COPD Flashcards by Joanna Flores

what are pharmacological recommendations for cold per GOLD 2025

bronchodilators (laba, lama)
ics

if symptoms persist, then escalate LABA/LAMA OR LABA-ICS COMBO

INTRODUCTION OF NEW THERAPIES SUCH AS :
ENSIFENTRINE
DUPILUMAB

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WHAT ARE SURGICAL RECOMMENDATION FOR COPD PER GOLD 2025

LUNG VOLUME REDUCTION THERAPY

BRONCHOSCOPIC LUNG VOLUME REDUCTION (I.E ENDOBRONCHIAL COILS OR ENDOBRONCHIAL VALVES)

BULLECTOMY

LUNG TRANSPLANATAION

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WHAT ARE THERAPY RECOMMENDATIONS FOR COPD PER GOLD 2025

SMOKING CESSATION

VACCINATIONS

PULM REHAB

PHARM TX
BRONCHODILATORS
ICS
ENSIFENTRINE

LUNG VOLUME REDUCTION SURGERY

BRONCHOSCOPIC LUNG VOL REDUCTION

O2 THERAPY

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WHAT ARE THE NUTRITION RECOMMENDATIONS FOR COPD PER GOLD 2025

CHOOSE COMPLEX CARBS

ADEQUEATE AMOUNT OF PROTIENS

OPT FOR HEALTHY FATS

ENSURE VITAMINS AND MINERALS (D, C, AND E AND POTASSIUM AND CALCIUM)

LIMIT PORCESSED FOODS

INCREASE HYDRATIONS

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WHAT TESTING RECOMMENDATIONS FOR COPD PER GOLD 2025

SPIROMETRY (PRE/POST BRONCHODILATOR)

LOW DOSE CT

CARDIOVASCULAR EVAL

PULM HYPERTENSION SCREENING

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WHAT ARE THE DIFFERENT TYPES OF FREQUENCIES PER GOLD 2025 FOR COPD

EXACERBATION

SYMPTOM

MEDICATION USE

02 THERAPY

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WHAT IS THE DIFFERENCE BETWEEN RESCUE OR RELIVER FOR COPD

USED INTERCHANGEABLY

THESE MEDICATIONS ARE TYPICALLY SHORT ACTING THAT WORK QUICKLY TO RELAX THE MUSCLES AROUND THE AIRWAYS

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PRN MEDICATIONS PER GOLD 2025 FOR COPD

GROUP A - LOW SYMPTOMS/LOW EXACERBATION

GROUP B - HIGH SYMPTOMS/LOW EXACERBATION

GROUP E - HIGH EXACERBATION

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WHAT IS THE DIFFERENCE BETWEEN MAINTENANCE MEDS AND RESCUE/RELIEVER

MAINTENANCE - SCHEDULED TIME USE//DAILY AND REGULAR BASIS

RESCUE/RELIEVER - AS NEEDED/PRN//FOR IMMEDIATE SYMPTOMS

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WHAT ARE EXAMPLES OF MAINTENANCE THERAPY

LABA

LAMA

ICS

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WHAT DO THE ABBREVIATIONS MEAN

BID

TID

QID

Q6H

QD - EVERY DAY

BID - 2X A DAY

TID - 3X A DAY

QID - 4X A DAY

Q6H - EVERY 6 HOURS

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HOW DOES A ABG LOOK LIKE FOR COPD PT

PH - ACIDOIC

PACO2 - ELEVATED

PA02 - LOWER

HC03- ELEVATED

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HOW DOES A PFT LOOK LIKE FOR COPD PT

FVC -DECREASED
FEV1 - DECREASED
FEV1/FVC RATIO - DECREASED
PEF - DECREASED
PEF 50% - DECREASED
PEF200-1200 -DECREASED

TIDAL VOL -NORMAL OR INCREASED
IPV - NORMAL OR DECREASED
ERV - NORMAL OR DECREASED
RV - NORMAL OR INACREASED

VC -DECREASED
IC - NORMAL OR DECREASED
FRC - INCREASED

TLC - NORMAL OR INCREASED
RV/TLC RATIO NORMAL OR INCREASED

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WHAT THERAPIES ARE USED TO ASSESS FOR IN ACUTE COPD EXACERBATION

SHORT ACTING BRONCHODILATORS (SABA FIRST LINE THERAPY)

