COPD Flashcards
Explain the pathophysiology of Chronic bronchitis?
Chronic airway obstruction:
- Hypersecretion of mucus, leading to airway narrowing
- This airway narrowing leads to increase in airway resistance and thus obstruction
- Mucus pluffing and mucociliary escalator destruction makes patients more prone to microbial infections*
On PE of a Chronic bronchitis patient, what will you hear on auscultation of the lungs?
- Rhonchi
- Wheezing: the air squeaking through a small airway
- Crackles (rales): small airways being popped open
A patient with Chronic bronchitis, what would you expect to see on an ABG with an exacerbation?
Respiratory acidosis
-Increased Hct/RBCs (Chronic hypoxemia stimulates erythropoiesis)
Why would a patient with Chronic bronchitis have an increased Hematocrit/RBCs?
Chronic hypoxemia stimulates erythropoiesis
What type of COPD patients are “obese and cyanotic”?
Chronic bronchitis
What type of COPD patients have a severe V/Q mismatch?
Chronic bronchitis
- Hypercapnea (high CO2)
- Hypoxemia (low O2)
What is the gold standard for diagnosing COPD?
Pulmonary Function Tests/Spirometry
- Decreased FEV1/FEV: < 70% : Obstructive
- Increased RV, TLC, RV/TLC: Hyperinflation
Which PFT is an important factor of prognosis and mortality?
FEV1: < 1L = increased mortality
Which COPD condition has hyperinflation, a flat diaphragm, an increased AP diameter with decreased vascular markings and bullae on CXR/CT?
Emphysema
A COPD patients CXR reveals an increased AP diameter, increased vascular markings, and an enlarged right heart border. What COPD condition is this more specific for?
Chronic bronchitis
Cor pulmonale is more seen with which COPD condition?
Chronic bronchitis
+/- Atrial flutter
+/- Atrial fibrillation
+MAT
Which medications can exacerbate COPD patients?
- Decongestants
- BB
- Sedatives
What other exacerbation triggers should you keep in mind with COPD patients?
Infections:
- Pneumonia
- Bronchitis
What is the most important step in the management of COPD?
Smoking cessation!
How are patients with COPD managed?
Combination therapy with anticholinergics + B2 agonists shows greater response than if used alone!
- Bronchodilators: Anticholinergics, B2 agonists, Theophylline (not really used)
- Corticosteroids
- Oxygen
What is the only medical therapy proven to decrease mortality in COPD treatment?
Oxygen
When should a patient be placed on oxygen for COPD treatment?
Use if:
- Cor pulmonale
- O2 sat <88%
- PaO2 <55mmHg
Which type of bronchodilators are preferred in the management of COPD?
Anticholinergics preferred over short acting B2 agonists
- Tiotroprium (Spiriva): inhaled long acting
- Ipratroprium (Atrovent)
What is the MOA of Triptroprium (Spiriva) or Ipratroprium (Atrovent)?
Anticholinergics: Block acetylcholine mediated bronchoconstriction and cause bronchodilation
A patient is currently on Triptroprium (Spiriva), what are some questions addressing the SE of this medication?
- Any dry mouth?: dry mouth
- Are you thirsty a lot?: increased thirst
- Have you noticed any blurry vision?: blurry vision
- How are you urinating? Has it decreased*?: urinary retention
What are some CI to using Anticholinergics, Spiriva and Atrovent?
- BPH: anticholinergics may cause increased urinary retention
- Glaucoma: anticholinergics may cause pupillary dilation
Which B2 agonists are used for the management of COPD?
- Albuterol (Provenil)
- Terbutaline (Brethine)
- Salmeterol (long acting)
What is the MOA of :
- Albuterol (Provenil)
- Terbutaline (Brethine)
- Salmeterol (long acting)
in COPD management?
B2 activation: bronchodilation
A patient is currently on Albuterol (Proventil), what are some questions addressing the SE of this medication?
1. B1 cross reactivity: tachycardia, arrhythmias, muscle tremor, CNS stimulation ?
What are some CI to:
- Albuterol (Provenil)
- Terbutaline (Brethine)
- Salmeterol (long acting)
in the management of COPD?
- Severe CAD
- CAUTION with DM patients: can cause HYPERglycemia
- Hyperthyroidism
Why should you be careful with DM patients on B2 agonists?
Can cause hyperglycemia
Which vaccines are used to prevent COPD exacerbations?
- Pneumococcal
2. Influenza
A patient is diagnosed with COPD. PFTs revealed a FEV1 of 80%. What stage of COPD is this considered? How do you manage this patient?
MILD: FEV1 > or = 80%
SA Bronchodilators
-decrease risk factors
A patient is diagnosed with COPD. PFTs revealed a FEV1 of 78%. What stage of COPD is this considered? How do you manage this patient?
MODERATE: FEV1 50-79%
SA Bronchodilators + LA dilator
-decrease risk factors
A patient is diagnosed with COPD. PFTs revealed a FEV1 of 30%. What stage of COPD is this considered? How do you manage this patient?
SEVERE: FEV1 30-50%
SA Bronchodilators + LA dilator + Pulmonary rehab + Steroids if there are increased exacerbations*
-decrease risk factors
A patient is diagnosed with COPD. PFTs revealed a FEV1 of 28%. What stage of COPD is this considered? How do you manage this patient?
VERY SEVERE: FEV1 < 30%
Cor pulmonale, Respiratory failure, heart failure
SA Bronchodilators + LA dilator + Pulmonary rehab + Steroids if there are increased exacerbations*
- decrease risk factors
- O2 therapy*
What is the only genetic disease linked to COPD in younger patients <40y?
alpha-antitrypsin deficiency
What is the purpose of alpha-antitrypsin?
protects the elastin in the lungs from damage from WBCs
-associated with PANlobar emphysema
Smoking is associated with which of the following?
A. Panlobar emphysema
B. Centrilobular emphysema
B. Centrilobar emphysema
Respiratory alkalosis is associated with which COPD condition?
Emphysema
Which COPD condition is associated with matched V/Q defects, mild hypoxemia, with CO2 often reading normal?
Emphysema
Which COPD condition is associated with cachectic, pursed lip breathing; “pink puffers”?
Emphysema
On PE of an Emphysema patient, what will you find?
Hyperinflation:
- Hyperresonance to percussion
- Decreased/ absent breath sounds
- Decreased fremitus
- Barrel chest: increased AP diameter
- Quiet chest
- Pursed lip breathing
Which bronchodilator is only used in refractory cases of COPD?
Theophylline
-higher doses are needed in Smokers*
Why should you monitor a COPD patient when prescribing Theophylline?
Narrow TI Monitor serum levels to prevent: 1. Nausea 2. Palpitations 3. Arrhythmias 4. Seizures from toxic levels
What is considered a toxic level of Theophylline when managing COPD?
> 20 mg/L
Which Corticosteroids are used in the management of COPD?
LA: Salmeterol + Fluticasone
Which management of COPD improves quality of life, subjective dyspnea, and exercise intolerance?
Pulmonary Rehab
Which COPD patients should receive antibiotics?
Acute Bacterial Exacerbations of Chronic Bronchitis if:
- Increased sputum
- Change in sputum quality
- CXR evidence of infx
Which management of COPD improves dyspnea by removing damaged lung, which allows the remaining lung to expand and function more efficiently?
Lung reduction surgery
T or F: Alpha-antitrypsin can be replaced and used as a management for COPD?
TRUE
In nonsmokers, what is the normal rate of decline in FEV1 after age 35?
20-30mL/year
