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clinical medicine II exam 2 > COPD > Flashcards

COPD Flashcards

1
Q

Describe process that leads to COPD

A

inflammation -> small airway disease (airway remodeling) and parenchymal destruction (loss of alveolar attachments; decrease of elastic recoil ) -> airflow limitation

  • think paper bag
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2
Q

what are the clinical subtypes of COPD

A
  1. chronic bronchitis
  2. emphysema
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3
Q

differentiate between chronic bronchitis and emphysema patients in terms of appearance

A
  • chronic bronchitis: blue bloaters
    • cyanosis; overweight
    • hypoxemia; respiratory acidosis, cor pulmonale more common
  • emphysema: pink puffers
    • pursed lip breathing
    • thin body habitus
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4
Q

define chronic bronchitis

A
  • chronic productive cough x 3 months, during 2 consecutive years with no other cause
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5
Q

structural changes associated with chronic bronchitis

A
  • mucous gland enlargement -> hypersecretion
  • bronchial squamous metaplasia
  • loss of ciliary transport
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6
Q

chronic bronchitis: inflammation of bronchial wall and infiltration of sub mucosal layer by what types of cells

A

neutrophils

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7
Q

in chronic bronchitis, the obstruction is inspiratory or expiratory?

A

inspiratory and expiratory -> leads to hypoxemia and hypercapnia

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8
Q

which subtype of COPD has more parenchymal damage

A

emphysema : more alveolar sac damage

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9
Q

define emphysema

A
  • pathologic enlargement of the air spaces distal to the terminal bornchioles due to desctruction of the alveolar walls
    • ​reduced alveolar surface area
    • decreased elastic recoil
    • loss of alveolar supporting structures -> airway narrowing
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10
Q

destructive process in emphysema is due to

A
  • too much elastase
    • breaks down elastin and destroys elasticity of lung
  • too little antitrypsin
    • inhibits elastase
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11
Q

in emphysema, airflow obstruction occurs mostly during inspiration or expiration?

A

exhalation

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12
Q

which COPD subytpe is associated with hypoxemia

A
  • chronic bronchitis
    • emphysema: not associated with significant hypoxemia until later in disease severity
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13
Q

asthma is a chronic inflammatory disorder of the airways that is primarily mediated by what cell type

A

eosinophil

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14
Q

define asthma and explain why is it different from COPD

A
  • airway hyper-reactivity -> increased secretions, mucosal edema -> constriction of bronchial smooth muscle -> aiway obstruction
  • reversible
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15
Q

name the risk factors for COPD

A
  • cigarette smoking
  • air pollution
  • genetic: alpha-1 antitrypsin deficiency
    • premature emphysema
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16
Q

how does cigarette smoking increase risk for COPD

A

stimulates elastase activity, causing degenerative changes in elastin and alveolar structures

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17
Q

alpha 1 antitrypin deficiency causes an early onset of

A

emphysema

  • <1% of US cases
  • develops in smokers at age 40 yo; nonsmokers 53 yo
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18
Q

what are the cardinal symptoms of COPD

A
  • dyspnea
  • chronic cough
  • sputum production
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19
Q

when does COPD typically present (what age)

A

50-60s

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20
Q

clinical presentation

  • accessory muscle use
  • increased AP diameter
  • pursed lip breathing
A

emphysema

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21
Q

function of pursed lip breathing

A
  • ordinary breathing in COPD allows early bronchial collapse on exhalation
  • pursed lip breathing achieves resistance to outflow at the lips -> raises intrabronchial pressure -> bronchi stay open -> more air expelled
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22
Q

what do you expect to hear on percussion of COPD patients

A

hyper-resonant: due to air trapping

23
Q

what test is used to establish the diagnosis and determine the stage of COPD

A
  • spirometry
24
Q

what do you expect to see in the spirometry results for COPD patents

A
  • FEV1/FVC < 0.7 -> obstruction
  • decreased FEV1
  • increased TLC
  • FEV1 predicted that is not reversible
25
Q

Why could CBC show polycythemia in COPD patients

A
  • polycythemia: abnormally increased concentration of hemoglobin in the blood
  • increase in RBC due to hypoxemia of chronic bronchitis
26
Q

when should you get an arterial blood gas

A

pulse oximetery shows O2 < 92%

27
Q

what imaging is used for routine workup of COPD

A
  • CXR
  • high resolution CT: greater sensitivity and specificity than CXR for the diagnosis of COPD but is not necessary for routine workup
28
Q

