COPD Flashcards
COPD characteristics
Cluster of disorders of bronchi, conducting airways, and lung parenchyma
Characterized by airflow limitation, progressive, not fully reversible
Assoc c inflammatory response of lungs
Bronchitis =
Chronic, persistent cough and/or sputum production for 3 consecutive months each year for 2 consecutive years with periodic acute exacerbations in which the symptoms worsen
Emphysema
Permanent and abnormal enlargement of any part of the air spaces distal to the terminal bronchioles. Also involves destruction of the alveolar walls without fibrosis
Risk Factors
Smoking Airway hyperreactivity Childhood respiratory infections Occupational disorders Age Air pollution Passive exposure to smoke Poor nutrition Low SE status Crowded living conditions Family members c COPD Alpha 1-antitrypsin deficiency
Symptoms
Coughing Sputum production Dyspnea on exertion Orthopnea soon after reclining these are not diagnostic
Criterion:
FEV1/FVC ratio <70% of expected
Complications
COPD associated hemoptysis can be caused by airway mucosal erosion from coughing but also consider CA or underlying infection like TB
Consider severe nocturnal hypoxia or hypercapnea if COPD pt presents with persistent morning HA
DD Chronic cough
Asthma Bronchiectasis TB GERD Interstitial Lung dx Chronic sinusitis Chronic bronchitis Neoplasm Congenital heart dz Cardiac dz (CHF, mitral stenosis) Medications (ACE, amiodarone)
DD Dyspnea
Asthma Cystic Fibrosis Interstitial Lung dz Pulm embolism Pulm HTN AV malformation other pulm. vascular dz's Phrenic nerve dysfxn Neuromusc dz Kyphoscoliosis/chest wall abnormalities Malignancy anemia Obesity Ascites Metabolic acidosis Hyperthyroidism Congenital heart dz Abnormal hemoglobinpathies Hereditary emphysema (alpha 1-antitrypsin)
PE
Diminished breath sounds Prolonged expiratory time Early inspiration crackles Wheezing with forced expiration Increased resonance with chest percussion Increased anterioposterior diameter Distant heart sounds, sometimes best heard in epigastrum Tripod position
Dx
Forced Expiratory Time (FET) >6sec suggestive of COPD
Consider clinical dx of COPD in any pt with dyspnea, chronic cough or sputum production or hx of exposure to risk factors of the disease
Confirm dx with spirometry:
FEV1/FVC <70 confirms presence of airflow limitation that is not fully reversible
Dx Tests
Initial:
Spiromtery
Pulse ox
Lab:
CBC c diff
ABG as indicated
Alpha 1-antitrypsin if strong fam hx of premature emphysema or A 1-atr deficiency
Imaging:
CXR
Pharm tx
Bronchodilators = mainstay of tx Decrease airway tone 3 types Short-acting anticholingergics Beta-2 agonists Methylxanthines
regular tx with long-acting bronchodilators is more effective and convenient than tx with short-acting bronchodliators
Anticholinergics
Ipratropruim Bromide
MDI 18ncg/inhalation 2-4 Puffs: 4-6x/day
Neb soln: 500mcg/2.5mL 3-4x/day q6-8hrs
Beta-2 Adrenergic Agonists
Albuterol sulfate
MDI: 90mcg/inhalation 1-2 puffs; 3-4x/day
Neb soln: 0.5mL of 0.5% soln 3-4x/day
Can use PRN no >12x/day
Methylxanthines
Theophyline
Immediate release tablet: 10mg/kg/day in 4 divided doses
Sustained release tablet: 10mg/kg/day in 1-3 doses
