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Clinical Med II > COPD > Flashcards

COPD Flashcards

1
Q

What is the destruction of the gas-exchanging surfaces of the lung (alveoli)?

A

Emphysema

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2
Q

What is the presence of cough and sputum production for at least 3 months in each of two consecutive year?

A

Chronic bronchitis

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3
Q

What are the systemic effects of COPD?

A
  • Hypoexemia; hypercapnia
  • Respiratory acidosis
  • Cyanosis
  • Cor pulmonale
  • Weight gain or weight loss
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4
Q

What is the most commonly early symptoms in COPD?

A

Dyspnea on exertion

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5
Q

What are symptoms associated with COPD?

A
  • Dyspnea
  • Chronic cough
  • Sputum production
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6
Q

Why is smoking such a big risk factor for COPD?

A

Smoking stimulates elastase, a proteolytic enzyme which causes the following:

  • Degenerative changes in elastin and alveolar structures
  • Release of cytotoxic oxygen radicals from WBCs in lung tissue
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7
Q

What does Alpha-1 Antitrypsin Deficiency cause in regards to COPD?

A
  • Causes premature emphysema as AAT is an inhibitor of proteases (elastase), so w/ a deficiency the elastase is able to cause degenerative changes
  • Process of lung destruction is accelerated in smokers with AATD
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8
Q

What kind of physical exam findings might you find in someone with COPD?

A
  • Tripod positioning, use of accessory muscles
  • Pursed lip breathing
  • Cyanosis
  • Muscle wasting
  • Peripheral edema
  • S3 gallop or RV lift
  • Barrel chest
  • Prolonged expiration
  • Decreased breath sounds
  • Wheezing or rhonchi
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9
Q

Why do patients exhibit pursed lip breathing in COPD?

A
  • In COPD, ordinary breathing allows early bronchial collapse on exhalation
  • Pursed-lip breathing achieves resistance to outflow at the lips; raising intrabronchial pressure, keeping the bronchi open
  • More air can be expelled
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10
Q

What is the most common cause of Cor Pulmonale?

A

COPD

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11
Q

What can Cor Pulmonale lead to?

A

S3 gallop, RVH, hepatomegaly, peripheral edema

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12
Q

What is Cor Pulmonale?

A

Altered structure and/or impaired function of the right ventricle that results from pulmonary HTN associated with lung disease

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13
Q

What diagnostic study is required to make a diagnosis of COPD?

A

Spirometry

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14
Q

What is the role of spirometry in COPD?

A

Used to establish the diagnosis AND to determine the severity of airway obstruction

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15
Q

What is the amount of air that is forcefully exhaled during maximal forced expiration?

A

Forced Vital Capacity (FVC)

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16
Q

What PFT confirms an obstructive pattern?

A

A Post-bronchodilator FEV-1/FVC ratio that is < 0.7

17
Q

The following will be increased or decreased in COPD:

TLC
DLCO

A

TLC: Increased
DLCO: Decreased

18
Q

What does FEV-1 determine in COPD?

A

GOLD Class I-IV (severity of obstruction)

19
Q

Will the following be increased, decreased, or normal in an obstructive disorder:

FEV-1
FVC
FEV-1/FVC
Exhalation

A

FEV-1: Decreased
FVC: Normal
FEV-1/FVC: Decreased
Exhalation: Prolonged

20
Q

When might you consider ordering an ABG?

A
  • FEV-1 < 50%
  • SPO2 < 92%
  • Depressed LOC
  • Acute exacerbation of COPD
21
Q

When might you consider obtaining Alpha-1 Antitrypsin?

A
  • Young patient (< 45 years old)
  • Non-smoker
  • Family hx of emphysema
22
Q

What findings will be seen on chest x-ray that are consistent with COPD?

A 
Signs of air trapping: 
- Increased AP diameter
- Hyperinflation (elongation of the lungs) and hyperlucency
- Flattened diaphragm
Blebs or bullae
Perivascular or peribronchial markings
23
Q

What can be seen on chest x-ray and is pathognomonic for emphysema?

A

Blebs or bullae (radiolucent areas)

24
Q

For a patient with Gold Grade A with low risk/less symptoms, what is the suggested treatment?

A

Short-acting bronchodilators (SABA, SAMA, or combo)

25
Q

For a patient with Gold Grade B with low risk/more symptoms, what is the suggested treatment?

A

LAMA or LABA

*SABA available for symptoms control as needed

26
Q

For a patient with Gold Grade C with high risk/less symptoms, what is the suggested treatment?

A

LAMA

*SABA available for symptoms control as needed

27
Q

For a patient with Gold Grade D with high risk/more symptoms, what is the suggested treatment?

A

LAMA

OR

LABA-LAMA if severe breathlessness

*SABA available for symptoms control as needed

28
Q

What is the mainstay of therapy in COPD?

A

Bronchodilators

  • Inhaled B2-agonists and anticholinergics
  • Short and long-acting options
29
Q

What are examples of short-acting B2-Agonists (SABA)?

A

Albuterol (2 puffs every 4-6 hours)

30
Q

What are examples of long-acting B2-Agonists (LABA)?

A

Salmeterol and formoterol (dosing every 12 hours)

31
Q

What are B2-agonists used for and what are their potential side effects?

A

Used for bronchodilation in COPD; no effect on sputum/secretions

Side effects: palpitations, tachycardia, insomnia, tremors

32
Q

What are examples of short-acting anticholinergics (SAMA)? What is the dosing?

A
  • Ipratropium bromide (Atrovent)
  • Ipratropium plus albuterol (Combivent)

Dosing: 2 puffs BID-QID

33
Q

What are examples of long-acting anticholinergicsm (LAMA)? What is the dosing?

A
  • Tiotropium bromide (Spiriva)
  • Umeclidinium (Incruse Ellipta)

Dosing: once daily

34
Q

What are anticholinergics used for and what are their potential side effects?

A

Used for bronchodilation in COPD; reduces “air trapping” in lungs. Less cardiac stimulatory effect.

Side effects: dry mouth, metallic taste, HA, cough

35
Q

What is the mechanism behind corticosteroids in COPD?

What are examples?

What are side effects?

A

Reduces mucosal edema/inflammation by inhibiting prostaglandins and increases responsiveness to beta-adrenergic.

Advair, Symbicort

Side effects: oral candidiasis, bruising

36
Q

What patients would you prescribe antiprotease therapy to?

A

Patients with alpha-1 antitrypsin deficiency (serum levels < 11)

37
Q

What is the outpatient management for COPD exacerbation?

A
  • Increase frequency of SABA
  • Oral Prednisone 40 mg daily x 5 days
  • Antibiotics x 5-7 days (for mod to severe exacerbations)
  • Consider hospitalization (if severe)

Clinical Med II (17 decks)

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