These CXR findings are consistent with

  • hyperinflation (possibly with bullae)
  • flattening of diaphragms
  • enlargement of retrosternal air space
A

emphysema

29
Q

These CXR findings are consistent with

  • cardiac enlargment
  • pulmonary congestion
  • increased lung markings
A

chronic bronchitis

30
Q

list the GOLD strategy for staging of COPD

A
  1. determine if obstructive pattern
    • FEV1/FVC <0.7
  2. determine severity
    • FEV1 %
  3. assess symptoms
    • patient rating scale: mMRC
  4. determine exacerbation risk (in past yr)
    • 0-1 exacerbations
    • > 2 exacerbations OR 1 or more hospitalizations
31
Q

goals of disease managment of COPD

A
  • prevent progression
    • smoking cessation
  • relieve symptoms
  • improve exercise tolerance
  • reduce mortality
32
Q

what is the mainstay of therapy for COPD

A
  • bronchodilators: inhaled B2-agonists and anticholinergics
33
Q

SABA: protype drug and dosing

A
  • albuterol (B2 agonist
  • 2 puffs q 4-6 hrs
34
Q

side effect of B2 agonists

A
  • palpitations
  • tachycardia
  • insomnia
  • tremors
35
Q

name two LABA (long acting beta 2 agonists)

A
  • Salmeterol
  • Formoterol
    • both given q12 hr
36
Q

Name two short acting anticholinergics used for COPD and dosage

A
  • Ipratropium bromide (atrovent)
  • Ipratropium plus albuterol (Combivent)
  • 2 puffs BID-QID
37
Q

Name one long acting cholinergics used for COPD and dosage

A
  • Tiotropium bromide (spiriva)
  • once a day
38
Q

side effects of anticholinergics

A
  • dry mouth
  • metallic taste
39
Q

function of corticosteroids in the treatment of COPD

A
  • reduces mucosal edema/inflammation by inhibiting prostaglandins
  • increases responsiveness to beta-adrenergics
  • SE: oral candidiasis, bruising
40
Q

what is Roflumilast? Function?

A
  • PDE-4 inhibitor
  • for refractory cases as adjunct to bronchodilator
  • anti-inflammatory effect
41
Q

side effects of Roflumilast

A
  • Nausea
  • Diarrhea
  • abd pain
  • weight loss
  • HA
42
Q

what is the first line treatment for COPD: Stage A

A

short acting bronchodilator

  • doesnt matter if beta 2 agonist or anticholinergic
  • used as rescue inhaler
43
Q

what is the first line treatment for COPD: Stage B

A

long acting bronchodilator

44
Q

what is the first line treatment for COPD: Stage C

A
  • inhaled corticosteroid +
  • LABA or long-acting anticholinergic
45
Q

what is the first line treatment for COPD: Stage D

A
  • inhaled corticosteroid +
  • LABA and/or long acting anticholinergic
46
Q

tx for patients with alpha1-antitrypsin deficiency

A
  • antiprotease therapy
    • weekly or monthly injections
47
Q

some patients with COPD wear supplemental oxygen a minimum of 12 hours a day. When is it indicated? Purpose?

A
  • indicated if chronic dyspnea at rest
    • PaO2 < 55 mmHg or SaO2 < 88%
  • prolongs survival
48
Q

what is the concern for patients with COPD to wear supplemental oxygen

A

concern that high flow O2 may reduce drive to breath and cause respiratory acidosis (maintain O2 sat 90-92%)

49
Q

what two things should patients with COPD get to minimize complications and exacerbations

A
  • annual influenza vaccine
  • pneumococcal vaccine (PPV23)
50
Q

signs of an acute COPD exacerbation

A
  • cough increases in frequency or severity
  • sputum production changes
  • dyspnea increases
51
Q

most common triggers for acute COPD exacerbation

A
  • viral infection: rhinovirus and influenza
52
Q

outpatient treatment/management for acute COPD exacerbation

A
  • SABA
  • oral steroids
  • antibiotics?
53
Q

when should abx be given in outpatient treatment/management for acute COPD exacerbation

A
  • if 2/3 cardinal symptoms are present
    • increased dyspnea
    • increased sputum production
    • increased sputum purulence
54
Q

What makes a COPD patient at a higher mortality risk

A
  • BODE index
    • cigarette smoking
    • BMI < 21
    • male
    • FEV1
    • mMRC score
    • exercise capacity

clinical medicine II exam 2 (7 decks)

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