COPD Flashcards
Sx COPD
Cough, dyspnea, decreased exercise tolerance, sputum production
Ix + results COPD
Spirometry (FEV1, FVC)
<70% = obstructive
Low DLCO
R/O MI, CHF, anemia, bronchiectasis, TB, bronchiolitis
If young, no smoking history or transaminitis = check alpha 1 anti-trypsin deficiency
FEV1 severity criteria - mild, mod, severe + v severe
FEV1 >80% = mild
FEV1 50-79% = moderate
FEV1 30-49% = severe
FEV1 <30% = very severe
RF COPD
smoking, exposure to pollutants (wildfires), severe childhood resp disease
Screening COPD
Spirometry in all smokers >40 w/ persistent cough, phlegm, wheeze, recurrent URT
Management COPD
Encourage smoking cessation - Wellbutrin, NRT
Vaccinations (influenza, pneumococcal)
Refer to other health professionals
RT
Pulmonary rehab
Discuss wishes for aggressive treatment interventions
Discuss understanding of illness
Discuss prognosis
Clarify wishes relating to health status
Document medical goals
Maintenance:
Mild: SABA PRN
Moderate/ severe: LAMA + LABA (Inspiolto) OR ICS + LABA (Symbicort)
Home O2 for sats >90%
Pulmonary rehab if SOB with dual therapy
Management of asthma COPD overlap
ICS + LAMA +/- LAMA
Management of COPD exacerbation inc abx for simple, complicated or pseudo risk
Oxygen
Pred 30-50mg 5/7 no taper
Salbutamol 2.5-5mg neb
Ipratroprium 500mcg
Abx
Simple: amox 500mg TID or doxy 100mg BID
Complicated: amox-clav 875mg BID or levofloxacin 500mg once daily
Pseudomonas risk (chronic steroids, constant purulent sputum): ciprofloxacin 750mg BID
Causes of COPDE
Infection (H influenza, S pneumonia, morazella catarrhalis)
CHF
Irritants
PE
MI
Sx PNA
SOB, productive cough, fever, hemoptysis, pleuritic CP, sweats
PNA exam findings
dullness to percussion, crackles, reduced AE
RF for PNA
elderly, smoking, asthma, lung cancer, COPD, DM, alcoholism, recent abx use, hospitalisation within 3mo
Ix for PNA
CXR PA/ lateral. If in hospital: blood culture, CBC, lytes, CRP, glucose, Cr, ALT, ABG
Prevention of PNA
smoking cessation, hand washing, flu + pneumococcal vaX
What to use to assess severity of PNA
PNA Severity Index or CURB-65
What are the RF for unusual pathogens
Hx of TB
Exposure to birds
Travel
HIV infection
Aspiration
Complications of PNA
Empyema
Pneumothorax
Abx for PNA: regular, LTC, aspiration, 3mo-5yrs, 5-18yrs
Amoxicillin 1g TID x 5/7
+ doxycycline 100mg BID x1/7 then 100mg OD (if in LTC or has comorbid conditions)
Aspiration: amox clav 500mg TID
3mo-5yrs: amoxicillin 80mg/kg/d divided TID
5-18yrs: amoxicillin
When to do contact tracing for PNA
TB
Nursing home residents
Legionnaires disease
When to order FU CXR after PNA
necrotising or extensive PNA, or if smoker, alcohol abuse, COPD, wt loss or >40 y/o
Common pathogens causing PNA
Streptococcus pneumoniae
Haemophilus influenza
Staphylococcus aureus
Moraxella catarrhalis
Mycoplasma pneumoniae (atypical)
Chlamydia pneumoniae (atypical)
Rx for asthma COPD overlap
ICS + LAMA +/- LAMA
