COPD Flashcards
Smoker reduction in FEV1
40ml/year
Alpha 1 antitrypsin deficiency
COPD
LFT abnormalities
cirrhosis
empheysema
enlargement of air spaces with destruction of alveolar walls
centriacinar
respiratory bronchioles distal to terminal bronchiole, remainder of acinus sparred
smoking
panacinar
alveolar ducts
adjacent alveoli
coalescence and bullae
alpha 1 antitrypsin deficiency
sites of airway obstuction
distal airways of less then 2mm
PE
distant heart sounds diminished breath sounds pedal edema distended jugular vv hepatic congestion cachexia
Mild
FEC1/FVC < 70%
FEC1 >=80% predicted
moderate
FEC1/FVC < 70%
FEV1 50-80% predicted
severe
FEC1/FVC < 70%
FEV1 30-50% predicted
very severe
FEC1/FVC < 70%
FEV1 30-50%, with chronic respiratory failure
Rx
beta adrenergic agonists- inhaled anticholingerics- inhaled methylxanthines phosphodiesterase-4 inhibitors corticosteriods
short acting beta 2 agonists
albuterol
levalbuterol
long acting beta 2 agonists
salmeterol
formoterol
short acting anticholinergics
ipatropium bromide
long acting anticholinergics
tiotropium
methylantines
thophylline oral
antagonizes adenosine Rs, increased cAMP, weak bronchodilator, close monitoring, narrow therapeutic window, numerous side effects and drug interactions
phosphodiesterase 4 inhibitor
roflumilast
corticosteroids
when inhaled reduces COPD exacerbations and added benefit when combined w/long acting beta agonist
systemic has not been shown to help and has lots of side effects
immunizations
influenza
penumococcus
bacterial infections
H. influenza
S. penumoniae
M. catarrhalis
less common- psudomonas and enteric bacilli
viral infections
rhino
influenza
RSV
