COPD Flashcards
Define Emphysema
Abornal enlargment of the airspace distal (Below) to the terminal of bronchioles, accompanied by destrcution of their walls and without obvious fibrisis
Define chronic bronchitis
Chrinoc cough for at least 3 months for 2 consecutive years
How do we diagnose COPD?
Spirometry
How how is the incidence of cigarette smoking and COPD?
80% of deaths
What are other causes of COPD?
Infections with chronic illnesses (HIV)
Socio-economic status
Genetic factors (1-antitrypsin deficiency)
What is the genetic factors that contribute to COPD hereditary
1-antitrypsin deficiency
What leads to a large occurence of emphysema?
Smoking
What other particles other then smoking can lead to increased risk factors of COPD?
Occupational dusts
Outdoor air pollution
Indoor air pollution
What infections can lead to increased incidence to COPD
HIV, Tuberculosis
What percentage of patients via genetic hereditary conditions lead to COPD?
5%
With a 1-antitrypsin deficiency what FEV1 absolute reduction can be seen?
7-10%
Is age a factor in COPD?
Possibly, obviously as someone who is older has longer exposure
Is asthma a risk factor of COPD?
Not necessarily it is more of a correlation
What is the pathophysiology of COPD?
Oxidative stress that leads to an neutrophil elastase reaction that leads to inflammation
Protease antiprotease
What is a hallmark of COPD?
Expiratory Flow limitation due to an increase of mucosal inflammation and airway remodelling
What is lung hyperinflation?
Obstruction of the small airways resulting in air trapping causing lung hyperinflation
Develops early and causes dypsnea
What happens to gas exchange in COPD?
Gas transfer for O2 and CO2 worsens as disease progresses
What is mucous hypersecretion?
leads to chronic productive cough, but not necessarily associated with airflow limitation
What occurs during exacerbations?
Increase hyperinflation and agas trapping with decreased expiratory flow
What are the three cardinal symptoms of COPD?
Shortness of breath
Chronic Cough
Phlegm
What are some other symptoms present in COPD?
Frequent lung infection
Reduced ability to go about daily activities
Barrel-shaped chest
Fatique
Unexplained weight loss
What occurs at end stage symptoms of COPD?
Adopt positions that relieve dyspnea
Cyanosis
Enlarged liver from right heart failure
How to patients initially present who have COPD?
Sedentary lifestyle with general fatigue
Patient has complaints of dyspnea and chronic cough
Patient who presents with episodes of cough sputum wheezing and fatigue and dyspnea
What is the general onset of COPD?
<40 years of age
What is the smoking history of someone who has COPD?
usually >10 packs-years
What is the sputum production in someone with COPD?
Often
Do allergens usually lead to COPD?
No/Infrequent
What are the clinical symptoms of COPD in terms of progression?
Persistent and progressive
What type of airway inflammation is COPD usually associated with?
Neutrophilic
How is COPD diagnoses?
We focus on Shortness of breath
Chronic Cough
Phlegm
Other secondary symptoms such as lung infections and barrel shaped chest
(Other co-mborbidities present)
What is spirometry measurement required for COPD diagnosis?
Spirometry post-bronchodilator FEV1/FVC ration <0.7 confirms diagnosis
How do we stage COPD?
FEV1 value
What are the risk factors for those who may have COPD (Screening)
Smoker, Persistent cough, RTI, SOB, evening wheeze
What is the pulmonary function testing?
Used to determine degree of reversibility
FEV <80%, FEV1/FVC ratio <0.7
What are the assessment of risk factors that we can measure
Quantification of tobacco consumption
Environmental exposures
What is the formula for determining pack years?
(# cigarettes smoker per day/20)*# years of smoking
What is the MRC dyspnea scale or CAT test?
used for the assessment of severity of breathlessness
What is the CAT test?
8 item and simple patient completed questionnaire for the purposes of monitoring COPD progression
Who do we usually suspect COPD in (population)?
Age >40 years
Smokers or ex smokers
Progressive dyspnea, worse with exercise
What is the definition of spirometry realted to COPD?
FEV1/FEVc ratio less then 70% after a bronchidilator
What is considered mild stage COPD? (FEV1)
> 80% of predicted
What is considered moderate stage COPD? (FEV1)
50-79
What is considered severe stage COPD? (FEV1)
30-49%
What is considered very severe stage COPD? (FEV1)
<30%
Do we treat based off the symptoms of the spirometry results (FEV1) with COPD?
Symptoms, we want them to feel better
When we compare asthma what is the criteria?
FEV1/FVC ratio 75-80% with 12% improvement post bronchodilator
When we evaluate COPD what is the criteria?
FEV1/FVC <70% is diagnostic, FEV1 used to stage/determine severity
Why should we provide smoking cessation resources for COPD?
Reduces to risk of developing COPD and the only intervention has been shown to slow its progression
What type of difference do we see in indivudals who stop smoking at an earlier stage.
As we age we seea decrease in FEV1, hence quitting early slows the deterioration of COPD
What type of drug classes should those with COPD avoid? Why?
Narcotics/sedatives due to the respiratory depression (Only exacerbate the issue more.
What vaccines are especially for individuals with COPD?
