COPD Flashcards
The physiologic marker of COPD
Airflow obstruction
Hallmark of COPD
Extensive small airway obstruction
Principal component of elastic fibers.
Critical for lung integrity.
Elastin
____ in COPD may worsen oxidative stress
Mitochondrial dysfunction
The major site of increased resistance in most individuals with COPD is in airways </= 2mm diameter
Small airways
Cough and mucus production
Chronic bronchitis
Characterized by destruction of gas-exchanging structures:
Respiratory bronchioles.
Alveolar ducts.
Alveoli.
Emphysema
Type of emphysema most frequently associated with cigarette smoking
Centrilobular
Centrilobular emphysema is usually most prominent in the ____
upper lobes
superior segment of lower lobes
Type of emphysema seen in α1-Antitrypsin Deficiency.
Panlobular
Type of emphysema distributed along pleural margins.
Relative sparing of lung core/central regions.
Paraseptal
The classic definition of COPD
persistent reduction in forced expiratory flow rates.
Volume of air exhaled in the first second of forced expiration.
FEV1
Total volume of air exhaled during the spirometric maneuver.
FVC
FEV₁/FVC Ratio is ____ in COPD
reduced
COPD shows ____ in FEV₁ with inhaled bronchodilators (≤15%).
minimal improvement
PaCO₂ (Arterial Carbon Dioxide Pressure):
elevation typically not seen until FEV₁ <__% of predicted.
25
PaO₂ (Arterial Oxygen Pressure):
remains near normal until FEV₁ <__% of predicted.
50
______ accounts for essentially all of the reduction in Pao 2 that occurs in COPD
Ventilation-perfusion mismatching
____ was a major risk factor for mortality from chronic bronchitis and emphysema
Cigarette smoking
______ is the most highly significant predictor of FEV 1
Pack-years of cigarette smoking
Individuals with ___ Z alleles or ___ Z and ____ null allele are referred to as PiZ , which is the most common form of severe α 1 AT deficiency.
two
one
one
The three most common symptoms in COPD are ___
cough, sputum production, and exertional dyspnea.
Signs of hyperinflation include a ____
barrel chest and enlarged lung volumes with poor diaphragmatic excursion as assessed by percussion.
Some patients with advanced disease have paradoxical inward movement of the rib cage with inspiration
Hoover’s sign
In COPD patients, the development of _____ is the most likely explanation for newly developed clubbing
lung cancer
The hallmark of COPD is ____
airflow obstruction
The degree of ____is an important prognostic factor in COPD and is the basis for the GOLD spirometric severity classification
airflow obstruction
It has been shown that a multifactorial index _____ is a better predictor of mortality.
(BODE) body mass index, airflow obstruction, dyspnea, exercise performance
An elevated ___ in ABG suggests the presence of chronic hypoxemia, as does the presence of signs of right ventricular hypertrophy.
hematocrit
CXR: Increased lung volumes, flattened diaphragm.
Hyperinflation
CXR: Bullae, hyperlucency, paucity of parenchymal markings.
Emphysema
______ is the current definitive test for establishing the presence or absence of emphysema, the pattern of emphysema, and the presence of significant disease involving medium and large airways
Chest CT scan
Smokers with COPD are at high risk for development of ____
lung cancer
Recent guidelines have suggested testing for _____ in all subjects with COPD or asthma with chronic airflow obstruction.
α1 AT deficiency
Triple Inhaled Therapy:
Components:
Long-acting beta agonist (LABA) bronchodilator.
Long-acting muscarinic antagonist (LAMA) bronchodilator.
Inhaled corticosteroid (ICS).
In general, _____ are the primary treatment for almost all patients with COPD and are used for symptomatic benefit and to reduce exacerbations
bronchodilators
The most frequent side effect of muscarinic antagonist
Dry mouth
The most frequent side effect of beta agonists
tremor tachycardia
The main role of ____is to reduce exacerbations.
ICS
Use of inhaled corticosteroids has been associated with increased rates of ____ and pneumonia and in some studies an increased rate of _____ and development of cataracts.
oropharyngeal candidiasis
loss of bone density
____ is the only pharmacologic therapy demonstrated to unequivocally decrease mortality in patients with COPD.
Supplemental O2
Resting hypoxemia (resting O2 saturation ___% in any patient or ___% with signs of pulmonary arterial hypertension, right heart failure or erythrocytosis)
≤88
≤89
This refers to a comprehensive t ment program that incorporates exercise, education, and psychosocial and nutritional counseling.