SAMA - IPATROPIUM (ATROVENT)

COMBINATION THERAPY SABA + SAMA USED FOR BETTER SYMPTOM RELIEF AND INCREASED EFFECTIVENESS

SYSTEMIC STEROIDS (ORAL OR IV)

ABX - IF EXACERBATION IS LIKELY DUE TO A BACTERIAL INFECTION, PARTICULARLY IN PT WITH INCREASED SPUTUM PURULENCE OR WORSENG OF BASELINE SYMPTOMS

O2 THERAPY - GOAL SPO2 88-92%

EVALUATE FOR NIV
ASSESS FOR MECH VENT

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HOW DOES A CHEST XRAY LOOK LIKE FOR A COPD PT

COMMON FINDINGS

TRANSLUCENT (DARK) LUNG FIELDS

DEPRESSED OR FLATTENED DIAPHRAGM

LONG AND NARROW HEART (PULLED DOWNWARD BY DIAPHRAGM)

INCREASED RETROSTERNAL OR SPACE (LATERAL RADIOGRAPH)

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WHAT LABORATORY TESTS ARE DONE FOR

HCT/HGB - POLYCYTHERMIA

ELECTROLYTES (EARLY AND LATE STAGES) - HYPOCHLOREMIA

HYPERNATREMIA (NA+)

SPUTUM EXAM - SPRETOCOCUS PNEUMONAIE
HEAMOPHILLUS INFLUENZAE
MORAXELLA CATARRHALIS

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BREATH SOUNDS FOR COPD PT

WHEEZE OFTEN SEEN EXPIRATION

DECREASED BREATH SOUNDS - DUE TO HYPERINFLATION AND AIR TRAPPING

CRACKLES OR RALES IN PT WITH CONSISTENT PULM INFECTIONS

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WHAT IS A PINK PUFFER

A TERM USED TO DESCRIBE AN EMPHYSEMA OR COPD PT

PT HAVE BARREL CHEST DUE TO HYPERINFLATION

PUFFER REFERS TO THE FACT THESE PT ARE PURSED LIPPED

PT OFTEN REFERS TO THE FACT THE PT APPEARS WELL OXYGENATION (PINK SKIN TONE)

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WHAT IS A BLUE BLOATER

A TERM USED TO DECSRIBE COPD PT WITH PREDOMINATELY CHRONIC BRONCHITIS

THESE PT TEND TO HAVE A CHRONIC COUGH, SPUTUM PORDUCTION AND CYANOSIS DUE TO SEVERE HYPOXEMIA

MAY DEVELOP RIGHT HEART FAILURE DUE TO LONG TERM PULM HYPERTENSION FROM HYPOXEMIA

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HOW DOES THE BP LOOK FOR COPD PT

PULSE PRESSURE CAN BE WIDENED WHICH MAY INDICATE CARDIOVASCULAR STRAIN

ELEVATED SYSTOLIC BP

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WHAT ARE THE 2 TYPES OF EMPHYSEMA

PANACINAR - ABNORMAL WEAKENING AND ENLARGEMENT OF ALL ALVEOLI DISTAL TO THE TERMINOLE BROCHIOLES
CENTRIACINAR - INVOLVE THE RESP BRONCHIOLES IN THE PROXIMAL (CENTRAL) PORTION OF THE ACINUS

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MAJOR PATHOLOGIC OR STRUCTURAL CHANGES THAT ARE ASSOCIATED WITH CHRONIC BRONCHITIS

CHRONIC INFLAMMATION AND THICKENING OF THE WALLS OF THE PERIPHERAL AIRWAYS
EXCESSIVE MUCUS PRODUCTION AND ACCUMULATION

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WHAT IS CHRONIC BRONCHITIS

THE PRESENCE OF A COUGH AND SPUTUM PRODUCTION FOR 3 MONTHS IN EACH CONSECUTEIVE YEARS, REMAIN A CLINICALLY AND EPIDEMICOLOGICALLY USEFUL BUT IT IS PRESENT IN A MINORITY OF SUBJECTS

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WHAT IS EMPHYSEMA

CHARACTERIZED BY A WEAKENING AND PERSISTENT ENLARGEMENT OF THE AIR SPACES DISTAL TO THE TERMINAL BRONCHIOLES AND BY THE DESTRUCTION OF THE ALVEOLI WALLS

