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Pulmonology > COPD > Flashcards

COPD Flashcards

1
Q

COPD definition

A
  • common
  • preventable
  • treatable
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2
Q
  • Small airway inflammation
  • Airway fibrosis
  • luminal plugs
  • UP airway resistance
  • Daily cough with sputum production >3 months, 2 years in a row
A

Chronic Bronchitis

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3
Q
  • parenchyma/alveolar destruction
  • Loss of alveolar attachments
  • decrease of elastic recoil
A

Emphysema

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4
Q

COPD Phenotypes

A
  • Emphysema
  • Chronic Bronchitis
  • ACOS - Asthma COPD Overlap Syndrome
  • Emphysema Interstitial Fibrosis Syndrome
  • Smoking-related Lung Disease (no obstruction)
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5
Q

All smoker’s get COPD?

A

NO

Only about 1/4

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6
Q

COPD Risk factors

A
  • CIGS
  • Occupational chems
  • Environmental smoke
  • indoor + outdoor pollution

+ GENOTYPE / INFECTIONS / SOCIO-ECONOMIC STATUS

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7
Q

_#__ leading cause of death

A

4th in world

3rd in US

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8
Q

Who has more COPD?

Men vs. Women

A

WOMEN

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9
Q

Once you show symptoms of COPD exacerbations…

A

The process takes off, no return

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10
Q

COPD associated conditions

A
  • Fat-free mass = low BMI ~ higher mortality
  • Impaired systemic muscle function
  • Osteoporosis
  • Anemia
  • Depression
  • Pulmonary Hypertension
  • Cor pulmonale
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11
Q

COPD Assessment

A
  • Risk factors
  • Symptoms
  • Spirometry = severity of airflow limitation
  • Impact on patient’s health
  • Risk of future exacerations
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12
Q

Best predictor of airflow obstruction

A

40-pack year smoking hx

*look for:
Hz of more than 55 pack years
wheezing

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13
Q

COPD s/s

A
  • dyspnea
  • chronic cough
  • chronic sputum (whitish/gray)
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14
Q

PE

A
  • Hyperinflation
  • hyper-resonance
  • DOWN breath sounds
  • wheezing
  • prolonged expiratory
  • crackles on inspiration
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15
Q

Don’t give diuretic for PulmTN

A

Right-sided failure can’t pump low volume across Pulm HTN pressure, OK for left-sided failure

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16
Q

Tripod

A

Push abdominal contents up to curve diaphragm

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17
Q

Spirometry COPD

A

Before + after SABA

Post-bronchodilator FEV1/FVC (<0.7)
*compare to age related normal

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18
Q

FEV1 =

FVC =

A

FEV1 =4 L
FVC = 5 L

Allergists : 0.8
Pulmonologists: 0.7

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19
Q

GOLD 1:

A

Mild

FEV1 = 80%< predicted

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20
Q

Gold 2:

A

Moderate

FEV1: 50%-80%

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21
Q

Gold 3 :

A

Severe

FEV1: 30% - 50%

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22
Q

Gold 4

A

Very severe

FEV1: <30%

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23
Q

CXR

A
  • Hyperinflation
  • increased lucency
  • increased retrosternal space
  • UP AP diameter
  • flattened diaphragm
24
Q

COPD other investigations

A
  • Oximetry/Arterial Blood gases
  • Caucasian under 45 w/ COPD or FH? –>Alpha 1 anti-trypsin deficiency
  • ventilation/perfusion scans NOT HELPFUL unless removing lung section
25
Q

Mild exacerbation?

A

Change in bronchodilator dose/antibio use

26
Q

Moderate exacerbation

A

Systemic corticosteroids

27
Q

Severe exacerbation

A

Hospital Admit

28
Q

High risk COPD (exacerbation)

A

Past year:

  • 2+ mild/moderate exacerbations
  • one+ severe exacerbations
29
Q

FRC =

A

Resting state

30
Q

COPD - exercise decreases inspiratory capacity (IC)

A
  • Residual volume UP
  • inspiratory capacity DOWN
  • intra-thoracic pressure UP
  • CO down
31
Q

CAT test

A

Measure of symptoms + impact on health status

32
Q

Modified medical research council questionnaire

A

Dyspnea measure

2= fall behind walking with friends

33
Q

Goals of Tx

A

REDUCE S/S
*exercise tolerance, health status

REDUCE RISK

  • prevent disease progression
  • exacerbations
  • mortality
34
Q

COPD tx

A
  • SMOKING CESSATION
  • pharmacotherapy/nicotine replacements
  • Physical activity
  • no pollution
  • Vaccination (flu, pneumococcal)
35
Q

TX

Bronchodilators

A
  • DOWN s/s
  • NO CURE
  • Beta ags + antichols + theophylline
36
Q

Systemic steroids?

A

Only during exacerbation , should be off by 10 day after discharge

37
Q

COPD A group

A

SAMA or SABA

38
Q

Group B Tx

A

LABA or LAMA

Then

LAMA + LABA

39
Q

Group C tx

A

LAMA

Then

LABA + LAMA /OR/ ICS+LABA(no)

40
Q

Group D tx

A

LAMA + LABA

then

LAMA+LABA+ICS

If need add:
Roflumilast. /. Macrolide

Nebulizer = low inspiratory capacity

41
Q

Unhelpful Tx

A
  • alpha-1 antitrypsin (if no deficiency)
  • Mucolytics
  • antitussives (tesselon pearls) = Give codeine
  • vasodilators
42
Q

Other tx

A

O2 therapy = Chronic respiratory failure (min 15 hours per day)

Ventilatory support = w/ long term O2
(Good w/ daytime hypercapnea)

43
Q

COPD surgery

A
  • UPPER-LOBE PREDOMINANT EMPHYSEMA + LOW EXERCISE CAPACITY = lung volume reduction surgery (living area will expand)
  • SEVERE COPD? Lung transplantation
44
Q

New Rx to patient?

A

Get back in 4 weeks, demonstrate how to use meds

45
Q

MDI

DPI

SMI

A

Metered dose inhaler

Dry powder inhaler

Slow mist inhaler

46
Q

Specific Rx guided by

A

Patient’s insurance

47
Q

Gold Category A

A
  • Less symptoms = CAT <10
  • Less Breathlessness = mMRC 0-1
  • Low risk = 1 exacerbation /year not leading to hospital admit
48
Q

Gold category B

A
  • more symptoms = CAT >10
  • Less Breathlessness = mMRC>2
  • Low Risk= 1 exacerbation no hospital admit
49
Q

Gold category C

A

VERY LITTLE HERE

  • Less symptoms = CAT <10
  • Less breathlessness mMRC = 0-1
  • High risk = >2 exacerbations no admit OR >1 w/ admit
50
Q

Gold Category D

A

*More symptoms : CAT>10
More breathlessness: mMRC>2
*Higher risk: >2 exacerbation no admit OR >1 exacerbation w/ admit

51
Q

LABAs

A

Salmeterol
Formoterol
Indacaterol
Vilanterol

52
Q

SAMA

A

Ipratropium

53
Q

LAMAs

A

Tiotropium
Aclidinium
Umeclidinium
Glycopyrrolate

54
Q

ICS

A

Fluticasone
Mometasone
Budesonide

55
Q

PDE4 inhibitors

A

Roflumilast

Pulmonology (12 decks)

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