COPD Flashcards
What is COPD?
Airflow limitation that is not fully reversible.
Limitation is usually progressive and associated with abn inflammatory response to noxious particles
What populations have higher prevalence of COPD?
Age 65-74 Non-Hispanic White Women Low income Current or former smokers
What are the risk factors of COPD
Cigarette Smoke Occ dust and chemicals Envt tobacco smoke Indoor and outdoor air pollution Genes Infections Socioeconomic status Aging pop.
What are the mechanisms of COPD?
SMall airway Disease -airway inflammation -airway fibrosis, luminal plugs -inc airway resistance Parenchymal Destruction -loss of alveolar attachments -decrease of elastic recoil
ALL LEAD to Airflow limitation
What is Chronic Bronchitis?
Cough that occurs every day with Sputum production that lasts for at least 3 months, two years in a row
What is the clinical presentation of COPD?
>60yo Productive cough Dyspnea on exertion Progressive symptoms Risk factors Later in disease: -Accesory Muscles at rest -increased AP diameter -Right Heart Failure Weight loss
What are the spirometry findings in COPD?
It takes much longer to reach plateau (complete Exhalation)
What are the steps of COPD Assesment?
Assess Symptoms
Assess Degree of Airflow limitation with spirometry
Assess risk of exacerbations
Assess comorbidities
What are the symptoms of COPD?
Dyspnia
Chronic Cough
Chronic Sputum Production
What is used to Assess risk of Exacerbation of COPD?
2 or more exacerbations within the last year OR FEV1 of
What are the COPD Comorbidities?
Cardiovascular Diseases Osteoporosis Resp infections Anxiety and Depression Diabetes Lung Cancer Bronchiectasis
What are the goals of COPD Therapy?
Reduce Symptoms -improve exercise tolerance -improve health status Reduce Risk -prevent disease progression -prevent and treat exacerbations -reduce mortaity
What are the drugs used in COPD?
Beta agonists -Albuterol -Salbutamol -Levabuterol -Metaproterenol Anticholinergic -Impratropium Bromide Long acting Beta Agonists (LABA) Long acting Muscarinic Agents (LAMA) Inhaled Corticosteroids
What is a possible danger of using Theophylline?
Very narrow theraputic index and has multiple factors that influence its metabolism
When are inhaled Corticosteroids Used?
In combo with LABA or LAMA
GOLD stage III or IV with significant symptoms or recurrent exacerbations
(earlier if asthma present)
Why are systemic Stroids not used for COPD?
Chronic Conitnuous Use associated with Increased Morbidity and Mortality
What are the criteria for Oxygen therapy?
pO2
What are the signs of Acute COPD Exacerbation?
Mental Status Changes Single word speaking Silent Chest Hemodynamic Instability Labored Breathing, Paradoxical Breathing
What are ancillary tests to do in a COPD Exacerbation?
ABG CXR Oximetry Monitoring EKG CBC, Chem 7
What is the Outpatient management of COPD Exacerbation?
Course of systemic Steroids Inc Dose of Short acting bronchodilators Use of Atbx if purulent sputum -Doxycycline, TMP/SMX -Azithromycin, Quinolones
What is Inpatient Management of COPD Exacerbation? How do you know who needs to be admitted?
Failure of outPt mangt Dyspnia at rest Evidence of Tachypnia Use of accessory muscles to breathe at rest Tachycardia Hypoxemia
Why do want to avoid overoxygenating a Pt with Severe COPD?
You will decrease perfusion to the oxygenated portions of the lung by getting overall vasodilation to whole lung. You’ll overcome the normal Hypoxia driven vasoconstriction. You will increase functional Dead Space.
Which Patients should be given antibiotics in COPD?
Cardinal Symptoms
Require Mechanical Ventilation