WHAT HAPPENS TO THE DISTAL AIRWAYS IN EMPHYSEMA

WEAKENED HAVE MUCUS BUILD UP AND TEND TO COLLAPSE DURING EXPIRATION IN RESPONSE TO INCREASED INTRAPLEURAL PRESSURE

WHAT ARE THE RISK FACTORS FOR COPD

GENETIC FACTORS - ALPHA 1 ANTITRYPSIN DEF AGE AND GENDER - AS A PERSON AGES THE RISK INCREASES GREATER AMONG MEN LUNG GROWTH AND DEVELOPMENT - ISSUES DURING GESTATION AND CHILDHOOD HAS POTENTIAL TO IMPACT FOR COPD EXPOSURE TO PARTICLES: TOBACCO OCCUPTAIONAL EXPOSURE INDOOR/OUTDOOR AIR POLLUTION SOCIOECONIMIC STATUS - POVERTY IS A CLEARLY A RISK FACTOR FOR COPD BRONCHIAL/ASTHMA HYPERSENSITIVITY CHRONIC BRONCHITIS RESP INFECTIONS DYSPANAPSIS

WHAT IS DYSPANPSIS

HAS BEEN INTRODUCED TO REFER TO A MISMATCH BETWEEN THE NORMAL CALIBER OF TEH AIRWAYS AND THE LUNG PARENCHYCHEMA CAPACITY

WHAT TEST IS REQUIRED TO DX COPD

SPIROMETRY SHOWING A POST BRONCHIDILATOR FEV1/FVC OF LESS THAN 0.7

WHAT 3 MAIN SPIROMETRY TESTS ARE USED TO MEASURE THE SEVERITY OF AIRFLOW LIMITATION

FVC FEV1 FEV1/FVC RATIO

WHAT ARE THE QUESTIONANIRES USED TO ASSESS SYMPTOMS

mMRC BREATHLESSNESS SCALE COPD ASSESSMENT TEST

ATS DEFINITION OF PT WITH COPD

BRONCHITIS - BASED ON MAJOR CLINICAL MANIFESTATIONS ASSOCIATED WITH THE DISEASE EMPHYSEMA - IS BASED ON PATHOLOGY

PT WITH COPD WHAT IS NORMALLY PRESENT

BRONCHITIS AND EMPHYSEMA

ANATOMIC ALTERATIONS ASSOCIATED WITH BRONCHIATITS

CHRONIC INFLAMM ABD THICKENING OF THE WALL OF THE PERIPHERAL AIRWAYS EXCESSIVE MUCUS PRODUCTION AND ACCUMULATION PARTIAL OR TOTAL MUCUS PLUGGING SMOOTH MUSCLE CONSTRICTION OF THE BRONCHIAL AIRWAYS AIR TRAPPING AND HYPERINFLATION OF ALVEOLI

ANATOMIC ALTERATIONS ASSOCIATED WITH EMPHYSEMA

PERSISTENT ENLARGEMENT AND DESTRUCTION OF THE AIR SPACES DISTAL TO THE TERMINAL BRONCHIOLES DESTRUCTION OF ALVEOLAR CAP MEMBRANE WEAKENING OF THE DISTAL AIRWAYS, PRIMARILY THE RESP BRONCHIOLES AIR TRAPPING AND HYPERINFLATION

ETIOLOGY AND EPIDEMIOLOGY OF COPD

ESTIMATED BETWEEN 10-15 MILLION PEOPLE IN THE US STATES EITHER HAVE CHRONIC BRONCHITIS, EMPHYSEMA, OR A COMBINATION OF BOTH

RISK FACTORS ACCORDING TO GOLD

GENETIC PRE-DISPOSITION AGE AND GENDER CONDITIONS THAT AFFECTS NORMAL LUNG GROWTH EXPOSURE TO PARTICLES SOCIOECONIMIC STATUS ASTHMA/BRONCHIAL HYPERSENSITIVITY CHRONIC BRONCHITIS RESP INFECTIONS TB

