COPD Flashcards
Four types of COPD
Emphysema
Chronic Bronchitis
Refractory Asthma
Severe bronchiectasis
What is COPD?
Persistent airflow limitation
Progressive
Associated with enhanced chronic inflammatory response in airways/lung
Describe a blue bloater (Chronic Bronchitis)
Overweight + Cyanotic
Elevated Hemoglobin
Peripheral Edema
Ronchi and Weezing
Describe a pink puffer (Emphysema)
Older, Thin
Severe Dyspnea
Quiet Chest
CXR shows hyperinflation w/ flattened diaphragm
Two mechanisms that underly airflow limitation in COPD
Small Airway Disease
Parenchymal Destruction
Manifestations of Small Airway Disease?
Airway inflammation
Airway fibrosis, luminal plugs
Increased Airway Resistance
Mechanisms underlying parenchymal destruction in COPD?
Loss of alveolar attachments
Decrease of elastic recoil
Risk factors for COPD
Smoking, Occupational Dust/Chemicals, Pollution
Genes, Infections, Socioeconomic Status
______ is required for a COPD diagnosis
Spirometry
Normal FEV1?
Normal FVC?
Normal FEV1/FVC?
4L
5L
0.8
Obstructive disorder. Effect on FVC, FEV1, FEV1/FVC, TLC.
FVC – normal or down
FEV1 – Down
FEV1/FVC – Down
TLC - Normal or Up
Restrictive disorder. Effect on FVC, FEV1, FEV1/FVC, TLC.
FVC – Down
FEV1 – Down
FEV1/FVC – Normal to Up
TLC - Down
Two indicators of a patient at high risk for exacerbations?
Two or more exacerbation in the last year OR an FEV1 less than half of the predicted value
Also – history of COPD hospitalizations
COPD comorbidities…
CV disease Osteoporosis Resp. Infections + Lung Cancer + Bronchiectasis Anxiety/Depression Diabetes
COPD vs. Asthma. Age
COPD - Older than 35
Asthma – Any age
COPD vs. Asthma. Cough
COPD - Persistent, Productive
Asthma - Intermittent, Unusally nonproductive
COPD vs. Asthma. Smoking
COPD - Typical
Asthma - Variable
COPD vs. Asthma. Dyspnea
COPD - Progressive, Persistent
Asthma - Variable
COPD vs. Asthma. Nocturnal Symptoms.
COPD - Breathlessness late in disease
Asthma - Coughing, Wheezing
When do you do alpha-1 antitrypsin deficiency screening?
COPD in Caucasian patients under 45 with strong COPD family history
Value of exercise testing in COPD?
Indicator of Health Status Impairment, Predictor of Prognosis
Two things proven to increase survival in COPD?
Smoking Cessation and Supplemental Oxygen
COPD Stage O. Characteristics and Treatment
Char – Cough, Sputum. No spirometric abnormalities
No treatment, Discuss smoking cessation
Characteristics and Treatment of Mild COPD
Char – FEV1/FVC under 70
FEV1 over 80% predicted value
Treat w/ short acting bronchodilator as needed
Characteristics and Treatment of Moderate COPD
FEV1/FVC under 70
FEV1 betweeen 50 and 80% predicted value
Regular bronchodilators, Rehab, Inhaled Steroids
Difference in primary inhaler type for asthma and COPD?
Asthma - beta agonist
COPD - anti cholinergic
Characteristics and Treatment of Severe COPD
Ratio under 70, FEV1 btw 30% and 50%
Treat w/ same as moderate (bronchodil., rehab, steroid)
Characteristics+Treatment of very severe COPD
ratio under 70, fev1 under 30%
Earlier things + Long term O2 therapy + consider surgical options
All COPD patients improve from this non-pharmacological treatment
Exercise training programs
Long term administration = ___ hrs/day
more than 15
What treatment should possibly supplement Oxygen in patients with pronounced daytime hypercapnia
Noninvasive ventilation
What should be considered for patients with upper lobe predominant emphysema?
Lung Volume Reduction Surgery
Requirements for Lung Transplant?
6 months smoke free + completed rehab
FEV below 20%
Under 65 y.o.
Patient has a PaO2 below 55 and a SaCO2 under 88. Qualifying conditions for long term oxygen therapy?
None required
Patient has a PaO2 btw 55-59 and an SaCO2 of 89. Qualifying conditions for long term oxygen therapy?
Polycythemia over 55%
History of edema
P Pulmonale
Patient has a PaO2 over 60 and SaCO2 over 90. Qualifying conditions for long term oxygen therapy?
Exercise/Sleep Desaturation uncorreted by CPAP
Lung disease w/ severe dyspnea responding to O2
Five important causes of COPD exacerbations
Infections Pulm. Edema Pulm. Embolism Pneumothorax Non-Compliance
When managing COPD exacerbation, oxygen target should be
88-92%
Recommended pharmacologic interventions for COPD exacerbation?
Bronchodilators + 40mg prednisone for 5 days
Criteria for giving ABs to COPD exacerbation patient
ANTHONISEN CRITERIA
Increased Dyspnea, Increased Sputum Volume, Increased Sputum Purulence
(also those who require ventilation)
