Question 11

when should ABGs be obtained for emphysema

Answer 11

O2 saturation < 92%
altered mental status
acute exacerbation

Question 12

tx emphysema

Answer 12

smoking cessation
influenza and pneumococcal vaccines
oxygen
pulmonary rehab

Question 13

indications for oxygen in emphysema

Answer 13

severe resting hypoxia (PaO2 55 mm Hg or less or oxygen saturation 88% or less) or cor pulmonale

Question 14

chronic bronchitis

Answer 14

a type of COPD defined as chronic productive cough for at least 3 months a year for 2 consecutive years

Question 15

sx chronic bronchitis

Answer 15

chronic cough (MC and earliest)
sputum production
dyspnea (esp on exertion)

Question 16

PE for chronic bronchitis

Answer 16

crackles (rales)
coarse rhonchi
wheezing
cyanosis
peripheral edema
obesity (blue bloater)

Question 17

what is the cornerstone of diagnosing pts w COPD

Answer 17

pulmonary function testing - especially spirometry

Question 18

DLCO in chronic bronchitis

Answer 18

usually normal

Question 19

chest XR for chronic bronchitis

Answer 19

pulmonary HTN - enlarged right heart border, increased AP diameter and vascular markings

Question 20

what will you see in labs for chronic bronchitis

Answer 20

CBC - increased hemoglobin and hematocrit (due to chronic hypoxia)
ABG - respiratory acidosis (due to severe hypoxemia and hypercapnia)

Question 21

tx for acute exacerbations chronic bronchitis

Answer 21

amoxicillin 500 mg tid for 5 days
doxycycline 200 mg on the first day, then 100 mg once a day for a 5 day total course
clarithromycin 500 mg bid for 5 days
cephalosporins

Question 22

what antibiotic for COPD exacerbations has anti-inflammatory properties in the lungs

Answer 22

azithromycin

Question 23

tx for COPD if 2 or more moderate exacerbations or 1 or more hospital admissions

Answer 23

LABA + LAMA

Question 24

when should you consider LABA + LAMA + ICS in COPD

Answer 24

if 2 or more moderate exacerbations or 1 or more hospital admissions and eosinophils >/= 300

Question 25

tx for COPD with 0 or 1 exacerbations (not leading to hospital admission

Answer 25

a bronchodilator (long acting preferred)
or
LABA + LAMA