COPD

Question 1

epidemiology of COPD: _____ of longterm smokers with well COPD, ____ of smokers will die from a smoking-related cause

Answer 1

25%, 50%

Question 2

Worldwide, COPD is expected to move up from being ____ leading cause of ______ lost in 1990 to ____ in 2020

Answer 2

12th , disability-adjusted life-years (DALYs)

5th

Question 3

while ____ is the leading cause of COPD,

_______ is important cause of COPD, especially in the absence of smoking

Answer 3

smoking,

Alpha 1 anti-trypsin deficiency

Question 4

onset of COPD (decade of life?)

Answer 4

5th-6th

Question 5

4 risk factors for COPD that are unchangable

Answer 5

genes, infections, socio-economic status, AGE

Question 6

“GOLD” definition of COPD

Answer 6

conditions of chronic bronchitis, emphysema and chronic asthma
“a preventable, treatable disease
-airflow limitation (progressive)
-enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases.”

Question 7

COPD is considered _____ b/c its chronic

Answer 7

irreversible

Question 8

emphysema, Chronic bronchitis, asthma… which has most reversibility, most sputum, most alveolar damage?

Answer 8

reversible: asthma
sputum: chronic bronchitis
alveolar damage: emphysema

Question 9

emphysema, chronic bronchitis, asthma… which has no reversibility?

Answer 9

emphysema

Question 10

onset late in life, smoking history and symptoms slowly progressive…

Answer 10

COPD

Question 11

onset early in life, symptoms vary and worse at night/morning, family history of disease…

Answer 11

Asthma

Question 12

what are elastases?

Answer 12

enzymes that breakdown elastic connective tissue that is there to support terminal bronchioles and alveoli - this breakdown leads to airway collapse

Question 13

______ and _______ leads to elastase increase

Answer 13

smoking and longterm irritation

Question 14

Alpha1- Antitrypsin deficiency

Answer 14

this is a proteolytic enzyme- deficiency leads to imbalance of elastase activity- can lead to emphysema

Question 15

patients with COPD symptoms who are young/non-smokers.. think …

Answer 15

Alpha1-antitrypsin deficiency

Question 16

loss of elasticity in the lung leads to …

Answer 16

small airways collapse and air is “trapped” due to premature small airway closure during expiration

Question 17

emphysema: no symptoms until ___ of lung is damaged

Answer 17

1/3

Question 18

_____ and ______of emphysema can be seen on ___ by not ___

Answer 18

bullae and cavities

CT, not Xray

Question 19

different between Chronic bronchitis and emphysema in regards to where in the bronchiole/alveoli they are influencing. both involve what airway wall changes

Answer 19

emphysema- distal to terminal bronchioles (loss of alveolar surface area
chronic bronchitis- proximal to alveoli (no alveolar loss)
-both: airway wall thickening

Question 20

Dx of COPD is based on ____

Answer 20

history! (smoker?, occupational exposure? age?, etc. )

and PFT!

Question 21

6 signs of COPD on PE : inspection (most show up in later stages)

Answer 21

barrel chest, pursed lips, cough, dyspnea, use of accessory muscles, clubbing/nicotine stains

Question 22

barrel chest is more common in emphysema or chronic bronchitis?

Answer 22

emphysema

Question 23

pursed lips are a sign of …

Answer 23

PEEP : positive end expiratory pressure

Question 24

palpation/percussion findings of PE for COPD (4)

Answer 24

hyper-resonance
distance heart sounds (long AP diamter - barrel chest),
expiratory>inspiratory,
possible crackles, wheezing, rhonci

Question 25

____ demonstrates degree of obstruction for COPD

Answer 25

spirometry | *COPD severity is assessed using the postdilator lung function (FEV1/FVC ratio before and after inhaled bronchodilator)

