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foundations pulm exam > COPD > Flashcards

COPD Flashcards

1
Q

define COPD

A

common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases

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2
Q

what are the most common respiratory symptoms of COPD?

A

dyspnea, cough, and/or sputum production

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3
Q

main risk factor for COPD?

A

tobacco smoking

biomass fuel exposure and air pollution may contribute

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4
Q

what host factors predispose individuals to develop COPD?

A

genetic abnormalities
abnormal lung development
accelerated aging

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5
Q

what is required to make the diagnosis of COPD?

A

spirometry

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6
Q

what are the goals of COPD assessment?

A

determine the level of airflow limitation
impact of disease on the pt’s health status
risk of future events (exacerbations, hospitalizations, or death)

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7
Q

what are concomitant chronic diseases that occur frequently in COPD pts?

A 
cardiovascular disease
skeletal muscle dysfunction
metabolic syndrome
osteoporosis 
depression
anxiety
lung cancer
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8
Q

what are other symptoms of COPD?

A 
wheezing/chest tightness
fatigue
weight loss
anorexia
syncope
rib fractures
ankle swelling
depression
anxiety
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9
Q

classify GOLD 1-4 for the severity of airflow limitation

A

GOLD 1 - mild, FEV1 80% or more
GOLD 2 - moderate, FEV1 50-79%
GOLD 3 - severe, FEV1 30-49%
GOLD 4 - very severe, FEV1 <30%

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10
Q

what are examples of diagnostic tools for COPD?

A

COPD assessment test (CAT)

chronic respiratory questionnaire (CRQ)

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11
Q

how to treat mild COPD?

A

SABAs

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12
Q

how to treat moderate COPD?

A

SABAs plus antibiotics and/or oral corticosteroids

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13
Q

how to treat severe COPD?

A

hospitalization or visits ER

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14
Q

what may also predict exacerbation rates in pts treated with LABA without ICS?

A

blood eosinophil count

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15
Q

ABCD assessment stool takes into account what?

A

exacerbation history

symptom score based on either CAT or mMRC

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16
Q

define mMRC scores from 0-4

A

0 - none, only breathlessness with strenuous exercise
1 - mild, SOB hurrying or walking up a hill
2 - moderate, walks slower than age group or has to stop for breath when walking on level ground at own pace
3 - severe, stops for breaths after walking 100 meters or a few minutes on level ground
4 - very severe, breathless when dressing/undressing or too breathless to leave the house

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17
Q

what does A mean on COPD severity assessment?

A

less symptoms low risk, FEV 1 50% or greater, 0-1 exacerbations in last year
<10 CAT score OR 0-1 mMRC

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18
Q

what does B mean on COPD severity assessment?

A 
more symptoms
FEV1 50% or greater
0-1 exacerbations in last year
10 or greater CAT score
2 or greater mMRC socre
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19
Q

what does C mean on COPD severity assessment?

A 
less symptoms, high risk
FEV1 less than 50%
2 or more exacerbations OR 1 or more exacerbations leading to hospital admission in past year
CAT score <10
mMRC score 0-1
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20
Q

what does D mean on COPD severity assessment?

A 
more symptoms, high risk
FEV1 <50%
2 or more exacerbations or 1 or more leading to hospital admission
10 or greater CAT score
2 or more mMRC score
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21
Q

what genetic deficiency is associated with COPD?

A

alpha-1 antitrypsin deficiency (AATD) in emphysema particularly less than 45 y/o

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22
Q

what is the key preventative measure against COPD?

A

smoking cessation

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23
Q

which vaccinations decrease lower respiratory tract infections?

A

flu vaccination

pneumococcal vaccination

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24
Q

in pts with severe resting chronic hypoxemia, what improves survival?

A

long-term O2

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25
Q

in pts with severe chronic hypercapnia and a hx of hospitalization for acute respiratory failure, what may decrease mortality and prevent re-hospitalization?

A

long-term non-invasive ventilation

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26
Q

pts with advanced emphysema refractory to optimized medical care should try what treatments?

A

surgical or bronchoscopic interventional treatments

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27
Q

between LABA and LAMA, which has a greater effect on exacerbation reduction?

A

LAMAs

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28
Q

regular treatment with ICS increases the risk of ____

29
Q

in pts with chronic bronchitis, severe to very severe COPD and a hx of exacerbations, what may improve lung function and reduce moderate and severe exacerbations?

A

PDE4 inhibitor

30
Q

what antibiotics help reduce exacerbations over one year?

A

azithromycin and erythromycin

31
Q

what does pulmonary rehab improve?

A

dyspnea
health status
exercise tolerance in stable pts

32
Q

which pts should receive long-term O2?

A

pts with severe chronic resting arterial hypoxemia

33
Q

which pts is lung volume reduction surgery indicated for?

A

severe emphysema pts with an upper-lobe emphysema and low post-rehab exercise capacity

34
Q

what are the main treatment goals of COPD?

