COPD Flashcards
COPD management is based on
symptom burden and risk for exacerbation. airflow limitation by FEV1 is considered but plays a smaller role since it provides a poorer correlation w/ symptoms and quality of life.
Groups B-D COPD should get
pulmonary rehab and this is based on their risk for having exacerbation >2 per year.
why is pulmonary rehab so good for COPD?
COPD pts often limit physical activity as this exercise worsens their dyspnea and leads to deconditioning and creates a physical vicious cycle of having dyspnea happening at lower levels of activity. Rehab breaks the cycle
what happens a pulmonary rehab?
consists of conditioning, breathing training, psychological support and dx education and helps to break the cycle and improve symptoms, increases exercise capacity and quality of life.
lung volume reduction surgery helps with COPD pts who have
upper lobe emphysema and low exercise capacity. meant for select pts with severe COPD who fail maximal therapy.
When do we use theophylline?
given to pts who have refractory disease on triple inhaler therapy (beat agonists, antimuscarinics and corticosteroids) helps with modest bronchodilation and requires close monitoring to prevent toxicity
when do we offer oxygen therapy for COPD pts?
improves survival and quality of life with chronic hypoxia when
resting PaO2< 55 mmHg or SpO2<88.
resting PaO2<59 or SaO2 <89 + have cor pulmonale (right sided heart failure) or erythrocytosis (hematocrit>55%)
Oxygen should be titrate to maintain SaO2 of 90-92% and should be used for 15 hrs per day or more.
PaO2 <55mg or SaO2<88 during exercise or sleep many benefit from supplemental oxygen therapy during those times too.
GOLD grade 1 COPD
mild FEV1>80% of predicted
GOLD grade 2 COPD
moderate FEV1 is between 50-80% of predicted
GOLD grade 3 COPD
severe FEV1 is between 30-50% predicted
GOLD grade 4 COPD
very severe FEV1<30% predicted
palliative care in COPD principles
treat underlying dx supplemental oxygen pulmonary rehab
If this fails due to worsening dyspnea, consider opioids (long and short acting), facial cooling, consider anxiolytics or consider theophylline
If dyspnea worsens consider end of life care with palliative sedation and non invasive positive pressure ventilation
pts with advanced COPD should be on
triple inhaler therapy (long acting beta agonist, long acting anticholinergic, and glucosteroid)
what can help relieve dyspena or sense of breathlessness in pts with end stage lung disease
opioids - underused by clinicians for fear or respiratory depression, addiction and dependence. societal and patient factors also limit their use.
roflumilast therapy provides what benefit for COPD pts?
decreases risk for COPD exacerbation in pts with frequent exacerbations.
chronic azithromycin therapy provides what benefit for pts who have COPD?
helps decrease risk for COPD exacerbations in pts who frequently have exacerbations.
Management of COPD
Indications for starting oxygen therapy in COPD pt?
Goal therapy SaO2 and duration of oxygen use?
resting PaO2< 55 mmHg or SpO2<88.
resting PaO2<59 or SaO2 <89 + have cor pulmonale (right sided heart failure) or erythrocytosis (hematocrit>55%)
Oxygen should be titrate to maintain SaO2 of 90-92% and should be used for 15 hrs per day or more.
Side effects of inhaled corticosteroid inhalers for COPD
helps improve symptoms, lung function and quality of life and reduces frequency of COPD exacerbations in pts who have FEV1<60 of predicted value.
Side effects are: oral candidiasis, hoarse voice, skin bruising and slightly increased risk for pneumonia.
what helps to improve long term survival in COPD
stop smoking
long term home oxygen therapy for people who have chornic hypoxemia
what does severe COPD would benefit from?
agressive pharmacology, pulmonary rehab and smoking cessation.
what does pulmonary rehab do?
How long is it?
pulmonary rehab helps teach lower and upper extremity exercises to improve endurance and conditioning, breathing and retraining to decrease breathing frequency, disease education/therapy and psychosocial support
Lasts for 6 weeks and can be done at home or outpatient
Benefits of pulmonary rehab for pt and for healthcare
benefits are to improve exercise capacity
reduce pt perceived dypsnea intensity
increase health related quality of life.
decreases anxiety and depression related to COPD
decreases hospitalizations or days in hospital due to decrease healthcare costs.
COPD recommended therapy
COPD can cause pulmonary HTN and this is seen in pts who have
hypoxemia,
peripheral edema,
murmur of tricuspid regurg
prominent pulmonic component of second heart sound
confers worse prognosis but no changes in regimen or treatment plan
Criteria for hospice in COPD
irreversible pulm dx
hypoxemia or hypercapnia
right heart failure from pulmonary dx
unintentional weight loss >10% body weight in last 6 months
resting tachycardia >100/min
criteria for lung transplantation for COPD
quit smoking for at least 6 months
- BODE index >5 body mass index, obstruction, dypsnea, and exercise
FEV1<25% predicted resting hypoxemia PaO2<,55-60
hypercapnia
secondary pulmonary HTN
acclerated decline in FEV1.
lung volume reduction surgery is
removal of hyperinflated lung tissue and allows for respiratory muscles to more effectively generate a pressure gradient and increases elastic recoil or remaining lung tissue. Meant for people who have upper lobe emphysema and frequent exacerbations.
helps improve the mechanical efficiency of breathing and improves expiratory flow rates and leads to reduced frequency of exacerbations.
No longer do bullectomy - no long term benefits. basically removes large bullae
Bronchoscopic lung volume reduction - newer procedure and needs more research.
