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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
Q

What are the GOLD criteria for assessment of COPD severity?

A
26
Q

What is DLCO in COPD?

A

Reduced due to obstruction

27
Q

What test should you perform in a patient under 45 who develops COPD or with a strong family history of COPD?

A

Alpha-1 Antitrypsin Deficiency Screening

28
Q

What is a COPD exacerbation?

A

worsening symptoms from stable state of dyspnea, cough and productive sputum.

29
Q

who is high risk for exacerbations?

A

patients in the past year who had two or more mild to moderate exacerbations

one or more severe exacerbations

30
Q

when using systemic corticosteroids, what must you do?

A

keep use short-term only and taper

31
Q

What does the mMRC questionnaire assess?

A

Degree of breathlessness

32
Q

What score on the CAT questionnaire is considered symptomatic?

A

> or equal to 10 = symptomatic

33
Q

How are the risk categories stratified o the GOLD combined assessment of COPD?

(A-D)

A

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
Q

What are the two major objectives of COPD therapy?

A

Reduce symptoms - improve health status and exercise tolerance

Reduce Risk - prevent progression, prevent and treat exacerbations and reduce mortality

35
Q

What is the most important thing people with COPD can do to slow the progression of the disease?

A

quit smoking

36
Q

What else, other than quitting smoking, is important for COPD patients to do?

A

get regular physical activity and remain active

reduce exposure to pollutants

get influenza and pneumococcal vaccinations

37
Q

What class of medications are central to the treatment of COPD?

A

bronchodilators

38
Q

What short acting Beta 2 agonists (SABAs) are used in the treatment of COPD?

A

albuterol

levoalbuterol

39
Q

What long-acting beta 2 agonists are used in treatment of COPD?

A

salmeterol

formoterol

indacaterol

vilanterol

40
Q

What muscarinic inhibitors (anticholinergics) are used in the management of COPD?

A

SAMA - ipotropium

LAMA - tiotropium, aclidinium, umeclidinium, glycopyrrolate

41
Q

What inhaled corticosteriods are sometimes used in COPD?

A

fluticasone, mometasone, budesonide

42
Q

What are some infrequently used drugs in the management of COPD?

A

Methylxantines - theophylline

phosphodisterase4 inhibitors - roflumist

systemic corticosteriods - for exacerbations only. No more than 10 days with a taper.

43
Q

Which is preferred in treatment? Long-acting or short-acting formulations?

A

long-acting

44
Q

Long-term monotherapy with what class of drugs is NOT recommended in COPD?

A

inhaled corticosteroids

45
Q

what is roflumilast useful for?

A

to reduce exacerbations in patients with chronic bronchitis

46
Q

What antibiotic class may be useful to reduce exacerbations in patients with chronic bronchitis?

A

macrolides

47
Q

What are the preferred treatments for GOLD group A?

A

SAMA or SABA prn

48
Q

What is the preferred treatment for GOLD Class B?

A

LABA or LAMA (1st line)

LAMA + LABA (2nd line)

49
Q

What is the preferred treatment for GOLD Class C?

A

LAMA + LABA

or

ICS + LABA (moving away from this)

50
Q

What is the preferred treatment for GOLD Group D?

A

LAMA + LABA (1st)

LAMA + LABA + ICS (2nd)

Roflumilast/Macrolide (exacerbation)

51
Q
A
52
Q

What is NOT recommended for use in COPD?

A

NO

antitussives

mucolytics

alpha-1 antitrypsin augmentation (unless genetically deficient)

Clin Med - Pulmonary (13 decks)

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