A

reduction of symptoms and future risk of exacerbations

35
Q

what types of counseling are recommended in treating tobacco use/dependence?

A

practical counseling
social support of family and friends
social support outside of treatment

36
Q

what are first-line pharmacotherapies for tobacco dependence?

A 
varenicline
bupropion sustained release
nicotine gum
nictonine inhaler
nicotine nasal spray 
nicotine patch
37
Q

when are SABAs recommended over LABAs and LAMAs?

A

only if pt has occasional dyspnea

38
Q

group A COPD, what treatment?

A

bronchodilator (can be short-acting or long-acting

39
Q

group B COPD, what treatment?

A

LABA or LAMA and if persistent symptoms, do LAMA + LABA

40
Q

group C COPD, what treatment?

A

LAMA

if further exacerbation, do LAMA + LABA

41
Q

group D COPD, what treatment?

A

LAMA + LABA

if further exacerbation, do LAMA + LABA + ICS

42
Q

if pts treated with LABA + LAMA + ICS still have exacerbations, what are you options?

A

roflumilast (FEV1 < 50% and at least one hospitalization for an exacerbation in the previous year)
macrolide (azithromycin)
stopping ICS

43
Q

what are non-pharmacological treatments of COPD?

A 
education/self-management
physical activity
pulmonary rehab program
exercise training
self-management education
end of live and palliative care
nutritional support
vaccination
oxygen therapy
44
Q

long-term O2 therapy indicated for stable pts who have?

A

PaO2 at or below 7.3 kPA (55 mmHg) or SaO2 at or below 88% with or without hypercapnia confirmed twice over a three week period

45
Q

when do you follow-up on supplemental oxygen?

A

recheck in 60-90 days to see if oxygen is still indicated or effective

46
Q

what pts is interventional bronchoscopy and surgery indicated for?

A

emphysema
large bulla, surgical bullectomy
very severe COPD - lung transplant consider

47
Q

what do you monitor and follow-up on each visit?

A 
measurements (spirometry)
symptoms (cough, sputum, breathlessness, fatigue, sleep disturbance)
exacerbations
imaging
smoking status
pharmacotherapy
48
Q

what is the most common cause of exacerbations of COPD?

A

upper respiratory tract infections

49
Q

what are the initial bronchodilators in treating acute exacerbations?

A

SABAs with or w/o anticholinergics

50
Q

what should be initiated as soon as possible before hospital discharge?

51
Q

what is the duration of therapy for systemic corticosteroids?

52
Q

what is the duration of therapy for antibiotics?

53
Q

what is the first mode of ventilation recommended in COPD pts with acute respiratory failure who have no absolute contraindication?

A

non-invasive mechanical ventilation

54
Q

define respiratory failure

A 
RR 20-30 bpm; no accessory respiratory muscles
no change in mental status
hypoxemia with supplemental O2
28-35% FiO2
no increase in PaCO2
55
Q

define acute respiratory failure - non-life-threatening

A 
RR > 30 bpm
use accessory muscles
no change in mental status
hypoxemia with 25-30% FiO2
PaCO2 increased 50-60 mmHg
56
Q

define acute respiratory failure - life-threatening

A 
RR > 30 bpm
use accessory muscles
acute changes in mental status
hypoxemia FiO2 > 40%
PaCO2 increased > 60 mmHg
acidosis pH 7.25 or less
57
Q

how to manage severe but not life-threatening exacerbations?

A 
administer supplemental O2
bronchodilators
consider oral corticosteroids
consider antibiotics
consider noninvasive mechanical ventilation 
monitor fluid balance
consider SC heparin
58
Q

what are the three main classes of medications for COPD exacerbations?

A

bronchodilators
corticosteroids
antibiotics

59
Q

what are indications for noninvasive mechanical ventilation?

A 
respiratory acidosis pH 7.35 or less or PaCO2 6 or greater (45 mmHg)
severe dyspnea (respiratory accessory muscles)
persistent hypoxemia despite supplemental O2
60
Q

what are indications for invasive mechanical ventilation?

A 
unable to tolerate NIV
s/p respiratory/cardiac arrest
diminished consciousness or psychomotor agitation
massive aspiration
severe hemodynamic instability
severe arrhythmias
61
Q

when should you follow up with COPD with exacerbation pt?

A

<4 weeks = early

<12 weeks = late

62
Q

the main cause of death in pts with COPD?

A

lung cancer

63
Q

in general, the presence of comorbidities should or should not altered COPD treatment?

A

should not alter

64
Q

what are frequent/important comorbidities of COPD?

A

osteoporosis

depression/anxiety

65
Q

what bronchodilator improves the effectiveness of pulmonary rehab?

A

tiotropium

66
Q

what FEV1 are PDE4 inhibitors indicated?

A

FEV1 < 50%

67
Q

what class of medication would you give to someone with high eosinophils?

A

corticosteroids

68
Q

what are ADR for beta agonists?

A

increase heart rate
decrease potassium
tremor

foundations pulm exam (10 decks)

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