COPD Flashcards

1
Q

COPD is?

A

chronic, inflammatory response a/w pollutants

preventable, treatable

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2
Q

Inflammation in lungs results in? (2)

A

1) Small airway disease:
airway inflamm and remodeling

2) Parenchymal destrutction:
loss of alveolar attachments and recoil

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3
Q

Emphysema-caused COPD characteristics?

A
"Pink Puffer"
Maintains adequate O2 for longer time
Pursed lip breathing,
Pink skin color,
Thin body
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4
Q

Chronic Bronchitis-caused COPD characteristics?

A

“Blue Bloater”
Hypoxemia/respiratory acidosis (C)
Cor pulmonale (enlarged R heart from pulm HTN)
Overweight

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5
Q

Chronic Bronchitis definition?

A

Chronic, productive cough
Lasting 3 mo during 2 yrs
With no other cause

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6
Q

Chronic Bronchitis structural Δs? (3)

A

Mucous gland hyperplasia ->
excess mucus and narrowed bronchioles

Bronchial squamous metaplasia (non-squ replaced w/ squamous cells)

Lost ciliary transport

(Less parenchymal damage than emphysema)

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7
Q

Chronic Bronchitis structural Δs results from?

A

Inflamm of submucosa of bronch wall by neutrophils

Chronic bacterial inf/hyper-active reaction

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8
Q

Chronic Bronchitis causes what type of obstruction?

Results in?

A

inspiratory and expiratory

hypoxemia and hypercarbia

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9
Q

Emphysema definition?

A

Pathological enlargement of air spaces DISTAL to terminal bronchs

Due to destruction of alveolar walls

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10
Q

Emphysema destructive process?

A

(P) > elastase or < antitrypsin

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11
Q

Emphysema structural Δs?

A

↓ alveolar SA available for gas exchange

↓ recoil -> limits airflow

↓ alveolar support structure -> airway narrowing

Destruction of capillary beds -> ↓ CO2 diffusion capacity

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12
Q

Emphysema causes what type of obstruction?

Results in?

A

exhalation

hypercarbia

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13
Q

Emphysemia vs. Chronic Bronch sxs:

Onset

Dyspnea

Cough

Sputum Production

Sputum Appearance

A

Onset: E = > 50, B = 30s-40s

Dyspnea:
E = progressive, constant, severe
B = intermitt, mild-mod

Cough:
E = absent -mild
B = persistent, severe

Sputum Production:
E = absent - mild
B = persistent, severe

Sputum Appearance:
E = clear, mucoid
B = mucopurulent

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14
Q

COPD presentation?

A

(U) 50s/60s
Dyspnea OE -> DAR
Chronic cough (U) a.m.
Sputum

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15
Q

Asthma definition?

A

Chronic inflamm of AIRWAYS
(U) eosinophils

Hyper-reactive airway -> ↑ secretion, mucosal edema, C of bronch sm mm

Reversible

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16
Q

COPD risk factors?

A
Smoking (80%)
Pollution
2nd hand smoke
Airway hyper-response
Genetic RF (⍺1 anti-trypsin deficiency)
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17
Q

Cigarette smoke mechanism of destruction? (2)

A

stims elastase -> degenerated elastin/alveolar structures

releases cytotoxic oxyrads from WBC

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18
Q

⍺1 Antitrypsin Deficiency (AATD)?

A

AAT is protease inhibitor

w/o AAT elastase/proteases destroy lung tissue

smoking accelerates destruction

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19
Q

COPD physical exam, look for?

Mouth

Neck

Chest

Lungs

Percussion

Heart

Abdomen

Ext

A

Mouth: tobacco staining

Neck: masses, JVD

Chest: ↑ AP diameter, accessory mm use, breathing rate/effort, central cyanosis

Lungs: ↓ breath sounds, rhonchi, wheeze, crackles; prolonged exhale, purse-lip breathing

Percussion: hyper-resonance

Heart: (P) gallop, RV lift, PMI

Abdomen: (P) hepatomegaly, tender

Ext: cyanosis, clubbing, mm wasting, tobacco stain fingers, peripheral edema

20
Q

COPD diagnositcs:

CBC

ABG

EKG

Sputum

A

CBC = (U) normal, (P) late polycythemia

ABG (Arterial blood gases) = hypoxemia, hypercarbia

EKG = sinus tachy, peaked P, R axis deviation, RVH

Sputum = gram stain, culture

21
Q

CXR findings:

Emphysema

Chronic Bronch

A

Emphysema = hyperinflation w/ (P) bullae,
flat diaph,
enlarged retrosternal air space

Chronic Bronch = cardiac enlargement,
pulmonary congestion,
↑ lung markings

22
Q

CXR vs CT for COPD?

