COPD Flashcards
usually observed in patients with 1AT deficiency,
Panacinar emphysema
usually observed in patients with 1AT deficiency,
Panacinar emphysema
usually observed in patients with 1AT deficiency,
Panacinar emphysema
patients with predominant emphysema
thin, noncyanotic at rest and have prominent use of accessory muscles
pink puffers
patients with predominant emphysema
thin, noncyanotic at rest and have prominent use of accessory muscles
pink puffers
most likely explanation for newly developed clubbing in COPD patient
development of lung cancer
hallmark of COPD
airflow obstruction
important prognostic factor in COPD and is the basis for the Global Initiative for Lung Disease (GOLD) redundant classification
degree of airflow obstruction
better predictor of COPD mortality rate than pulmonary function alone
airflow obstruction, exercise performance, dyspnea, and body mass index
GOLD classification
Stage I
Mild severity
FEV1/FVC
GOLD classification
Stage 0
At risk
Chronic cough, sputum production
Normal spirometry
GOLD classification
Stage IIa
FEV1/FVC
GOLD classification
Stage III
FEV1/FVC
GOLD classification
Stage IV
FEV1/FVC
change in pH per rise in PaCO2
- 08 units/10 mmHg acutely “Eight-cute”
0. 03 units/10 mmHg (chronic state)
ventilatory failure
PCO2 >45 mmHg
current definitive test for establishing the presence or absence of emphysema in living subjects
Computed tomography (CT) scan
Only three interventions demonstrated to influence the natural history of patients with COPD
- smoking cessation
- oxygen therapy in chronically hypoxemic patients
- lung volume reduction surgery
Evidence for tiotropium in COPD
trend toward reduced mortality rate in the tiotropium-treated patients that approached, but did not reach, statistical significance
Available data suggest that inhaled glucocorticoids reduce COPD exacerbation frequency by ___
25%
Evidence for theophylline in COPD
produces modest improvements in expiratory flow rates and vital capacity and a slight improvement in arterial oxygen and carbon dioxide levels in patients with moderate to severe COPD
common SE theophylline
Nausea
N-acetyl cysteine in COPD
mucolytic and antioxidant properties
Patients are excluded Lung Volume Reduction Surgery (LVRS)
significant pleural disease
pulmonary artery systolic pressure >45 mmHg
extreme deconditioning
congestive heart failure, or other severe comorbid conditions
criteria for Lung transplantation
lung transplantation should be
oral glucocorticoids in exacerbation
30-40 mg of oral prednisolone or its equivalent x 10-14 days
reduce the length of stay
hasten recovery
reduce the chance of subsequent exacerbation or relapse for a period of up to 6 months
Contraindications to noninvasive positive-pressure ventilation (NIPPV)
> cardiovascular instability
impaired mental status/unacooperative
copious secretions or unable to clear secretions
craniofacial abnormalities/ trauma precluding effective fitting of mask
extreme obesity
significant burns
most frequently reported acute complication of glucocorticoid treatment
Hyperglycemia
most frequently reported acute complication of glucocorticoid treatment
Hyperglycemia
Chronic obstructive pulmonary disease (COPD) definition
disease state characterized by airflow limitation that is not fully reversible (http://www.goldcopd.com/)
COPD
emphysema
chronic bronchitis
small airways disease
the most highly significant predictor of FEV1
pack-years of cigarette smoking
allele is associated with normal 1AT levels
M allele
associated with slightly reduced 1AT levels
S allele
associated with markedly reduced 1AT levels
Z allele
associated with markedly reduced 1AT levels
Z allele
most common form of severe 1AT deficiency
Individuals with two Z alleles or one Z and one null allele (PiZ)
