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ICM -- Pulmonology > COPD > Flashcards

COPD Flashcards

1
Q

Four types of COPD

A

Emphysema
Chronic Bronchitis
Refractory Asthma
Severe bronchiectasis

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2
Q

What is COPD?

A

Persistent airflow limitation
Progressive
Associated with enhanced chronic inflammatory response in airways/lung

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3
Q

Describe a blue bloater (Chronic Bronchitis)

A

Overweight + Cyanotic
Elevated Hemoglobin
Peripheral Edema
Ronchi and Weezing

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4
Q

Describe a pink puffer (Emphysema)

A

Older, Thin
Severe Dyspnea
Quiet Chest
CXR shows hyperinflation w/ flattened diaphragm

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5
Q

Two mechanisms that underly airflow limitation in COPD

A

Small Airway Disease

Parenchymal Destruction

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6
Q

Manifestations of Small Airway Disease?

A

Airway inflammation
Airway fibrosis, luminal plugs
Increased Airway Resistance

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7
Q

Mechanisms underlying parenchymal destruction in COPD?

A

Loss of alveolar attachments

Decrease of elastic recoil

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8
Q

Risk factors for COPD

A

Smoking, Occupational Dust/Chemicals, Pollution

Genes, Infections, Socioeconomic Status

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9
Q

______ is required for a COPD diagnosis

A

Spirometry

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10
Q

Normal FEV1?
Normal FVC?
Normal FEV1/FVC?

A

4L
5L
0.8

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11
Q

Obstructive disorder. Effect on FVC, FEV1, FEV1/FVC, TLC.

A

FVC – normal or down
FEV1 – Down
FEV1/FVC – Down
TLC - Normal or Up

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12
Q

Restrictive disorder. Effect on FVC, FEV1, FEV1/FVC, TLC.

A

FVC – Down
FEV1 – Down
FEV1/FVC – Normal to Up
TLC - Down

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13
Q

Two indicators of a patient at high risk for exacerbations?

A

Two or more exacerbation in the last year OR an FEV1 less than half of the predicted value
Also – history of COPD hospitalizations

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14
Q

COPD comorbidities…

A 
CV disease
Osteoporosis
Resp. Infections + Lung Cancer + Bronchiectasis
Anxiety/Depression
Diabetes
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15
Q

COPD vs. Asthma. Age

A

COPD - Older than 35

Asthma – Any age

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16
Q

COPD vs. Asthma. Cough

A

COPD - Persistent, Productive

Asthma - Intermittent, Unusally nonproductive

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17
Q

COPD vs. Asthma. Smoking

A

COPD - Typical

Asthma - Variable

18
Q

COPD vs. Asthma. Dyspnea

A

COPD - Progressive, Persistent

Asthma - Variable

19
Q

COPD vs. Asthma. Nocturnal Symptoms.

A

COPD - Breathlessness late in disease

Asthma - Coughing, Wheezing

20
Q

When do you do alpha-1 antitrypsin deficiency screening?

A

COPD in Caucasian patients under 45 with strong COPD family history

21
Q

Value of exercise testing in COPD?

A

Indicator of Health Status Impairment, Predictor of Prognosis

22
Q

Two things proven to increase survival in COPD?

A

Smoking Cessation and Supplemental Oxygen

23
Q

COPD Stage O. Characteristics and Treatment

A

Char – Cough, Sputum. No spirometric abnormalities

No treatment, Discuss smoking cessation

24
Q

Characteristics and Treatment of Mild COPD

A

Char – FEV1/FVC under 70
FEV1 over 80% predicted value
Treat w/ short acting bronchodilator as needed

25
Q

Characteristics and Treatment of Moderate COPD

A

FEV1/FVC under 70
FEV1 betweeen 50 and 80% predicted value
Regular bronchodilators, Rehab, Inhaled Steroids

26
Q

Difference in primary inhaler type for asthma and COPD?

A

Asthma - beta agonist

COPD - anti cholinergic

27
Q

Characteristics and Treatment of Severe COPD

A

Ratio under 70, FEV1 btw 30% and 50%

Treat w/ same as moderate (bronchodil., rehab, steroid)

28
Q

Characteristics+Treatment of very severe COPD

A

ratio under 70, fev1 under 30%

Earlier things + Long term O2 therapy + consider surgical options

29
Q

All COPD patients improve from this non-pharmacological treatment

A

Exercise training programs

30
Q

Long term administration = ___ hrs/day

A

more than 15

31
Q

What treatment should possibly supplement Oxygen in patients with pronounced daytime hypercapnia

A

Noninvasive ventilation

32
Q

What should be considered for patients with upper lobe predominant emphysema?

A

Lung Volume Reduction Surgery

33
Q

Requirements for Lung Transplant?

A

6 months smoke free + completed rehab
FEV below 20%
Under 65 y.o.

34
Q

Patient has a PaO2 below 55 and a SaCO2 under 88. Qualifying conditions for long term oxygen therapy?

A

None required

35
Q

Patient has a PaO2 btw 55-59 and an SaCO2 of 89. Qualifying conditions for long term oxygen therapy?

A

Polycythemia over 55%
History of edema
P Pulmonale

36
Q

Patient has a PaO2 over 60 and SaCO2 over 90. Qualifying conditions for long term oxygen therapy?

A

Exercise/Sleep Desaturation uncorreted by CPAP

Lung disease w/ severe dyspnea responding to O2

37
Q

Five important causes of COPD exacerbations

A 
Infections
Pulm. Edema
Pulm. Embolism
Pneumothorax
Non-Compliance
38
Q

When managing COPD exacerbation, oxygen target should be

A

88-92%

39
Q

Recommended pharmacologic interventions for COPD exacerbation?

A

Bronchodilators + 40mg prednisone for 5 days

40
Q

Criteria for giving ABs to COPD exacerbation patient

A

ANTHONISEN CRITERIA
Increased Dyspnea, Increased Sputum Volume, Increased Sputum Purulence

(also those who require ventilation)

ICM -- Pulmonology (9 decks)

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