COPD

Question 1

What are the requirements for a COPD diagnosis?

Answer 1

Risk factors present:
- tobacco use
- occupational/environmental exposure

Symptoms compatible with COPD:
- shortness of breath w/ or w/o activity
- chronic cough & sputum (may be episodic)

Confirmation of diagnosis with:
- post-bronchodilator spirometry FEV1/FVC < 70%

Question 2

What are the characteristics of COPD?

Answer 2

Mid/later life onset

Slow progression of symptoms

Question 3

What intervention has the greatest influence on slowing COPD progression and what is the accompanying first line pharmacological therapy?

Answer 3

Smoking cessation

First line meds:
- Varencline/Chantix
- Nicotine patch
- Bupropion ER/Zyban

Question 4

What are common differential diagnoses for COPD exacerbations?

Answer 4

Pneumonia - most common @ 80%:
- confirm with chest x-ray

Pulmonary embolism:
- diagnose with D-dimer & chest x-ray
- treat with PE protocol

Atrial fibrillation/flutter:
- diagnose with EKG

Pleural effusion:
- diagnose with chest x-ray

Question 5

What are common COPD comorbidities?

Answer 5

Cardiovascular diseases

Lung cancer

Depression/anxiety
- due to dyspnea, etc.

Osteoporosis &/or Metabolic Syndrome
- due to frequent steroid use & little/no activity/weight-bearing exercise

Question 6

What are the treatments for stable COPD?

Answer 6

**Oral prednisone is NOT given for COPD!

1. SABA&/or SAMA PRN
   (Both are better than either alone)
2. LABA &/or LAMA scheduled
   (Both are better than either alone, LAMA is better for exacerbations)
3. Inhaled corticosteroid w/ or w/o LABA or LAMA
   (Only given when FEV1/FVC < 60%)
4. Inhaled corticosteroid w/ LABA &/or LAMA

Question 7

What are the USPSTF routine lung cancer screening recommendations?

Answer 7

Adults aged 50 - 80 years old who:

  - have a 20 pack-year smoking history & currently smoke 
                                 —OR—
  - have quit smoking within the past 15 years

Diagnostic tool: Low-dose CT annually