COPD

Question 1

What is the predominant risk factor?

Answer 1

Smoking

Question 2

What gene deficiency is commonly associated with COPD?

Answer 2

Alpha-1 antitrypsin deficiency

Question 3

What are the two major types of COPD that usually coexist together?

Answer 3

Emphysema and Chronic Bronchitis

Question 4

What would evidence would help classify/Dx a PT with chronic bronchitis?

Answer 4

Productive cough >3 months in

2 consecutive years (other causes must be excluded)

Question 5

What are some risk factors for COPD development?

Answer 5

Alpha 1-antitrypsin gene deficiency
Smoking exposure
Tb
Recurrent lung infxns
Asthma
Pollutant/environmental exposures

Question 6

If a PT appears cachectic with pursed lip breathing and mild hypoxemia… What might you suspect their clinical Dx is?

What else might they present with clinically?

Answer 6

Emphysema

Dyspnea
Increased barrel chest
Decreased fremitus
HYPERINFLATION & HYPERRESONANCE

Question 7

A PT presents with a productive cough, rales and SEVERE hypoxemia… What condition do you suspect they are suffering from?

What other conditions might this PT present with?

Answer 7

CHRONIC BRONCHITIS

Respiratory Acidosis
Increased Hct and RBC (Hypoxemia leads to erythropoiesis)
Obese
Cyanotic

Question 8

T/F

Chronic Bronchitis is IRREVERSIBLE.

Answer 8

True

Question 9

Decreased breath sounds may be present with COPD and what altered sound might be noted (elongated or shortened) upon auscultation of breathing phases?

Answer 9

PROLONGED EXPIRATORY phase

Question 10

Late stage of COPD may present with what clinical S/Sx?

Answer 10

Skeletal wasting/weakness
JVD (Pulm HTN w/ cor pulmonale)
Osteoporosis
Depression / Anxiety
Hepatomegaly
Polycythemia
Pursed lip breathing
Clubbing (or yellow stains on fingers)

Question 11

How is the diagnosis of COPD made?

Answer 11

Spirometry –> FEV1/FVC <70%

CXR can r/o CHF and malignancy
BNP (r/o CHF) or CBC (polycythemia r/in COPD)

Question 12

What are the classifications of COPD?

Answer 12

Class 1: FEV1 >80% mild
Class 2: FEV1 50-80% moderate
Class 3: FEV1 30-50% severe
Class 4: FEV1 <30% VERY SEVERE

Question 13

What are the only two therapies which will improve survival with COPD?

Answer 13

Smoking Cessation

O2 Therapy

Question 14

What is the Tx protocol for Class I COPD?

What does every PT get?

Answer 14

BRONCHODILATOR (class I is SABA)
Anticholinergic (Ipratropium)
Beta2 agonist: (Albuterol)

Question 15

If a Class II COPD PT is present (50-80% predicted FEV1) what would you Rx them?

Answer 15

Class 1 SABA + a LABA/LAMA
LABA: Salmetrol
LAMA (Anticholinergic): Tiotropium

Question 16

If you wanted to combine your short acting beta agonist and anticholinergic what could you order?

Answer 16

Combivent (Albuterol + Ipratropium)

both short acting

Question 17

What would a Class III (30 to 50% FEV1 predicted) COPD PT receive for pharmacotherapy?

Answer 17

SABA (Albuterol), Ipratropium (anticholin), or Combivent (Albuterol + ipratropium)
             ~~~PLUS~~~~~
LABA (Salmetrol) or LAMA (Tiotropium)
           ~~~~~PLUS~~~~~
ICS:  Triamcinolone
          Budesonide
          Fluticasone

Question 18

What is a potential common side effect of ICS therapies?

Answer 18

Increased infection risk

Oral THRUSH

Question 19

The PDE4 enzyme is commonly involved in inflammatory processes and airway/tissue remodeling; what new medication focuses on inhibiting this enzyme to Tx COPD?

Answer 19

Roflumilast (Daliresp)

Good for those PTs who cannot tolerate ICS

Question 20

Fluticasone and Salmeterol combination therapies are used for which Class of PTs? What is its more common name?

Answer 20

ADVAIR

SEVERE, SEVERE COPD PTs

Question 21

What Vaccines are recommended for COPD at risk or COPD Tx’d PTs?

Answer 21

Influenza

Pneumococcal (Prevnar 13, Pneumovax 23)

Question 22

When is pulmonary rehab recommended for COPD PTs?

Answer 22

FEV1 < 50% predicted (Class III and IV COPD PTs)

Question 23

What are the MC microorganisms to cause infxns in COPD PTs?

Answer 23

H. influenzae
S. pneumoniae

Rx: Azithro or Levofloxacin (Levo is great if complicated)

Question 24

When is O2 therapy indicated for COPD PTs?

Answer 24

Cor Pulmonale present
O2 Sats <88%
PaO2 <55 to 60mmHg