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COPD Flashcards

1
Q

What is COPD?

A

An obstructive pulmonary disease, characterized by airflow limitation that is not fully reversible, and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases

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2
Q

What is the difference between COPD and asthma?

A

Asthma is reversible

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3
Q

What percent of the US population has COPD?

A

6.3%

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4
Q

What is the typical COPD pt?

A

65+ poor white woman that smokes

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5
Q

What are the risk factors for COPD?

A

Cigarette smoking
Occupational exposures
Air pollution

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6
Q

What are the three characteristics of the small airway disease underlying COPD?

A

Airway inflammation
Airway fibrosis
Increased resistance

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7
Q

Parenchymal destruction in COPD results in what two major effects?

A
  • Loss of alveolar attachments

- Decrease of elastic recoil

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8
Q

What is the definition of chronic bronchitis?

A

Productive cough that occurs everyday for at least 3 months, two years in a row

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9
Q

What are the three COPD subsets?

A

Chronic bronchitis
Emphysema
Asthma

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10
Q

What are the ssx of COPD? How fast is the onset?

A
  • Productive cough
  • DOE
  • progressive symptoms
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11
Q

What are the physical findings late in the course of COPD? (3)

A
  • Using accessory muscles at rest
  • Increased AP diameter
  • Heart failure
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12
Q

What happens with FEV1 and FEV1/FVC with COPD patients?

A

Decreased FEV1, and lower FEV1/FVC (less than 0.7)

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13
Q

What are the four steps of assessing COPD?

A
  1. Assess symptoms
  2. Assess severity by spirometry
  3. Exacerbations
  4. Comorbidities
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14
Q

Is the cough associated with COPD usually productive?

A

No, but may be variable from day-to-day

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15
Q

What are the characteristics of dyspnea with COPD?

A

Progressive, worse with exercise

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16
Q

What are the post bronchodilator FEV1 percentages for mild, moderate, severe, and very severe COPD?

A

mild = more than 80%
moderate = 50-80%
severe = 30-50%
Very severe = less than 30%

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17
Q

What happens to the flow-volume loop with obstructive lung disease?

A

Indentation of the curve

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18
Q

What are the two main predictors of exacerbation risk for a patient with COPD?

A
  • Two or more exacerbations within the last year, or

- an FEV1 less than 50%

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19
Q

True or false: any hospitalization for COPD exacerbations should be considered a high risk pt

A

True

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20
Q

What are the comorbidities with COPD?

A
  • CV disease
  • Osteoporosis
  • Respiratory infections
  • DM
  • Lung CA
  • Bronchiectasis
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21
Q

What is bronchiectasis?

A

Chronic inflammation of the airway leading to fibrotic changes, and impaired mucus clearance

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22
Q

What are the two main goals of therapy for COPD?

A

Relieve ssx

Reduce risk

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23
Q

What is the single most important intervention for COPD?

A

Smoking cessation

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24
Q

How much faster do your lungs age with smoking?

A

x2

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25
Q

True or false: there is still benefit of smoking cessation at age 65

A

True

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26
Q

What medications have been should to modify long term decline of lung function with COPD?

27
Q

What are the goals of pharmacotherapy with COPD?

A

Decrease ssx and complications

28
Q

What are the beta agonists used to treat COPD?

A
  • albuterol
  • Salbutamol
  • Levalbuterol
  • Metaproterenol
29
Q

What is the major anticholinergic used to treat COPD?

A

Ipratropium

30
Q

What is the MOA of theophylline?

A

PDE inhibitors to Increase cAMP to induce bronchodilation

31
Q

What are the major issues of theophylline use?

A

Narrow therapeutic index

32
Q

What are the 5 long acting bronchodilators?

A
  • salmeterol
  • Formoterol
  • Arformoterol
  • Indacaterol
  • Vilanterol
33
Q

What are the four major muscarinic long acting bronchodilators?

A
  • Tiotropium
  • Aclidinium
  • Umeclidinium
  • Glycopyrronium
34
Q

When are corticosteroids used for COPD?

