COPD Flashcards
1
Q
COPD definition
A
- common
- preventable
- treatable
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
3
Q
- parenchyma/alveolar destruction
- Loss of alveolar attachments
- decrease of elastic recoil
A
Emphysema
4
Q
COPD Phenotypes
A
- Emphysema
- Chronic Bronchitis
- ACOS - Asthma COPD Overlap Syndrome
- Emphysema Interstitial Fibrosis Syndrome
- Smoking-related Lung Disease (no obstruction)
5
Q
All smoker’s get COPD?
A
NO
Only about 1/4
6
Q
COPD Risk factors
A
- CIGS
- Occupational chems
- Environmental smoke
- indoor + outdoor pollution
+ GENOTYPE / INFECTIONS / SOCIO-ECONOMIC STATUS
7
Q
_#__ leading cause of death
A
4th in world
3rd in US
8
Q
Who has more COPD?
Men vs. Women
A
WOMEN
9
Q
Once you show symptoms of COPD exacerbations…
A
The process takes off, no return
10
Q
COPD associated conditions
A
- Fat-free mass = low BMI ~ higher mortality
- Impaired systemic muscle function
- Osteoporosis
- Anemia
- Depression
- Pulmonary Hypertension
- Cor pulmonale
11
Q
COPD Assessment
A
- Risk factors
- Symptoms
- Spirometry = severity of airflow limitation
- Impact on patient’s health
- Risk of future exacerations
12
Q
Best predictor of airflow obstruction
A
40-pack year smoking hx
*look for:
Hz of more than 55 pack years
wheezing
13
Q
COPD s/s
A
- dyspnea
- chronic cough
- chronic sputum (whitish/gray)
14
Q
PE
A
- Hyperinflation
- hyper-resonance
- DOWN breath sounds
- wheezing
- prolonged expiratory
- crackles on inspiration
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
16
Q
Tripod
A
Push abdominal contents up to curve diaphragm
17
Q
Spirometry COPD
A
Before + after SABA
Post-bronchodilator FEV1/FVC (<0.7)
*compare to age related normal
18
Q
FEV1 =
FVC =
A
FEV1 =4 L
FVC = 5 L
Allergists : 0.8
Pulmonologists: 0.7
19
Q
GOLD 1:
A
Mild
FEV1 = 80%< predicted
20
Q
Gold 2:
A
Moderate
FEV1: 50%-80%
21
Q
Gold 3 :
A
Severe
FEV1: 30% - 50%
22
Q
Gold 4
A
Very severe
FEV1: <30%
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
Mild exacerbation?
Change in bronchodilator dose/antibio use
26
Moderate exacerbation
Systemic corticosteroids
27
Severe exacerbation
Hospital Admit
28
High risk COPD (exacerbation)
Past year:
* 2+ mild/moderate exacerbations
* one+ severe exacerbations
29
FRC =
Resting state
30
COPD - exercise decreases inspiratory capacity (IC)
* Residual volume UP
* inspiratory capacity DOWN
* intra-thoracic pressure UP
* CO down
31
CAT test
Measure of symptoms + impact on health status
32
Modified medical research council questionnaire
Dyspnea measure
| 2= fall behind walking with friends
33
Goals of Tx
REDUCE S/S
*exercise tolerance, health status
REDUCE RISK
* prevent disease progression
* exacerbations
* mortality
34
COPD tx
* SMOKING CESSATION
* pharmacotherapy/nicotine replacements
* Physical activity
* no pollution
* Vaccination (flu, pneumococcal)
35
TX
Bronchodilators
* DOWN s/s
* NO CURE
* Beta ags + antichols + theophylline
36
Systemic steroids?
Only during exacerbation , should be off by 10 day after discharge
37
COPD A group
SAMA or SABA
38
Group B Tx
LABA or LAMA
Then
LAMA + LABA
39
Group C tx
LAMA
Then
LABA + LAMA /OR/ ICS+LABA(no)
40
Group D tx
LAMA + LABA
then
LAMA+LABA+ICS
If need add:
Roflumilast. /. Macrolide
Nebulizer = low inspiratory capacity
41
Unhelpful Tx
* alpha-1 antitrypsin (if no deficiency)
* Mucolytics
* antitussives (tesselon pearls) = Give codeine
* vasodilators
42
Other tx
O2 therapy = Chronic respiratory failure (min 15 hours per day)
Ventilatory support = w/ long term O2
(Good w/ daytime hypercapnea)
43
COPD surgery
* UPPER-LOBE PREDOMINANT EMPHYSEMA + LOW EXERCISE CAPACITY = lung volume reduction surgery (living area will expand)
* SEVERE COPD? Lung transplantation
44
New Rx to patient?
Get back in 4 weeks, demonstrate how to use meds
45
MDI
DPI
SMI
Metered dose inhaler
Dry powder inhaler
Slow mist inhaler
46
Specific Rx guided by
Patient's insurance
47
Gold Category A
* Less symptoms = CAT <10
* Less Breathlessness = mMRC 0-1
* Low risk = 1 exacerbation /year not leading to hospital admit
48
Gold category B
* more symptoms = CAT >10
* Less Breathlessness = mMRC>2
* Low Risk= 1 exacerbation no hospital admit
49
Gold category C
VERY LITTLE HERE
* Less symptoms = CAT <10
* Less breathlessness mMRC = 0-1
* High risk = >2 exacerbations no admit OR >1 w/ admit
50
Gold Category D
*More symptoms : CAT>10
More breathlessness: mMRC>2
*Higher risk: >2 exacerbation no admit OR >1 exacerbation w/ admit
51
LABAs
Salmeterol
Formoterol
Indacaterol
Vilanterol
52
SAMA
Ipratropium
53
LAMAs
Tiotropium
Aclidinium
Umeclidinium
Glycopyrrolate
54
ICS
Fluticasone
Mometasone
Budesonide
55
PDE4 inhibitors
Roflumilast
