COPD

Question 1

COPD is a spectrum of which diseases?

Answer 1

Emphysema and chronic bronchitis

Question 2

What is emphysema?

Answer 2

Abnormal, permanent dilatation of the
airspaces distal to the terminal bronchioles

Accompanied by alveolar wall destruction
without fibrosis

Question 3

What are the characteristics of individuals with predominance of emphysema?

Answer 3

“Pink Puffer”
Maintain normal O 2 and CO 2 levels until late

Thin and cachectic (high energy expenditures to
maintain normal O 2 and CO 2

Cor pulmonale(right sided heart failure) occurs late

Question 4

What is chronic fibrosis?

Answer 4

Productive cough (> 250 ml sputum/day) for
at least 3 months per year for 2 consecutive
years
–
With airflow obstruction (COPD)

Question 5

What are the characteristics of individuals with predominance of chronic bronchitis?

Answer 5

"Blue Boater"
Individuals with chronic bronchitis do not
do the extra work required to maintain
normal ventilation
•
Hypercapnia and hypoxemia occur
relatively early in the disease process
•
Cor pulmonale(right sided heart failure)
tends to develop early

Question 6

What are comorbidities with COPD?

Answer 6

Weight loss with
decreased fat free
mass
•
Muscle wasting and
weakness
•
Other systemic effects:
– osteoporosis, anemia,  depression, cardiac Disease

Question 7

What genetic deficiency is associated with COPD?

Answer 7

A1AT deficiency is the only known genetic defect that
leads to COPD
• Accounts for <1% of all diagnosed COPD cases

Question 8

What is the role of A1AT?

Answer 8

Injury from Activated Neutrophils releasing proteolytic enzymes (leukocyte elastase) to normal tissue is minimized by A1AT

Question 9

Who should be screened for A1AT?

Answer 9

• diagnosed before age 65 years or

- with a smoking history of < 20 pack years.

Question 10

How to diagnosis COPD?

Answer 10

• Symptoms (cough, sputum, dyspnea)
• Exposure to risk factors (tobacco, occupation, indoor/outdoor pollution, familiy history)
• Spirometry [confirmatory]

Question 11

T or F: TLC and RV increase in COPD

Answer 11

T

Question 12

Who should be screened for COPD?

Answer 12

Smoker or ex smoker > 40 yrs old with:

• coughing
• sputum
• dyspnea on basic exertion
• frequent and longer colds?

Question 13

What are the stages for COPD?

Answer 13

Mild:
FEV1 greater than 80% predicted, FEV1/FVC <0.7

Moderate:
FEV1 50-79% predicted, FEV1/FVC <0.7

Severe:
FEV1 30 - 49% predicted, FEV1/FVC <0.7

Very Severe:
FEV1 <30% predicted, FEV1/FVC <0.7

Question 14

What is the MRC dyspnea scale and

CTS COPD classification?

Answer 14

Grade 1:
Dyspnea only with strenuous exercise

Grade 2:
Dyspnea when hurrying or walking up a slight hill

Grade 3:
Walks slower than people of the same age because of dyspnea or has to stop for breath when walking at own pace

Grade 4:
Stops for breath after walking 100 yards (91 m) or after a few minutes

Grade 5:
Too dyspneic to leave house or breathless when dressing

Question 15

What are some non-pharmacotherapy for COPD?

Answer 15

• Vaccinations
• Smoking cessation
• Exercise/ Pulmonary Rehabiitation

Question 16

What kind of vaccines are recommended in COPD?

Answer 16

• annual influenza

- pneumoccocal every 5-10 years

Question 17

What is the intervention that will affect the decline FEV1?

Answer 17

smoking cessation

Question 18

What is mild COPD and what pharmacotherapy is recommended?

Answer 18

CAT <10, MRC 1-2
Use a SABA as PRN
USe LABA or LAMA if gets worse

Question 19

What is moderate and severe COPD?

Answer 19

CAT > 10, MRC 3-5
can be either:
infrequent AECOPD OR frequent or Severe AECOPD

Question 20

What is pharmacotherapy for infrequent AECOPD?

Answer 20

LAMA or LABA
Worsen: LAMA/LABA
Wrosen: LAMA +ICS/LABA

Question 21

What is pharmacotherapy for severe COPD?

Answer 21

LAMA/LABA
Worsens: LAMA + ICS/LABA
Worsens: LAMA + ICS/LABA + PDE4 Inhibitor

Question 22

T or F: in COPD undergoes dynamic lung hyperinflation

Answer 22

T:

IC goes down
RV goes up

Question 23

T or F: LABA/LAMA improve exercise tolerance (via reducing hyperinflammation) and reduce rate of AECOPD?

Answer 23

T

Question 24

What is AECOPD?

Answer 24

An acute event characterized by a worsening of a patient’s respiratory symptoms that is beyond normal
day to day variations

Question 25

What characterizes AECOPD?

Answer 25

• Increased sputum volume
• Increased sputum purulence
• Worsening dyspnea

Question 26

What is the treatment of AECOPD?

Answer 26

Non-Invasive Positive Pressure Ventilation (NIPPV)
•Reduces the need for invasive ventilation/ICU
•Shortens time in hospital; reduces mortality

Short (5 day) course of systemic oral steroids
are of proven benefit in managing acute COPD exacerbations
•Improve the rate of recovery back to baseline
•Decreased length of hospitalization
5 day is as effective as 14 days treatment

Antimicrobial agents are of benefit when there is evidence of bacterial lower RTI

Question 27

What is the contraindication for NIPPV?

Answer 27

Hemodynamic instability
Copious secretions
Inability to protect the airway
Poor cooperation
Impaired mental status
Aspiration risk or poor mask fit/seal

Question 28

Which patient with AECOPD should receive antibiotics?

Answer 28

Increased dyspnea, sputum volume AND

sputum purulence

Question 29

What kind of antibiotic should be prescribed for AECOPD?

Answer 29

1 st line: doxycycline, amoxicillin,
TMP/SMX(usually outpatients)

2 nd line: amoxicillin clavulanate, cefuroxime,
macrolides, respiratory fluoroquinolones

End stage/debilitated: anti Pseudomonal
agents + Fluoroquinolone