KEY INDICATORS FOR CONDISERING COPD IN PT OVER 40

DYSPNEA CHRONIC COUGH CHRONIC SPUTUM HX OF EXPOSURE TO RISK FACTORS FAMILY HX OF COPD

GOLD RECOMMENDS COMBINING ALL THE ABOVE ASSESSMENTS TO DETERMINE COPD

SYMPTOM ASSESMENT AIR FLOW LIMITATION ASSESMENT RISK OF EXACERBATION ASSESSMENT

ADDITIONAL SCREENING TOOLS TO DX COPD

BODE INDEX CHEXT RADIOGRAPHS CT OF CHEST LUNG VOL AND DIFFUSING CAPACITY OXIMETRY AND ABG ALPHA 1 ANTITRYPSIN DEF SCREENING EXERCISE TESTING

INSPECTION SIGNS FOR COPD

PURSED LIP BREATHING COUGH MUCUS PRODUCTION

HOW DOES THE PALPATION OF THE CHEST IN EMPHYSEMA

DECREASED TACTILE FREMITUS DECREASED CHEST EXPANSION PMI SHIFTS TO THE EPIGASTRIC AREA

HOW DOES THE PALPATION OF THE CHEST IN CHRONIC BRONCHITIS

NORMAL

HOW IS THE PERCUSSION OF THE CHEST IN EMPHYSEMA

HYPERRESONANCE DECREASED DIAPHTAGMATIC EXCURSION

HOW IS THE PERCUSIION OF THE CHEST CHRINIC BRIONCHITIS

NORMAL

HOW IS THE AUSCULATAION OF THE CHEST FOR EMPHYSEMA

DIMINISHED BREATH SOUNDS PROLONGED EXPIRATION DIMINISHED HEART SOUNDS

HOW IS AUSCULTATION OF THE CHEST FOR CHRONIC BRONCHITIS

CRACKLES WHEEZE

WHAT IS A TELL TALE SIGN OF EMPHYSEMA

DECREASED DLCO

WHAT ARE 2 DANGEROUS ABG SITUATIONS FOR EMPYSEMA AND CHRONIC BRONCHITIS

1.ACUTE ALVEOLAR HYPERINFLATION SUPERIMPOSED ON A CHRONIC VENTILATIORY FAILURE 2. ACUTE VENTILATORY FAILURE (ACUTE HYPOVENTILATION)SUPERIMPOSED ON CHRONIC VENTILATORY FAILURE

HOW DOES HCT/HGB LOOK LIKE IN CHRONIC BRINCHITIS

POLYCYTHEMIA

HOW DOES ELECTROLYTES LOOK LIKE CHRONIC BRONCHITIS

HYPOCHLOREMEIA HYPERNATREMIA (NA+)

HOW IS SPUTUM IN EMPHYSEMA

NORMAL

HOW IS SPUTUM IN CHRONIC BRONCHITIS

STREPTOCOCCUS PNEUMONIAE HAEMOPHILUS INFUENZAE MORAXELLA CATARRHALIS

HOW DOES A BRONCHOGRAM LOOK LIKE FOR CHRONIC BRONCHITIS

SMALL SPIKELIKE PROTRUSIONS

HOW DOES CHEST RADIOGRAPH LOOK LIKE FOR CHRONIC BRONCHITIS

LUNGS MAY BE CLEAR IF ONLY IN LARGE BRONCHIOLES OCCASSIONALLY TRANSLUCENT DEPRESSED OR FLATTENED DIAPHRAGM

HOW DOES THE MANAGEMENT OF STABLE COPD LOOK LIKE

REDUCE EXPOSURE TO RISK FACTORS PHARMALOGIC TX NON PHARMOLOGIC TX

WHAT ARE THE COPD GRADES BASED ON SEVERITY OF AIRFLOW

GARDE 1 - MILD = FEV1 GREATER OR EQUAL TO 80% GRADE 2 - MODERATE = FEV1 50% LESS THAN 80% GRADE 3 - SEVERE = 30% LESS THAN 50% THAN PREDICTED GRADE 4 - VERY SEVERE = FEV 1 LESS THAN 30%

TX FOR GRADE 1 COPD

LABA + LAMA GROUP A - A BRONCHODILATOR GROUP B - LABA/LAMA

WHAT IS THE PHARMACOLOGIC MANAGEMENT OF COPD

GROUP A - SABA/LABA PRN GROUP B - LABA-LAMA MAINTENANCE SABA PRN GROUP E - LABA-LAMA (ASSESS FOR ICS) MAINTENANCE SABA PRN