COPD Flashcards
What is the predominant risk factor?
Smoking
What gene deficiency is commonly associated with COPD?
Alpha-1 antitrypsin deficiency
What are the two major types of COPD that usually coexist together?
Emphysema and Chronic Bronchitis
What would evidence would help classify/Dx a PT with chronic bronchitis?
Productive cough >3 months in
2 consecutive years (other causes must be excluded)
What are some risk factors for COPD development?
Alpha 1-antitrypsin gene deficiency Smoking exposure Tb Recurrent lung infxns Asthma Pollutant/environmental exposures
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?
Emphysema
Dyspnea
Increased barrel chest
Decreased fremitus
HYPERINFLATION & HYPERRESONANCE
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?
CHRONIC BRONCHITIS
Respiratory Acidosis
Increased Hct and RBC (Hypoxemia leads to erythropoiesis)
Obese
Cyanotic
T/F
Chronic Bronchitis is IRREVERSIBLE.
True
Decreased breath sounds may be present with COPD and what altered sound might be noted (elongated or shortened) upon auscultation of breathing phases?
PROLONGED EXPIRATORY phase
Late stage of COPD may present with what clinical S/Sx?
Skeletal wasting/weakness JVD (Pulm HTN w/ cor pulmonale) Osteoporosis Depression / Anxiety Hepatomegaly Polycythemia Pursed lip breathing Clubbing (or yellow stains on fingers)
How is the diagnosis of COPD made?
Spirometry –> FEV1/FVC <70%
CXR can r/o CHF and malignancy
BNP (r/o CHF) or CBC (polycythemia r/in COPD)
What are the classifications of COPD?
Class 1: FEV1 >80% mild
Class 2: FEV1 50-80% moderate
Class 3: FEV1 30-50% severe
Class 4: FEV1 <30% VERY SEVERE
What are the only two therapies which will improve survival with COPD?
Smoking Cessation
O2 Therapy
What is the Tx protocol for Class I COPD?
What does every PT get?
BRONCHODILATOR (class I is SABA)
Anticholinergic (Ipratropium)
Beta2 agonist: (Albuterol)
If a Class II COPD PT is present (50-80% predicted FEV1) what would you Rx them?
Class 1 SABA + a LABA/LAMA
LABA: Salmetrol
LAMA (Anticholinergic): Tiotropium
If you wanted to combine your short acting beta agonist and anticholinergic what could you order?
Combivent (Albuterol + Ipratropium)
both short acting
What would a Class III (30 to 50% FEV1 predicted) COPD PT receive for pharmacotherapy?
SABA (Albuterol), Ipratropium (anticholin), or Combivent (Albuterol + ipratropium)
~~~PLUS~~~~~
LABA (Salmetrol) or LAMA (Tiotropium)
~~~~~PLUS~~~~~
ICS: Triamcinolone
Budesonide
FluticasoneWhat is a potential common side effect of ICS therapies?
Increased infection risk
Oral THRUSH
The PDE4 enzyme is commonly involved in inflammatory processes and airway/tissue remodeling; what new medication focuses on inhibiting this enzyme to Tx COPD?
Roflumilast (Daliresp)
Good for those PTs who cannot tolerate ICS
Fluticasone and Salmeterol combination therapies are used for which Class of PTs? What is its more common name?
ADVAIR
SEVERE, SEVERE COPD PTs
What Vaccines are recommended for COPD at risk or COPD Tx’d PTs?
Influenza
Pneumococcal (Prevnar 13, Pneumovax 23)
When is pulmonary rehab recommended for COPD PTs?
FEV1 < 50% predicted (Class III and IV COPD PTs)
What are the MC microorganisms to cause infxns in COPD PTs?
H. influenzae
S. pneumoniae
Rx: Azithro or Levofloxacin (Levo is great if complicated)
When is O2 therapy indicated for COPD PTs?
Cor Pulmonale present
O2 Sats <88%
PaO2 <55 to 60mmHg
