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Clin Med - Pulmonary > COPD > Flashcards

COPD Flashcards

1
Q

What is the definition of COPD?

A

A

  • common,
  • preventable, and
  • treatable
  • disease characterized by persistent respiratory symptoms and airflow limitation due to airway or alveolar abnormalities
  • caused by significant exposure to noxious particles or gases.
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2
Q

What are the two major subtypes of airflow limitation in COPD?

A

Chronic Bronchitis

Emphysema

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3
Q

What are the criteria for chronic bronchitis?

A

daily cough with sputum production lasting for at least three months, two years in a row

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4
Q

What are the findings in the airways in chronic bronchitis?

A

In the small airways:

  • inflammation
  • fibrosis
  • luminal
  • increased airway resistance
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5
Q

What are the findings in the airways in emphysema?

A

In the parenchyma:

  • alveolar destruction
  • loss of alveolar attachments
  • decrease of elastic recoil
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6
Q

What are the answers to all the questions on the exam?

A

I don’t know

BUT

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7
Q

COPD Epidemiology

A
  • onset usually in mid-life >40 years
  • symptoms slowly progressive
  • usually long smoking / exposure history
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8
Q

Asthma epidemiology

A
  • usually diagnosed early in life (childhood)
  • symptoms vary from day-to-day
  • symptoms often worse at night/early morning
  • allergy, rhinitis and eczema also present
  • family history of asthma
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9
Q

What percentage of smokers go on to develop COPD?

A

About 24% develop clinically significant COPD

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10
Q

What are some other environmental causes of COPD?

A

exposure to pollution from biomass fuels

expsoure to smoke from fires or second hand

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11
Q

What are common COPD phenotypes?

A

emphysema

chronic bronchitis

ACOS - Asthma/COPD overlap syndrome

emphysema interstitial fibrosis syndrome

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12
Q

What are some risk factors for COPD?

A

lower socio-economic status

infections

genotype

female gender

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13
Q

COPD is the ____ leading cuase of death in the world

A

4th

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14
Q

Approximately how many adults in the US are living with COPD (2011 figure)?

A

24 million

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15
Q

What symptoms and history should prompt you to consider COPD?

A

Symptoms (not all need to be present): dyspnea, chronic cough, sputum production

Risk factors: tobacco smoking, biomass smoke, occupation, indoor/outdoor pollution

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16
Q

What other conditions are associated with COPD?

A

depression

anemia

pulmonary hypertension

cor pulmonale

osteoporosis

impaired systemic muscle function

decreased fat-free mass

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17
Q

What should you do to diagnose COPD if suspected?

A

Spirometry/Pulmonary Function Testing

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18
Q

How do you determine the severity of the disease?

A

Assessment of:

  • risk factors
  • symptoms
  • severity of airflow limitation with spirometry
  • impact on patient’s health status
  • risk of future exacerbations
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19
Q

What is the best single predictor of airflow obstruction?

A

40 pack-year smoking history

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20
Q

What signs on PE are suggestive of COPD?

A
  1. hyperinflation (barrel chest)
  2. hyperresonance on percussion
  3. decreased breath sounds
  4. wheezing on regular and forced expiration
  5. prolonged expiratory phase
  6. crackles on inspiration (sometimes)
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21
Q

What are some common signs seen suggestive of the chronic bronchitic phenotype?

A
  • possible obesity
  • signs of right heart failure - edema and cyanosis
  • frequent cough and expectoration
  • use of accessory muscles of respiration (SCM)
  • coarse wheezes may be heard on auscultation
22
Q

what are some common signs of the emphysematic phenotype?

A
  • may be thin with barrel chest
  • litte to no cough
  • pursed lips and use of accessory respiratory muscles
  • tripod sitting position (in distress)
  • hyperresonant chest with wheezing
  • heart sounds very distant
23
Q

What is diagnostic on spirometry of obstruction?