Pulmo Rehab
Patients with ____ lobe–predominant emphysema and a low postrehabilitation exercise capacity are most likely to benefit from LVRS.
upper
____ is currently the second leading indication for lung transplantation.
COPD
The strongest single predictor of exacerbations is ____
a history of a previous exacerbation.
Other factors, such as an ___ and ____, are also associated with increased risk of COPD exacerbations.
elevated ratio of the diameter of the pulmonary artery to aorta on chest CT
gastroesophageal reflux
The single greatest risk factor for hospitalization with an exacerbation is a ___
history of previous hospitalization.
The need for inpatient treatment of exacerbations is suggested by the presence of respiratory acidosis and hypercarbia, new or worsening hypoxemia, severe underlying disease, and those whose living situation is not conducive to careful observation and the delivery of prescribed treatment.
Bacteria frequently implicated in COPD exacerbations include ____
Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Chlamydia pneumoniae
In patients admitted to the hospital, the use of _____reduces the length of stay, hastens recovery, and reduces the chance of subsequent exacerbation or relapse.
systemic glucocorticoids
_____, is the most frequently reported acute complication of glucocorticoid treatment.
Hyperglycemia
Supplemental O2 should be supplied to maintain oxygen saturation ___
≥90%.
Contraindications to NIPPV include ___
cardiovascular instability, impaired mental status, inability to cooperate, copious secretions or the inability to clear secretions, craniofacial abnormalities or trauma precluding effective fitting of mask, extreme obesity, or significant burns.
Among stable COPD patients in the primary care setting with FEV1≥80% or mmRC<2* and are not in exacerbation, we suggest the use of ______
LAMA monotherapy over LABA monotherapy or LABA/LAMA combination therapy
Among stable COPD patients in the primary care setting with FEV1<80% or mmRC≥2* with increased risk for exacerbations and absence of concurrent respiratory infection*
inhaled corticosteroids in combination with inhaled long-acting bronchodilators
Among outpatients with COPD, we recommend initiation of oral antibiotics in the presence of at least two of the following symptoms: _____
increased dyspnea, increased frequency of cough
increased sputum volume or purulence
Among patients with advanced-stage or end-stage COPD and/or refractory dyspnea, we suggest to consider the use of ____ with close supervision to relieve dyspnea that persists despite maximized medical management
opioids
Among symptomatic COPD patients with moderate to severe breathlessness,** who are not hypoxemic, and does not fulfill criteria for long-term oxygen therapy (LTOT), we suggest using _____ for relief of dyspnea with caution and close supervision of attending physician
low flow oxygen therapy
Among COPD patients in acute exacerbation with worsening symptoms and not responding to bronchodilators, we recommend the use of short course*** ______ in the primary care setting
oral steroids
Among patients with COPD, we recommend the use of ____ in the management of acute exacerbation. In situations where it is not readily available, ____ may be used
SABA+SAMA (combination therapy)
Among stable COPD patients in the primary care setting with FEV1<80% or mMRC≥2* and are not in exacerbation, we suggest the use of ____ over ____
LAMA over LABA
A 62-year-old male with COPD has a history of 0 exacerbations in the past year and reports occasional dyspnea but no significant daily symptoms (mMRC 1, CAT 8). Which initial treatment is most appropriate?
A) Long-acting muscarinic antagonist (LAMA)
B) Long-acting beta agonist (LABA)
C) Inhaled corticosteroid (ICS)
D) Short-acting bronchodilator
D
A patient with COPD presents with two exacerbations in the past year, one requiring hospitalization. The patient’s CAT score is 15. Which treatment option is most appropriate?
A) LAMA
B) LABA
C) LAMA + LABA
D) ICS + LABA
A
A 68-year-old female with COPD reports a CAT score of 22 and two moderate exacerbations in the past year. Which therapy should be considered?
A) LAMA
B) LAMA + LABA
C) ICS + LABA
D) LABA only
B
For a COPD patient in Group D with eosinophil counts ≥300 cells/μL, which treatment is specifically indicated?
A) LAMA
B) LAMA + LABA
C) ICS + LABA
D) Triple therapy (ICS + LABA + LAMA)
C