A

Used in combination of LABA or LAMA for severe obstruction and frequent exacerbation

35
Q

What are the three major corticosteroids used to treat COPD?

A

Fluticasone
Budesonide
Mometasone

36
Q

What is the MOA of PDE-4 inhibitors in treating asthma?

A

increase cAMP to induce Smooth muscle relaxation and decreased inflammation

37
Q

What are the two PDE-4 inhibitors used to treat COPD?

A

Cilomilast

Roflumilast

38
Q

When are inhaled corticosteroids used in COPD?

A

For repeated exacerbations

39
Q

What is the benefit of mucoactive agents in COPD treatment?

A

No effect on airflow or sputum volume, and can actually induce bronchoconstriction

40
Q

What is the only therapy that improves survival with COPD?

41
Q

What are the benefits of pulmonary rehab? (4)

A
  • Improves exercise capacity
  • Decreases dyspnea
  • Improve QOL
  • Decreases healthcare utilization
42
Q

What are the severe ssx of COPD exacerbation? (5)

A
  • Mental status change
  • Only single words spoken
  • Silent chest
  • Hemodynamic instability
  • Paradoxical breathing
43
Q

What are the 5 major ancillary tests for COPD exacerbation?

A
  • ABG
  • CXR
  • Oximetry
  • EKG
  • CBC, lytes
44
Q

What happens to the bicarb with COPD?

45
Q

What are the three steps of outpatient management of COPD exacerbation?

A
  • Systemic steroids
  • Increase short acting bronchodilators
  • abx if infx
46
Q

What are the indications for inpatient management of COPD?

A
  • Dyspnea at rest
  • failed outpatient management
  • hypoxemic
  • accessory muscle use
47
Q

What causes the orthopnea with COPD?

A

Increased pressure from the diaphragm

48
Q

Why is it important to assess for edema with COPD exacerbation?

A

r/o right heart failure

49
Q

What is the oxygen saturation goal with COPD pts? Why?

A
  • 88-92%
  • any higher will encourage V/Q mismatch d/t dead space (“stealing blood from the good parts”) and actually increase CO2 levels
50
Q

What are the three cardinal ssx that warrant abx treatment with COPD?

A
  • Increased dyspnea
  • Increased sputum volume/purulence
  • if mechanical ventilation is required
51
Q

What is the treatment for an acute COPD exacerbation?

A

Short acting beta-2 agonists wwo anticholinergics

52
Q

What are the CT findings of COPD, besides the barrel chest?

A

Can find bullae

53
Q

What are the two goals of trying to reduce the symptoms of COPD?

A

Improve exercise status

Improve health

54
Q

What are the three goals of reducing risk for COPD patients?

A
  • Prevent disease progression
  • Prevent and treat exacerbations
  • Reduce mortality
55
Q

Why are steroids not first line therapy for COPD?

A

Not dealing with inflammation like asthma

56
Q

What should be done with patients with MIld, moderate, and severe COPD?

A

Mild =Short term bronchodilator
Moderate = +Long acting bronchodilator
Severe= +inhaled glucocorticoid

57
Q

When is long term oxygen therapy needed for COPD?

A

Very severe: FEV1 less than 30% predicted, or chronic respiratory failure

58
Q

What is the use of systemic corticosteroids in treating COPD?

A

There is none–increases morbidity and mortality

59
Q

What is the level of pO2 on RA that indicates the need for supplemental oxygen?

A

Less than 55 mmHg

60
Q

What is the level of pO2 on RA with cor pulmonale that indicates the need for supplemental oxygen?

A

56-59 mmHg

61
Q

A decrease in SpO2 to less than what percent is an indication for supplemental oxygen?

A

Less than 88%

62
Q

What is the ABG presentation order? (5)

A

pH/pCO2/pO2/HCO3/sat

63
Q

When is lung volume surgical resection indicated for COPD?

A

Upper lobe emphysema with low base-line exercise capacity

64
Q

What is the trade off of endobronchial valve treatment?

A

Improved lung function and exercise tolerance for most exacerbations and pneumonia

Respiratory (34 decks)

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