COPD Flashcards
epidemiology of COPD: _____ of longterm smokers with well COPD, ____ of smokers will die from a smoking-related cause
25%, 50%
Worldwide, COPD is expected to move up from being ____ leading cause of ______ lost in 1990 to ____ in 2020
12th , disability-adjusted life-years (DALYs)
5th
while ____ is the leading cause of COPD,
_______ is important cause of COPD, especially in the absence of smoking
smoking,
Alpha 1 anti-trypsin deficiency
onset of COPD (decade of life?)
5th-6th
4 risk factors for COPD that are unchangable
genes, infections, socio-economic status, AGE
“GOLD” definition of COPD
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.”
COPD is considered _____ b/c its chronic
irreversible
emphysema, Chronic bronchitis, asthma… which has most reversibility, most sputum, most alveolar damage?
reversible: asthma
sputum: chronic bronchitis
alveolar damage: emphysema
emphysema, chronic bronchitis, asthma… which has no reversibility?
emphysema
onset late in life, smoking history and symptoms slowly progressive…
COPD
onset early in life, symptoms vary and worse at night/morning, family history of disease…
Asthma
what are elastases?
enzymes that breakdown elastic connective tissue that is there to support terminal bronchioles and alveoli - this breakdown leads to airway collapse
______ and _______ leads to elastase increase
smoking and longterm irritation
Alpha1- Antitrypsin deficiency
this is a proteolytic enzyme- deficiency leads to imbalance of elastase activity- can lead to emphysema
patients with COPD symptoms who are young/non-smokers.. think …
Alpha1-antitrypsin deficiency
loss of elasticity in the lung leads to …
small airways collapse and air is “trapped” due to premature small airway closure during expiration
emphysema: no symptoms until ___ of lung is damaged
1/3
_____ and ______of emphysema can be seen on ___ by not ___
bullae and cavities
CT, not Xray
different between Chronic bronchitis and emphysema in regards to where in the bronchiole/alveoli they are influencing. both involve what airway wall changes
emphysema- distal to terminal bronchioles (loss of alveolar surface area
chronic bronchitis- proximal to alveoli (no alveolar loss)
-both: airway wall thickening
Dx of COPD is based on ____
history! (smoker?, occupational exposure? age?, etc. )
and PFT!
6 signs of COPD on PE : inspection (most show up in later stages)
barrel chest, pursed lips, cough, dyspnea, use of accessory muscles, clubbing/nicotine stains
barrel chest is more common in emphysema or chronic bronchitis?
emphysema
pursed lips are a sign of …
PEEP : positive end expiratory pressure
palpation/percussion findings of PE for COPD (4)
hyper-resonance
distance heart sounds (long AP diamter - barrel chest),
expiratory>inspiratory,
possible crackles, wheezing, rhonci
____ demonstrates degree of obstruction for COPD
spirometry
*COPD severity is assessed using the postdilator lung function (FEV1/FVC ratio before and after inhaled bronchodilator)
ratio of FEV1/FVC < ____ indicates obstruction
0.7
COPD: mild, moderate, severe stages based on FEV1 percent predictive value
mild: >80%
moderate: 50%-80%
severe: 30%-50%
COPD: Dx w/ ____ , level severity with _____
PFT, ABGs
4 things to do for evaluation of person with confirmed moderate COPD
glucocorticoid reversibility testing, chest Xray, ABGs, anti-trypsin screen (if not usual population)
two types of COPD
A. pink puffer - mainly emphysema
B. blue bloater - mainly chronic bronchitis
pink puffer
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
blue bloater
coughing up mucus Overweight Perioral/digital cyanosis Digital clubbing younger
steroids better for chronic bronchitis or emphysema?
chronic bronchitis
what is chronic bronchitis and where does it come from?
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
fibrosis inflammation and mucus comes from…
chronic bronchitis
emphysema
enlargement of airspaces distal to terminal bronchioles
destruction of alveolar walls
results in: inc. CO2, pulm. HTN, inc. effort, polycythemia, cor pulmonale
Single most effective (and cost effective) intervention to reduce the risk of developing COPD and stop its progression
stop smoking
the five As to help someone stop smoking
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
pharmacotherapy for COPD is used to do….
pharmacotherapy is used to decrease symptoms, reduce the frequency and severity of exacerbations,
the only therapy that impacts the natural history of COPD
O2 therapy
_______ medications are central to the symptomatic management of COPD.
bronchodilators
inhaled anti-cholinergics and COPD?
be careful, one study showed theyre associated with increased risk of cardiovascular death, MI, or stroke among patients with COPD.”
PDE-4 inhibitors may reduce ___ by ___% for COPD
May reduce exacerbation rate, by ~15-20%. but there are toxic ADRs- tacchyarrythmia, nausea/vomit, seizures
ICS for stable COPD:
regular txt w/ ICS does not modify the longterm decline in FEV1
-only helpful for some symptomatic pts
An inhaled corticosteroid combined with a ______is more effective in treating COPD symptoms than either alone
long-acting beta2-agonist
LVRS- lung volume reduction surgery for COPD
is pallative, improves elastic recoil and diaphragm expansion
for emphysema- predominant COPD
acute exacerbation of chronic bronchitis/COPD (AECB)
Increase in dyspnea, sputum purulence or sputum volume
- fever
- 20-50% du to viral infections
AECB should be treated with:
Abx
morning headache can be a sign of …
inc. CO2 (hypercapnea)- COPD
for COPD, expiration is ____ than inspiration
longer
