COPD Flashcards
what happens in COPD
bronchial walls break, can no longer perform gas exchange
main cells of inflammation in COPD
neutrophils, caused by noxious agent
pink puffer is seen w/
emphysema
chronic bronchitis critera
productive cough for 3 months in each of 2 successive eyars
blue bloater is seen w/
chronic bronchitis
main risk factors for COPD
- smoking
- alpha 1 antirtrypsin deficiency
- HIV
- low birth weight
how does alpha 1 antitrypsin work
produced by liver, reaches alveolar lining, binds to extra elastase that is used to kill bacteria to neutralize it
deficiency causes emphysema, specifically lower lobe
TLC is max b/w 25-27 years, after this how many CCs of air are lost normally per year? how much for smokers?
25cc
75 cc
how is COPD diagnosed
spirometry
radiographic findings of COPD
- low, flattened diaphragm
- increased AP diameter
what is the best marker of mortality for COPD?
FEV1
what happens with cigarette smokers
dopamine released in nucleus accumens, give artificial nicotine
tx of cigarette replacement
varenicline tartrate, increases dopamine
therapy for stable COPD
- smoking cessation (group A)
- pulmonary rehab( A/B)
- flu/pneumococcal vaccine
COPD meds for group
SAMA (short acting muscarinic antagonist-vasodilation)
SABA (short acting beta agonist)
phosphodiesterase inhibitors are used for
group D pts, roflumilast
common LABA drugs
salmeterol, formoterol, olodaterol
common anticholinergic (SAMA/LAMA)
short acting-ipratropium bromide (atrovent)
long acting-tiotropium bromide (spiriva), aclinidium (tudorza)
common LAMA/LABA combo meds
umeclidinium/vilantgerol (anoro, ellipta)
tiotropium/olodaterol (stiolto, respimat)
glycopyrronium/formoterol
when to use glucocorticosteroids
- if FEV1<50% predicted and repeated exacerbations
- does not modify long term decline in FEV1, but does reduce freq of exacerbations and improve health status
Group A tx
bronchodilator
use SAMA if pt has heart disease
Group B tx
LAMA first or LABA
Group C tx
LAMA and LABA plus ICS
Group D tx
LAMA, LABA, ICS,forlumilast if FEV1<50% pred and pt has chronic bronchitis
adverse effects of inhaled steroids
- pneumonia
- thrush
systemic effects of COPD
- abnormal oxidative metabolism
- reduced skeletal muscle mass and function
- reduced lean body mass
when is long term O2 required?
when P02 <60
common pathologic organisms
H influenza
S pneumoniae
M catarrhalis
COPD presents w/
- cough
- slight sputum
