COPD

Question 1

COPD acronym

Answer 1

chronic obstructive pulmonary disease

Question 2

COPD definition

Answer 2

characterized by the presence of airflow obstruction due to chronic bronchitis or emphysema; the airflow obstruction is generally progressive, may be accompanied by airway hyperreactivity, and may be partially reversible

Question 3

chronic bronchitis diagnosis

Answer 3

excessive secretion of bronchial mucus and is manifested by daily productive cough for 3 months or more in at least 2 consecutive years.

Question 4

emphysema diagnosis

Answer 4

pathologic diagnosis that denotes abnormal permanent enlargement of air spaces distal to the terminal bronchiole, with destruction of their walls and without obvious fibrosis

Question 5

causes of COPD

Answer 5

Cigarette smoking
environmental tobacco smoke,
occupational dusts and chemicals, and
indoor air pollution from biomass fuel used for cooking
heating in poorly ventilated buildings
Outdoor air pollution,
airway infection,
familial factors
allergy
hereditary factors (deficiency of alpha-1-antiprotease [alpha-1-antitrypsin])
Atopy and the tendency for bronchoconstriction to develop in response to nonspecific airway stimuli may be important risks

Question 6

COPD have excessive lysis of what?

Answer 6

elastin and other proteins

Question 7

what are lung matrices elastace and other proteases derived from?

Answer 7

derived from lung neutrophils, macrophages, and mononuclear cells

Question 8

when do S&S of COPD occur?

Answer 8

6th-7th (60-70 y.o)

Question 9

S&S of COPD

Answer 9

dyspnea, sputum production, excessive cough

dyspnea initially b/c exertion, but as progresses occurs with minimal activity

pneumonia, pulmonary hypertension, cor pulmonale, chronic respiratory failure

Question 10

types of COPD

Answer 10

type A= pink puffer (emphysema predominant)

type B= blue bloater (bronchitis)

Question 11

COPD obstructive or restrictive and what happens to FEV1/FVC

Answer 11

obstructive
lower FEV1= lower ratio
have higher residual volume
an increase total lung capacity
increased residual vol/tot lung cap= more air trapped ie emphysema

Question 12

EKG finding in COPD

Answer 12

sinus tachycardia
supraventricular arrhythmias
ventricular irritability

Question 13

are COPD pt hypoxemia?

Answer 13

yes, low concentration of oxygen in blood

Question 14

are COPD pt respiratory acidosis or alkalosis?

Answer 14

respiratory acidosis

hypoventilation, more CO2 left in lungs

Question 15

possible differential diagnosis of COPD?

Answer 15

asthma, 
bronchiectasis, 
alpha-1-antiprotease (alpha-1-antitrypsin) deficiency
cystic fibrosis, 
bronchopulmonary mycosis, and 
central airflow obstruction

Question 16

complications of COPD?

Answer 16

spontaneous pneumothorax
pulomary hypertension
cor pulmonale (enlarged right heart)
chronic respiratory failure
hemoptysis (coughing blood)
Acute bronchitis, pneumonia, pulmonary thromboembolism, atrial dysrhythmias (such as atrial fibrillation, atrial flutter, and multifocal atrial tachycardia), and concomitant left ventricular failure may worsen otherwise stable COPD.

Question 17

what 2 things can one do to prevent COPD?

Answer 17

quit smoking/tobacco use
H1N1 (influenza A) vaccine
pneumococcal infection vaccine

Question 18

what has been shown to be reliable therapy for COPD?

Answer 18

oxygen supplementation
those with Hypoxemic patients with pulmonary hypertension, chronic cor pulmonale, erythrocytosis, impaired cognitive function, exercise intolerance, nocturnal restlessness, or morning headache are particularly likely to benefit from home oxygen therapy

Question 19

Medications for bronchodilators for COPD

Answer 19

Anticholinergic ipratropium bromide and beta-2-agonists (eg, albuterol, metaproterenol),
Long-acting beta-2-agonists (eg, formoterol, salmeterol, indacaterol, arformoterol) and anticholinergics (tiotropium)

Question 20

Can corticosteroids be used for COPD management?

Answer 20

yes but usually along with beta 2 agonists (terols) to reduce frequency of exacerbations

Question 21

what does drug Theophylline do?

Answer 21

bronchodilate
inflammatory properties
extrapulmonary effect of diaphragm strength, myocardial contractility, and kidney fxn

Question 22

what do you need to monitory closely with pts taking theophylline?

Answer 22

serum levels

Question 23

what 3 things can antibiotics provide for COPD management?

Answer 23

(1) to treat an acute exacerbation,
(2) to treat acute bronchitis, and
(3) to prevent acute exacerbations of chronic bronchitis (prophylactic antibiotics).

Question 24

pulmonary rehabilitation examples for COPD

Answer 24

aerobic
training inspiratory muscles
pursed-lip breathing
improve exercise capacity, decrease hospitalizations, and enhance quality of life

Question 25

treatment for hospitalized pts with COPD

Answer 25

Management of the hospitalized patient with an acute exacerbation of COPD includes supplemental oxygen (titrated to maintain SaO2 between 90% and 94% or PaO2 between 60 mm Hg and 70 mm Hg), inhaled ipratropium bromide (500 mcg by nebulizer, or 36 mcg by MDI with spacer, every 4 hours as needed) plus beta-2-agonists (eg, albuterol 2.5 mg diluted with saline to a total of 3 mL by nebulizer, or MDI, 90 mcg per puff, four to eight puffs via spacer, every 1–4 hours as needed), and broad-spectrum antibiotics

Question 26

what is prognosis for COPD?

Answer 26

poor

The degree of pulmonary dysfunction at the time the patient is first seen is an important predictor of survival: median survival of patients with FEV1 ≤ 1 L is about 4 years

Question 27

when should you refer COPD pts?

Answer 27

onset before the age of 40.

Frequent exacerbations (two or more a year)

Severe or rapidly progressive COPD.
Symptoms disproportionate to the severity of airflow obstruction.

Need for long-term oxygen therapy.

Onset of comorbid illnesses (such as bronchiectasis, heart failure, or lung cancer).

Question 28

when to admit COPD pts?

Answer 28

Severe symptoms or acute worsening that fails to respond to outpatient management.

Acute or worsening hypoxemia, hypercapnia, peripheral edema, or change in mental status.
Inadequate home care, or inability to sleep or maintain nutrition/hydration due to symptoms.

The presence of high-risk comorbid conditions.