COPD Flashcards
what makes up COPD?
chronic bronchitis and emphysema
COPD definition
common, preventable airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gasses
chronic bronchitis
productive cough for 3 months in each of two consecutive years
emphysema
permanent enlargement of the air spaces distal to terminal bronchioles that is accompanies by destruction of the airspace walls
why does emphysema cause loss of elastic recoil?
destruction of alveolar walls
what parts of the respiratory system does emphysema effect?
terminal bronchioles, alveolar ducts, and alveoli
what parts of the respiratory system does chronic bronchitis effect?
trachea and bronchi
1 cause of COPD
smoking
risk factors for COPD
smoking
occupational exposure
pack years
ppd x years smoked
who should be screened for lung cancer?
adults 50-80 who have a 20 pack year history and currently smoke or quit within the past 15 years
how is lung cancer screening performed?
low dose CT
abnormalities in the airway in COPD patients
- chronic inflammation
- increased goblet cells and mucus production
- narrowing of airways and collapse
centrilobular emphysema
upper part of acinus damages
Panacinar emphysema
entire acinus is damages
periseptal emphysema
lower part of acinusis damaged
symptoms of COPD
- dyspnea
- chronic cough
- sputum production
- wheezing and chest tightness
PE of COPD
- increased resonance to percussion
- decreased breath sounds
- yellow stains on fingers
- chronic hoarseness of voice
- barrel chest
PE findings for emphysema
- pink complexion
- thin build with barrel chest
- cough is rare
- no peripheral edema
PE findings for chronic bronchitis
- cyanotic complexion
- peripheral edema
- stocky build
- primary complaint of productive cough
comorbid conditions associated with COPD
- lung cancer
- bronchiectasis
- sleep apnea
universal screening for COPD
none
cornerstone of diagnosis for COPD
spirometry
how to determine difference between COPD and Asthma on PFT
asthma is reversible and COPD is not
interpretation of PFT for COPD diagnosis
- FEV1 less than 80%
- FEV1/FVC less than 70%
Diffusing Capacity (DLCO)
measures the ability of the lungs to transfer gas form inhaled air to the RBCs in pulmonary capillaries
use for a CXR in COPD
- evaluates for comorbidities
- identifies complications
t/f CXR is necessary for routine diagnosis of COPD
false
CXR of COPD
- hyperinflation of lungs
- flat diaphragm
- narrow heart shadow
CT has a greater sensitivity and specificity for …
emphysema
pulse ox for person with mild COPD
over 90%
pulse ox % that needs supplemental O2
less than 90%
pulse ox % that medicare will cover supplemental O2
less than 88%
What does ABG measure?
pH
PaO2
PaCO2
HCO3
when do you do an ABG?
- FEV1 less than 50% predicted
- low O2 sat
- decreased level of consciousness
- severe COPD exacerbation
ABG of mild COPD
- low pO2
- normal pCO2
ABG of moderate to severe COPD
- low pO2
- high pCO2
COPD Assessment Test (CAT)
eight question questionnaire that assessed the impact of COPD on health status
mMRC Breathlessness Scale
5 question questionnaire that measures limitation based on scale of 0-4
GOLD categories
- 1: 80 or higher
- 2: 50-79
- 3: 30-49
- 4: less than 30
category A COPD
- 0-1 exacerbations not needing hospitalizations
- mMRC 0-1
- CAT less than 10
category B COPD
- 0-1 exacerbations not needing hospitalization
- mMRC over 2
- CAT over 10
category C COPD
- 2 exacerbations not needing hospitalizations or 1 that does need hospitalization
- mMRC 0-1
- CAT less than 10
category D COPD
- 2 exacerbations not needing hospitalizations or 1 that does need hospitalization
- mMRC over 2
- CAT over 10
non-pharm treatment for COPD
- smoking cessation
- vaccinations
- oxygen therapy
- pulm rehabilitation
pharm treatment for smoking cessation
- wellbutrin
- chantix
- nicotine replacement
when is a patient recommended to get pneumonia vaccines?
- all patients 19-64 with comorbidities
- everyone over 65
what pneumonia vaccine should be administered?
- PVC15 + PPSV23 one year later
- one dose of PVC20
patient education for COPD
- proper inhaler technique
- self management
- pulm rehab
- O2 therapy
management for category A COPD
intermittent use of SABA
if the SABA is not controlling the COPD in category A, what can be added?
