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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
True or false: there is still benefit of smoking cessation at age 65
True
26
What medications have been should to modify long term decline of lung function with COPD?
None
27
What are the goals of pharmacotherapy with COPD?
Decrease ssx and complications
28
What are the beta agonists used to treat COPD?
- albuterol - Salbutamol - Levalbuterol - Metaproterenol
29
What is the major anticholinergic used to treat COPD?
Ipratropium
30
What is the MOA of theophylline?
PDE inhibitors to Increase cAMP to induce bronchodilation
31
What are the major issues of theophylline use?
Narrow therapeutic index
32
What are the 5 long acting bronchodilators?
- salmeterol - Formoterol - Arformoterol - Indacaterol - Vilanterol
33
What are the four major muscarinic long acting bronchodilators?
- Tiotropium - Aclidinium - Umeclidinium - Glycopyrronium
34
When are corticosteroids used for COPD?
Used in combination of LABA or LAMA for severe obstruction and frequent exacerbation
35
What are the three major corticosteroids used to treat COPD?
Fluticasone Budesonide Mometasone
36
What is the MOA of PDE-4 inhibitors in treating asthma?
increase cAMP to induce Smooth muscle relaxation and decreased inflammation
37
What are the two PDE-4 inhibitors used to treat COPD?
Cilomilast | Roflumilast
38
When are inhaled corticosteroids used in COPD?
For repeated exacerbations
39
What is the benefit of mucoactive agents in COPD treatment?
No effect on airflow or sputum volume, and can actually induce bronchoconstriction
40
What is the only therapy that improves survival with COPD?
Oxygen
41
What are the benefits of pulmonary rehab? (4)
- Improves exercise capacity - Decreases dyspnea - Improve QOL - Decreases healthcare utilization
42
What are the severe ssx of COPD exacerbation? (5)
- Mental status change - Only single words spoken - Silent chest - Hemodynamic instability - Paradoxical breathing
43
What are the 5 major ancillary tests for COPD exacerbation?
- ABG - CXR - Oximetry - EKG - CBC, lytes
44
What happens to the bicarb with COPD?
Increases
45
What are the three steps of outpatient management of COPD exacerbation?
- Systemic steroids - Increase short acting bronchodilators - abx if infx
46
What are the indications for inpatient management of COPD?
- Dyspnea at rest - failed outpatient management - hypoxemic - accessory muscle use
47
What causes the orthopnea with COPD?
Increased pressure from the diaphragm
48
Why is it important to assess for edema with COPD exacerbation?
r/o right heart failure
49
What is the oxygen saturation goal with COPD pts? Why?
- 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
What are the three cardinal ssx that warrant abx treatment with COPD?
- Increased dyspnea - Increased sputum volume/purulence - if mechanical ventilation is required
51
What is the treatment for an acute COPD exacerbation?
Short acting beta-2 agonists wwo anticholinergics
52
What are the CT findings of COPD, besides the barrel chest?
Can find bullae
53
What are the two goals of trying to reduce the symptoms of COPD?
Improve exercise status | Improve health
54
What are the three goals of reducing risk for COPD patients?
- Prevent disease progression - Prevent and treat exacerbations - Reduce mortality
55
Why are steroids not first line therapy for COPD?
Not dealing with inflammation like asthma
56
What should be done with patients with MIld, moderate, and severe COPD?
Mild =Short term bronchodilator Moderate = +Long acting bronchodilator Severe= +inhaled glucocorticoid
57
When is long term oxygen therapy needed for COPD?
Very severe: FEV1 less than 30% predicted, or chronic respiratory failure
58
What is the use of systemic corticosteroids in treating COPD?
There is none--increases morbidity and mortality
59
What is the level of pO2 on RA that indicates the need for supplemental oxygen?
Less than 55 mmHg
60
What is the level of pO2 on RA with cor pulmonale that indicates the need for supplemental oxygen?
56-59 mmHg
61
A decrease in SpO2 to less than what percent is an indication for supplemental oxygen?
Less than 88%
62
What is the ABG presentation order? (5)
pH/pCO2/pO2/HCO3/sat
63
When is lung volume surgical resection indicated for COPD?
Upper lobe emphysema with low base-line exercise capacity
64
What is the trade off of endobronchial valve treatment?
Improved lung function and exercise tolerance for most exacerbations and pneumonia

Respiratory (34 decks)

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