COPD

Question 1

Four types of COPD

Answer 1

Emphysema
Chronic Bronchitis
Refractory Asthma
Severe bronchiectasis

Question 2

What is COPD?

Answer 2

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

Question 3

Describe a blue bloater (Chronic Bronchitis)

Answer 3

Overweight + Cyanotic
Elevated Hemoglobin
Peripheral Edema
Ronchi and Weezing

Question 4

Describe a pink puffer (Emphysema)

Answer 4

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

Question 5

Two mechanisms that underly airflow limitation in COPD

Answer 5

Small Airway Disease

Parenchymal Destruction

Question 6

Manifestations of Small Airway Disease?

Answer 6

Airway inflammation
Airway fibrosis, luminal plugs
Increased Airway Resistance

Question 7

Mechanisms underlying parenchymal destruction in COPD?

Answer 7

Loss of alveolar attachments

Decrease of elastic recoil

Question 8

Risk factors for COPD

Answer 8

Smoking, Occupational Dust/Chemicals, Pollution

Genes, Infections, Socioeconomic Status

Question 9

______ is required for a COPD diagnosis

Answer 9

Spirometry

Question 10

Normal FEV1?
Normal FVC?
Normal FEV1/FVC?

Answer 10

4L
5L
0.8

Question 11

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

Answer 11

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

Question 12

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

Answer 12

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

Question 13

Two indicators of a patient at high risk for exacerbations?

Answer 13

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

Question 14

COPD comorbidities…

Answer 14

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

Question 15

COPD vs. Asthma. Age

Answer 15

COPD - Older than 35

Asthma – Any age

Question 16

COPD vs. Asthma. Cough

Answer 16

COPD - Persistent, Productive

Asthma - Intermittent, Unusally nonproductive

Question 17

COPD vs. Asthma. Smoking

Answer 17

COPD - Typical

Asthma - Variable

Question 18

COPD vs. Asthma. Dyspnea

Answer 18

COPD - Progressive, Persistent

Asthma - Variable

Question 19

COPD vs. Asthma. Nocturnal Symptoms.

Answer 19

COPD - Breathlessness late in disease

Asthma - Coughing, Wheezing

Question 20

When do you do alpha-1 antitrypsin deficiency screening?

Answer 20

COPD in Caucasian patients under 45 with strong COPD family history

Question 21

Value of exercise testing in COPD?

Answer 21

Indicator of Health Status Impairment, Predictor of Prognosis

Question 22

Two things proven to increase survival in COPD?

Answer 22

Smoking Cessation and Supplemental Oxygen

Question 23

COPD Stage O. Characteristics and Treatment

Answer 23

Char – Cough, Sputum. No spirometric abnormalities

No treatment, Discuss smoking cessation

Question 24

Characteristics and Treatment of Mild COPD

Answer 24

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

Question 25

Characteristics and Treatment of Moderate COPD

Answer 25

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

Question 26

Difference in primary inhaler type for asthma and COPD?

Answer 26

Asthma - beta agonist | COPD - anti cholinergic

Question 27

Characteristics and Treatment of Severe COPD

Answer 27

Ratio under 70, FEV1 btw 30% and 50% | Treat w/ same as moderate (bronchodil., rehab, steroid)

Question 28

Characteristics+Treatment of very severe COPD

Answer 28

ratio under 70, fev1 under 30% | Earlier things + Long term O2 therapy + consider surgical options

Question 29

All COPD patients improve from this non-pharmacological treatment

Answer 29

Exercise training programs

Question 30

Long term administration = ___ hrs/day

Answer 30

more than 15

Question 31

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

Answer 31

Noninvasive ventilation

Question 32

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

Answer 32

Lung Volume Reduction Surgery

Question 33

Requirements for Lung Transplant?

Answer 33

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

Question 34

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

Answer 34

None required

Question 35

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

Answer 35

Polycythemia over 55% History of edema P Pulmonale

Question 36

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

Answer 36

Exercise/Sleep Desaturation uncorreted by CPAP | Lung disease w/ severe dyspnea responding to O2

Question 37

Five important causes of COPD exacerbations

Answer 37

``` Infections Pulm. Edema Pulm. Embolism Pneumothorax Non-Compliance ```

Question 38

When managing COPD exacerbation, oxygen target should be

Answer 38

88-92%

Question 39

Recommended pharmacologic interventions for COPD exacerbation?

Answer 39

Bronchodilators + 40mg prednisone for 5 days

Question 40

Criteria for giving ABs to COPD exacerbation patient

Answer 40

ANTHONISEN CRITERIA Increased Dyspnea, Increased Sputum Volume, Increased Sputum Purulence (also those who require ventilation)