A

CT = higher resolution but not necessary for routine

23
Q

PFT (plumonary fxn tests):

FVC

FEV1

FEV1/FVC

A

HALLMARK of dz

FVC (forced vital capacity) =
amount forcefully exhaled after max inspiration,
(U) N w/ COPD,
↓ w/ restrictive

FEV1 (forced exp vol in 1 sec) =
(N is >80% of predicted value)
↓ w/ obstructive

FEV1/FVC =
(N is 70-80%)
↓ w/ N FVC is obstructive

24
Q

Stage I: Mild COPD characteristics?

A

FEV1/FVC =80% w/ or w/o sxs

25
Q

Stage II: Mod COPD characteristics?

A

FEV1/FVC < FEV1 < 80%

DOE w/ or w/o cough/sputum

26
Q

Stage III: Severe COPD characteristics?

A

FEV1/FVC < FEV1 < 50%

↑ dysp, ↓ exercise capacity, fatigue, repeat exacerbation

27
Q

Stage IV: Severe COPD characteristics?

A

FEV1/FVC < 30%

or <50% w/ respiratory failure

28
Q

Steps to evaluating Obstructive Dz?

A

1st: Obstructive pattern? (FEV1/FVC < 70%)

2nd: Severity/Stage? (FEV1 post bronchodilator)
FEV1 % predicted?
FEV1 ↑ >12% (if yes = asthma)

3rd: Sxs/Exacerb? (mMRC or CAT)
0-1 or >2 exacer/ >=1 hospitalization

29
Q

mMRC Scale?

A

0 = breathless only w/ strenuous exercise

1 = SOB hurrying on level ground, or walking up slight hill

2 = walk slower on level ground, or stop for breath if walk at regular pace

3 = stop for breath 100 yds or few minutes on level ground

4 = too breathless to leave house or breathless when dressing

30
Q

Smoking Cess 5-A approach?

A
Ask abt tobacco
Advise to quit
Assess willingness
Assist w/ quitting
Arrange support f/u
31
Q

Bronchodilators for COPD?

A

β2-agonists and anticholingergics

Inhaled (site specific vs systemic): hydrofluoroalkane

Helps by bronchdil, ↑ ciliary mvmt, ↑ diaph action, ↑ cardiac contract

Φ effect on secretions

32
Q

β2-agonists help COPD how?

A

Helps by bronchdil,
↑ ciliary mvmt,
↑ diaph action,
↑ cardiac contract

Φ effect on secretions

33
Q

β2-agonists: short acting?

β2-agonists: long acting?

A

albuterol

salmeterol
formoterol

34
Q

Anticholinergics help COPD how?

A

bronchodia
↓ air trapping
less cardiac stim

35
Q

Anticholinergics: short acting?

Anticholinergics: long acting?

A

ipratropium bromide

tiotropium bromide

36
Q

Corticosteriods help COPD how?

A

Inhaled for maintenance

↓ mucosal edema/inflamm
inhibit prostaglandins
↑ response to βs

37
Q

Theophylline (Methylxanthine) common toxicities?

A

tachycard, arrhy, seizures

don’t use anymore

38
Q

PDE-4 Inhibitor helps COPD how?

Indications for use?

Drug name?

A

anti-inflamm - suppresses cytokine release,
inhibits neutrophils and WBCs from lungs

add-on to bronchodia in refractory cases

roflumilast

39
Q

Methods to mobilize secretions? (4)

A

1) Moisture: PO and humidify
2) Postural drainage (not effective)
3) Expectorants (not effective)
4) Mucolytic agents (in-pt only)

40
Q

Antiprotease therapy used for?

A

for ⍺1-antitryp deficiency

controversial

41
Q

Pursed lip breathing, why?

A

causes outflow resistance at lips ->
↑ intrabronch pressure ->
keeps bronch open ->
↑ expelled air

42
Q

Early signs of pulmonary infection? (6)

A
↑ sputum
fever
↑ dysp
fatigue
chest pain
hemoptysis
43
Q

Acute exacerbation of COPD management?

A

↑ frequency of short-act β2-agonists
steroids (↓ recovery and hospit)
antibiotics

44
Q

COPD and low respir infections common why?

Etiology?

A

↓ expectoration causes colonization of bacteria,
virals become co-infected

H. influ, S. pneumo, M. catarrhalis,
Pseudomonasaeruginosa

45
Q

Antibiotics for low resp infection (outpt)? (4)

A

Macrolides (azithro, clarithro)

Fluoroquinolones (levofloxacin, maxiflozacin)

Augmentin

Doxy

Trimeth-Sulfmeth

Cephalosporins (cefdinir)

46
Q

Hospitalization for COPD when?

A
↑ intensity of sxs
New physical signs (cyanosis, edema, etc)
Failure to respond to meds
Significant co-morbids
Frequent exacerbations
↑ age
Insuff home support
47
Q

Supplemental O2 used when?

For how long?

Concerns w use?

A

pO2 less than 55 or sat less than 88%

At least 12 hrs/day

Reduce urge to breathe, result in acidosis