Influenza vaccine, pneumococcal vaccine, and Covid-19 vaccine
When is long term oxygen therapy introduced with people living with COPD>
When someone has severe hypoxemia and they have a goal of PaO2 of greater then 60mmHg
What drug class has a larger role in COPD treatment?
Muscarinic antagonists (SAMA/LAMA)
What drug class plays less of a role in COPD treatment?
ICS
What are our short acting bronchodilators for usage in COPD patients?
Salbutamol and Terbutaline
What are our SAMA for usage in COPD patients?
Ipratropium
What is the combination therapy of SABA + SAMA use for therapy in COPD?
Salbutamol and Ipratropium
What type of usage is SABA therapy used in COPD patient?
PRN and higher doses are obviously used for more bronchodilaton
May increase beyond recommended dose in severe disease states
When is the SABA + SAMA used in COPD treatment?
usually during asthma exacerbation or initial COPD treatment
What is a possible S/E from our SAMA/LAMA therapy
Dry mouth
constipation
Headache
Possible cardiovascular
Rinse mouth to avoid the dry mouth S/E
What are our long acting bronchodilators? SABA (4)
Salmeterol
Formeterol
Indacaterol
Olodaterol
What are our long acting muscarinic antagonists? LAMA
Tiotropium
Aclindinium
Glycopyrronium
Umeclidinium
What are the differences between LAMA and LABA therapy
LAMA is generally more tolerated
Main difference in S/E is drymouth/constipation in LAMA
LAMA (Tiotropium) may be superior in decreasing exacerbations
Which drug should not be used as monotherapy in COPD
ICS
What type of cellular increased count will patients generally respond to better with respect to ICS
Eosinophil count
Why would we recommend prophylactic azithromycin for a patient?
Aids in inflammation
What is N-acetylcysteine
Potentially used in COPD for the resolution or reduction of exacerbations in those who had greater then 2 events in the previous 2 year period
What is Roflumilast?
This is a PDE4 inhibitor that improves FEV1 and decreases exacerbations
What is Theophylline?
Bronchodilator, but has a range of side effects
What is considered a mild exacerbation?
Worsening or new respiratory symptoms without a change in prescribed medications
What is a moderate exacerbation?
Prescribed an antibiotic and oral corticosteroid
What is considered a severe exacerbation?
Requires hospital admission or ED visit
What is considered to a a low-risk of exacerbations
If they had 1 or less moderate exacerbation in the last year and did not require an ED visit or hospitalization
What is considered a high-risk of exacerbations
If they had at least 2 moderate or 1 severe exacerbation in the last year requiring hospital admission
What is the therapy used for mild COPD?
LAMA or LABA
What is the therapy used for low AECOPD Risk?
LAMA/LABA then LAMA/LABA/ICS
What is the therapy used for high AECOPD Risk?
LAMA/LABA/ICS** Where the ICS may be added if the patient also has asthma or
LAMA/LABA/ICS + Prophylactic macrole/PDE4- inhibitor, mucolytic agents
What are considered our last ditch therapies for COPD?
Lung volume reduction surgery
Lung Transplant
When would we consider stepping down COPD therapy?
When side effects are exceeding the benefit
What encompasses AECOPD?
Reduced health related quality of life
Increased mortality
Accelerated decline in lung function
increase health resource utilization and cost
What is the treatment for an acute exacerbation?
Bronchodilator
Systemic steroid
Consider antibiotic
What percentage of AECOPD are thought to be infectious in nature?
50%
What is considered the symptoms of simple COPD?
Cough, sputum, dyspnea,
What is considered as antibiotic 1st line treatment for simple COPD?
amoxicilin doxy, cotrimoxazole
What is considered complicated COPD?
FEV1 <50%
What abx are used to treat complicated COPD AECOPD?
amox/clav
Cefuroxime axetil
Levofloxacin
If someone has a FEV1 >80% predicted what is their stage in accordance to the Canadian Thoracic Society?
Mild
If someone has a FEV1 50-79% predicted what is their stage in accordance to the Canadian Thoracic Society?
Moderate
If someone has a FEV1 30-49% predicted what is their stage in accordance to the Canadian Thoracic Society?
Severe
If someone has a FEV1 <30% predicted what is their stage in accordance to the Canadian Thoracic Society?
Very Severe
Post bronchodilator if FEV1/FVC is less then _____ is diagnostic while _____ use to stage/determine severity
70%, FEV1
What is Titropium?
LAMA
What is Aclindinium?
LAMA
What is Glycopyrronium>?
LAMA
What is Umeclidinium?
LAMA
When would we consider stepping down therapy for COPD?
If treatment benefits not realized or side effects exceed benefits
What are the four consequences of AECOPD?
Reduce health related quality
Increased mortality
Accelerated decline in lung function
Increased health resource utilization and costs
What are the Simple COPD without risk factors antibiotic treatment?
What are the COmplicated COPD with risk factors treatment?
What is considered moderate therapy for COPD? What is FEV?
What is considered Severe therapy for COPD? What is FEV?
What is considered therapy for Mod/Sev COPD with Low AECOPD risk? ? What is FEV?
Picture
What is ipratropium>
SAMA