LABA
onset of action of SABA
5 minutes
duration of action of SABA
4-6 hours
SABA SE
tachycardia, shakiness, nervousness, dizziness
anticholinergic SABA SE
- dry mouth
- glaucoma
- urinary retention
management of category B COPD
LABA or LAMA
category B management additives
- SABA rescue inhaler for LAMA patients
- SAMA for LABA patients
LABA onset of action
5 minutes
LABA duration of action
12-24 hours
category C COPD management
LAMA
category C COPD management additives
add LABA and/or inhaled glucocorticoid
category D COPD management
LABA-LAMA
category D COPD management additives
LABA-LAMA-inhaled corticosteroid
in what patient population of COPD do you use ICS as maintenance therapy?
category C and D with frequent exacerbations
SE of ICS
- thrush
- sore throat
- glaucoma
- osteoporosis
COPD exacerbation
acute worsening of respiratory symptoms that results in additional therapy
cardinal symptoms of COPD exacerbations
- increased dyspnea
- increased sputum production
- increased cough or wheeze
risk factors for COPD exacerbation
- age
- chronic mucus and productive cough
- duration of COPD
- antibiotic use
- comorbid conditions
- respiratory infections!!!
mild COPD exacerbation
controlled by increased dose of regular medication
moderate COPD exacerbation
requires treatment with systemic corticosteroids or antibiotics
Severe COPD exacerbation
requires ER evaluation and/or hospitalization
….% of COPD exacerbations can be managed outpatient
80
when to hospitalize for COPD exacerbation
- inadequate response to outpatient therapy
- new onset of cyanosis, peripheral edema, and altered mental status
- serious coborbidities
home management of COPD exacerbations
- intense bronchodilator therapy
- nebulizer therapy
- oral glucocorticoids
- abx for productive cough
what antibiotics are prescribed for COPD exacerbations?
zithromax or doxy
hospital management for COPD exacerbation
- supplemental oxygen
- SABA+ICS+short acting anticholinergic
- smoking cessation
- treat inf
- pulmonary rehab
Alpha-1-antitrypsin deficiency
deficiency that leads to imbalance between neutrophil elastase in lung and AAT
AAT
protects against degradation of elastin
presentation of alpha 1 antitrypsin deficiency
- early onset emphysema
- dyspnea, cough, wheezing, phlegm production
- bronchodilator responsiveness
risk factors for AAT related emphysema
- smoking
- occupational exposure
- asthma
why can AAT deficiency lead to liver disease?
toxic accumulation of unsecreted AAT protein
organic manifestations of AAT deficiency
- panniculitis
- IBD
- glomerulonephritis
who do you suspect of AAT deficiency?
- emphysema in a young individual
- emphysema in a nonsmoker
- changes in the base of the lungs on CXR
- family history of emphysema
diagnostic testing of AAT deficiency
serum AAT levels below 11
Treatment of AAT deficiency
- avoid smoking
- bronchodilators
- supplemental O2
bronchiectasis
permanent abnormal dilation and destruction of the bronchial walls of the large airways
diagnosis of bronchiectasis
clinical: chronic daily cough with copious sputum and crackles on auscultation
what would you see on CT of bronchiectasis?
bronchial wall thickening and dilated airways
treatment of bronchiectasis
- Antibiotics
- Bronchodilators
- Chest physiotherapy to break up mucus
- Treatment of primary condition
obstructive sleep apnea
recurrent collapse of pharyngeal airway during sleep leading to reduces airflow and intermittent disturbances in gas exchange
risk factors of obstructive sleep apnea
- obesity
- male
- smoking
cardinal features of obstructive sleep apnea
- apnea
- daytime somnolence
- signs of disturbed sleep
Diagnosis of obstructive sleep apnea
polysomnography
diagnostic criteria for obstructive sleep apnea
-5 or more obstructive respiratory event per hour + one for more associated symptom
complications of obstructive sleep apnea
- daytime sleepiness
- cardio problems
- metabolic syndrome
treatment of obstructive sleep apnea
- CPAP
- weight loss
- surgery
CPAP
delivers fixed level of positive airway pressure and splints open airway