Question 26

ratio of FEV1/FVC < ____ indicates obstruction

Answer 26

0.7

Question 27

COPD: mild, moderate, severe stages based on FEV1 percent predictive value

Answer 27

mild: >80% moderate: 50%-80% severe: 30%-50%

Question 28

COPD: Dx w/ ____ , level severity with _____

Answer 28

PFT, ABGs

Question 29

4 things to do for evaluation of person with confirmed moderate COPD

Answer 29

glucocorticoid reversibility testing, chest Xray, ABGs, anti-trypsin screen (if not usual population)

Question 30

two types of COPD

Answer 30

A. pink puffer - mainly emphysema | B. blue bloater - mainly chronic bronchitis

Question 31

pink puffer

Answer 31

Pink Puffer:- O2 stays up, breath fast and shallow (puffing) - skinny b/c putting so much metabolic effort into breathing Hypertrophy of accessory breathing muscles ( lung compliance inc.) Thin Pink (polycythemia) Pursed lips

Question 32

blue bloater

Answer 32

``` coughing up mucus Overweight Perioral/digital cyanosis Digital clubbing younger ```

Question 33

steroids better for chronic bronchitis or emphysema?

Answer 33

chronic bronchitis

Question 34

what is chronic bronchitis and where does it come from?

Answer 34

Classic definition: presence of cough/sputum production for most days for at least 3 consecutive months during 2 consecutive years. Results from prolonged exposure to irritants including cigarettes and allergens, pollutants, and recurrent infections. Have inflammatory changes in bronchial mucosa and increase in the number and size of mucus glands

Question 35

fibrosis inflammation and mucus comes from...

Answer 35

chronic bronchitis

Question 36

emphysema

Answer 36

enlargement of airspaces distal to terminal bronchioles destruction of alveolar walls results in: inc. CO2, pulm. HTN, inc. effort, polycythemia, cor pulmonale

Question 37

Single most effective (and cost effective) intervention to reduce the risk of developing COPD and stop its progression

Answer 37

stop smoking

Question 38

the five As to help someone stop smoking

Answer 38

The Five A’s ASK about tobacco use ADVISE clear, nonjudgmental personalized ASSESS readiness to quit ASSIST with a plan (materials, resources, Rx, referral) ARRANGE for follow-up, Don’t give up on your patients if they relapse

Question 39

pharmacotherapy for COPD is used to do....

Answer 39

pharmacotherapy is used to decrease symptoms, reduce the frequency and severity of exacerbations,

Question 40

the only therapy that impacts the natural history of COPD

Answer 40

O2 therapy

Question 41

_______ medications are central to the symptomatic management of COPD.

Answer 41

bronchodilators

Question 42

inhaled anti-cholinergics and COPD?

Answer 42

be careful, one study showed theyre associated with increased risk of cardiovascular death, MI, or stroke among patients with COPD.”

Question 43

PDE-4 inhibitors may reduce ___ by ___% for COPD

Answer 43

May reduce exacerbation rate, by ~15-20%. but there are toxic ADRs- tacchyarrythmia, nausea/vomit, seizures

Question 44

ICS for stable COPD:

Answer 44

regular txt w/ ICS does not modify the longterm decline in FEV1 -only helpful for some symptomatic pts

Question 45

An inhaled corticosteroid combined with a ______is more effective in treating COPD symptoms than either alone

Answer 45

long-acting beta2-agonist

Question 46

LVRS- lung volume reduction surgery for COPD

Answer 46

is pallative, improves elastic recoil and diaphragm expansion for emphysema- predominant COPD

Question 47

acute exacerbation of chronic bronchitis/COPD (AECB)

Answer 47

Increase in dyspnea, sputum purulence or sputum volume - fever - 20-50% du to viral infections

Question 48

AECB should be treated with:

Answer 48

Abx

Question 49

morning headache can be a sign of ...

Answer 49

inc. CO2 (hypercapnea)- COPD

Question 50

for COPD, expiration is ____ than inspiration

Answer 50

longer