COPD Flashcards
Describe staging of COPD
All stages FEV1/FVC < 70%
Stage I: FVC > 80% predicted
Stage II: FVC btw 50-80%
Stage III: FVC btw 30-50%
Stage IV: FVC <50 plus chronic respiratory failure
What are normal diffusing capacities in women and men?
> 6 mL CO/mmHg in women
> 8.1 mL CO/mmHg in men
Pathophysiology of COPD
Hyperplasia of mucus glands and narrowing of small airways
–> airway edema, excess mucus production, loss of ciliary transport
How does COPD cause alveolar destruction?
Cigarette smoke causes an inbalance between elastase and antitripsen. Elastase breaks down alveolar walls and so airspace is increased causing diffusing capacity of CO to drop
What is the diagnostic tool for COPD?
Spirometry
FEV1/FVC < 70%
What are the classic radiographic findings in empysema?
Flattening of diaphragm
Blunting of costophrenic angle
Enlargement of retrosternal space
When should you check blood gases?
If a patient’s O2 sat < 92%
When a patient is diagnosed in Stage III or IV they should have these on file
What are the main goals of treatment?
- Slow progression
- Prolongation of survival
- Prevention and management of exacerbations
What is the first line treatment for patients w/ COPD?
Bronchodilators
–> SABA or LABA
How to treat COPD Stage I
Reduce risk factors
SABA when needed
How to treat COPD Stage II
Reduce risk factors, SABA when needed…Add LABA and rehab
How to treat COPD Stage III
Reduce risk factors, SABA or LABA bronchodilators and rehab… Add ICS
How to treat COPD Stage IV
Reduce risk factors, SABA or LABA bronchodilators w/ rehab, ICS, add long term O2 and consider surgery if severe
What are the causes of exacerbations of COPD?
40% tracheobronchial infections
30% atypical infections
6-9% atmospheric pollution
How do you treat COPD exacerbations?
Abx: macrolides, doxycline
Increase bronchodilator therapy
Add corticosteroids
