COPD Flashcards
COPD is a spectrum of which diseases?
Emphysema and chronic bronchitis
What is emphysema?
Abnormal, permanent dilatation of the
airspaces distal to the terminal bronchioles
Accompanied by alveolar wall destruction
without fibrosis
What are the characteristics of individuals with predominance of emphysema?
“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
What is chronic fibrosis?
Productive cough (> 250 ml sputum/day) for
at least 3 months per year for 2 consecutive
years
–
With airflow obstruction (COPD)
What are the characteristics of individuals with predominance of chronic bronchitis?
"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
What are comorbidities with COPD?
Weight loss with decreased fat free mass • Muscle wasting and weakness • Other systemic effects: – osteoporosis, anemia, depression, cardiac Disease
What genetic deficiency is associated with COPD?
A1AT deficiency is the only known genetic defect that
leads to COPD
• Accounts for <1% of all diagnosed COPD cases
What is the role of A1AT?
Injury from Activated Neutrophils releasing proteolytic enzymes (leukocyte elastase) to normal tissue is minimized by A1AT
Who should be screened for A1AT?
- diagnosed before age 65 years or
- with a smoking history of < 20 pack years.
How to diagnosis COPD?
- Symptoms (cough, sputum, dyspnea)
- Exposure to risk factors (tobacco, occupation, indoor/outdoor pollution, familiy history)
- Spirometry [confirmatory]
T or F: TLC and RV increase in COPD
T
Who should be screened for COPD?
Smoker or ex smoker > 40 yrs old with:
- coughing
- sputum
- dyspnea on basic exertion
- frequent and longer colds?
What are the stages for COPD?
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
What is the MRC dyspnea scale and
CTS COPD classification?
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
What are some non-pharmacotherapy for COPD?
- Vaccinations
- Smoking cessation
- Exercise/ Pulmonary Rehabiitation
What kind of vaccines are recommended in COPD?
- annual influenza
- pneumoccocal every 5-10 years
What is the intervention that will affect the decline FEV1?
smoking cessation
What is mild COPD and what pharmacotherapy is recommended?
CAT <10, MRC 1-2
Use a SABA as PRN
USe LABA or LAMA if gets worse
What is moderate and severe COPD?
CAT > 10, MRC 3-5
can be either:
infrequent AECOPD OR frequent or Severe AECOPD
What is pharmacotherapy for infrequent AECOPD?
LAMA or LABA
Worsen: LAMA/LABA
Wrosen: LAMA +ICS/LABA
What is pharmacotherapy for severe COPD?
LAMA/LABA
Worsens: LAMA + ICS/LABA
Worsens: LAMA + ICS/LABA + PDE4 Inhibitor
T or F: in COPD undergoes dynamic lung hyperinflation
T:
IC goes down
RV goes up
T or F: LABA/LAMA improve exercise tolerance (via reducing hyperinflammation) and reduce rate of AECOPD?
T
What is AECOPD?
An acute event characterized by a worsening of a patient’s respiratory symptoms that is beyond normal
day to day variations
What characterizes AECOPD?
- Increased sputum volume
- Increased sputum purulence
- Worsening dyspnea
What is the treatment of AECOPD?
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
What is the contraindication for NIPPV?
Hemodynamic instability Copious secretions Inability to protect the airway Poor cooperation Impaired mental status Aspiration risk or poor mask fit/seal
Which patient with AECOPD should receive antibiotics?
Increased dyspnea, sputum volume AND
sputum purulence
What kind of antibiotic should be prescribed for AECOPD?
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