A

FEV1/FVC < .70 post-bronchodilator

24
Q

What should you not give people with right-sided heart failure?

A

diuretics - it increases the pre-load volume and exacerbates the problem

25
What are the GOLD criteria for assessment of COPD severity?
26
What is DLCO in COPD?
Reduced due to obstruction
27
What test should you perform in a patient under 45 who develops COPD or with a strong family history of COPD?
Alpha-1 Antitrypsin Deficiency Screening
28
What is a COPD exacerbation?
worsening symptoms from stable state of dyspnea, cough and productive sputum.
29
who is high risk for exacerbations?
patients in the past year who had two or more mild to moderate exacerbations one or more severe exacerbations
30
when using systemic corticosteroids, what must you do?
keep use short-term only and taper
31
What does the mMRC questionnaire assess?
Degree of breathlessness
32
What score on the CAT questionnaire is considered symptomatic?
\> or equal to 10 = symptomatic
33
How are the risk categories stratified o the GOLD combined assessment of COPD? (A-D)
A (low risk) - CAT\<10 and mMRC 0-1 with 0-1 exacerbations in the past 12 months that did not lead to hospital admission B (low risk) - CAT\> or equal to 10 and mMRC \> or equal to 2 with 0-1 exacerbations not leading to hospital admission C (high risk) - CAT \<10 and mMRC 0-1 with 2 or more exacerbations or one or more leading to hospitalization in the past 12 months D (high risk) - CAT \> or equal to 10 and mMRC \> or equal to 2 with 2 or more exacerbations or one or more leading to hospitalization in the past 12 months
34
What are the two major objectives of COPD therapy?
Reduce symptoms - improve health status and exercise tolerance Reduce Risk - prevent progression, prevent and treat exacerbations and reduce mortality
35
What is the most important thing people with COPD can do to slow the progression of the disease?
quit smoking
36
What else, other than quitting smoking, is important for COPD patients to do?
get regular physical activity and remain active reduce exposure to pollutants get influenza and pneumococcal vaccinations
37
What class of medications are central to the treatment of COPD?
bronchodilators
38
What short acting Beta 2 agonists (SABAs) are used in the treatment of COPD?
albuterol levoalbuterol
39
What long-acting beta 2 agonists are used in treatment of COPD?
salmeterol formoterol indacaterol vilanterol
40
What muscarinic inhibitors (anticholinergics) are used in the management of COPD?
SAMA - ipotropium LAMA - tiotropium, aclidinium, umeclidinium, glycopyrrolate
41
What inhaled corticosteriods are sometimes used in COPD?
fluticasone, mometasone, budesonide
42
What are some infrequently used drugs in the management of COPD?
Methylxantines - theophylline phosphodisterase4 inhibitors - roflumist systemic corticosteriods - for exacerbations only. No more than 10 days with a taper.
43
Which is preferred in treatment? Long-acting or short-acting formulations?
long-acting
44
Long-term monotherapy with what class of drugs is NOT recommended in COPD?
inhaled corticosteroids
45
what is roflumilast useful for?
to reduce exacerbations in patients with chronic bronchitis
46
What antibiotic class may be useful to reduce exacerbations in patients with chronic bronchitis?
macrolides
47
What are the preferred treatments for GOLD group A?
SAMA or SABA prn
48
What is the preferred treatment for GOLD Class B?
LABA or LAMA (1st line) LAMA + LABA (2nd line)
49
What is the preferred treatment for GOLD Class C?
LAMA + LABA or ICS + LABA (moving away from this)
50
What is the preferred treatment for GOLD Group D?
LAMA + LABA (1st) LAMA + LABA + ICS (2nd) Roflumilast/Macrolide (exacerbation)
51
52
What is NOT recommended for use in COPD?
NO antitussives mucolytics alpha-1 antitrypsin augmentation (unless genetically deficient)

Clin Med - Pulmonary (13 decks)

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