COPD Flashcards
Because COPD is a systemic disease, what are 6 other systemic manifestations?
IHD, cardiac failure, osteoporosis, metabolic syndrome, anemia, and depression
Describe grade 1-5 of the dyspnea scale and how many points each grade gets?
Grade 1: only lose breath during strenuous exercise
Grade 2: get short of breath hurrying on level ground or up a slight hill
Grade 3: walk slower than most people and need to stop because loses breath (1point)
Grade 4: stop after about 100 yards or a few minutes for breath (2 points)
Grade 5: too breathless to leave the house or even dress (3 points)
What is the system called that we use to predict COPD survivability?
BODE system BMI Airway obstruction Dyspnea scale Exercise capacity with 6 minute walk
What is the BMI part of it?
If you are over 21 you do not get a point
If you are equal to or under 21 you get a point
What is the airway obstruction part of it?
Measuring FEV1. If its equal to or over 65% no points 50-64, 1 point 36-49, 2 points Less than or equal to 35, 3 points
What is the 6 minute walk test part of it?
350 meters or over, no points
250-349, 1 point
150 - 249, 2 points
Less than 149, 3 points
The scale is based on a 4 year survival of COPD, so what total numbers equal what survival percentages?
0-2, 80%
3-4, 67%
5-6, 57%
7-10, 18%
What are the 4 reasons for dyspnea in COPD?
Increased dead space leading to increased CO2
Messed up V/Q ratio leading to hypoxemia
Airflow obstruction
Reduced mechanical advantage of the diaphragm
What is the Hoover sign referring to?
The diaphragm and lower ribs being sucked in while inhaling instead of expanding.
What are the two differential diagnosis for COPD he wants us to know?
Asthma and left ventricular failure
What are two similarities between COPD and asthma?
Weather can make it worse
Exam findings of cough, wheeze and prolonged expiratory phase
What are 4 differences about asthma that wouldn’t usually be identified with COPD?
It can be reversed almost completely
Seasonal component
Younger onset
ENT allergic component to it
What are the 3 similarities between left ventricular failure and COPD?
Dyspnea
Orthopnea
And exam showing cough and wheeze
3 differences unique to left ventricular heart failure?
PND
History of heart disease
And the exam shows heart problems
What is the suffix for SAMA and LAMA?
IUM
Suffix for short SABA?
Ol
Suffix for LABA?
Terol
Two suffixes for ICS?
Asone and ide
What is a Respimat inhaler?
Propellant free liquid inhaler that creates a cloud
What 4 other medicine groups are we using for COPD?
Antibiotics, oral corticosteroids, methyxanthines and PDE inhibitors
How do we classify milder and younger patients, what is the antibiotic of choice, and what other families of antibiotics do we use?
Milder means FEV1 greater than 50 and less than 65 years old.
Doxycycline
Cephalosporins and macrolide
S
What two families of antibiotics do we use for sicker and older patients?
Amoxicillin-clavulunate
Fluoros
What is the most common steroid prescribed and what is the cited dose?
Prednisone
1 mg/kg
What is the first indication for supplemental O2?
PaO2 less than 56 or SpO2 less than 89 measured twice over a 3 week period.
What is the second indication for supplemental oxygen?
PaO2 less than 60 and SpO2 less than 90 and evidence of: PHTN, CHF, or HCT over 55
What level of disease is GOLD 1 and what is treatment?
Mild COPD
Give either SABA or SAMA
What is GOLD 2 level disease and treatment?
Moderate COPD
LABA or LAMA
What is GOLD 3 level disease and treatment?
Severe COPD
ICS and LABA or ICS and LAMA
What is Gold 4 level of disease and treatment?
Very severe COPD
ICS and LABA or ICS and LAMA or ICS and LABA and LAMA and oxygen therapy is needed
If patient symptoms are still not under control in GOLD 3 and GOLD 4, what can we also prescribe?
Roflumilast or theophylline
What is a good program for these COPD patients and what are two vaccinations they need big time?
Pulmonary rehab program.
Flu and pneumococcal
What are we thinking with younger patient with COPD?
Alpha 1 antitrypsin deficiency
Top 3 patients with COPD?
Smokers, former smokers and a1at
All patients with unexplained dyspnea should be evaluated for what?
A1at deficiency
Treatment for COPD is largely based on what?
PFTS
What do we never use alone for treatment of COPD?
ICS
Besides left heart failure, what are 5 differentials for COPD?
Asthma, bronchiectasis, alpha 1 antitrypsin deficency, CF, and bronchiolitis
Most common cause of COPD?
Smoking
What combo of medicine is especially useful in patients with COPD?
Anticholinergic and SABA
What are the three top pathogens causing COPD exacerbation?
H influenza, strep pneumonia, and moraxella catarrhalis
