COPD

Question 1

COPD management is based on

Answer 1

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.

Question 2

Groups B-D COPD should get

Answer 2

pulmonary rehab and this is based on their risk for having exacerbation >2 per year.

Question 3

why is pulmonary rehab so good for COPD?

Answer 3

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

Question 4

what happens a pulmonary rehab?

Answer 4

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.

Question 5

lung volume reduction surgery helps with COPD pts who have

Answer 5

upper lobe emphysema and low exercise capacity. meant for select pts with severe COPD who fail maximal therapy.

Question 6

When do we use theophylline?

Answer 6

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

Question 7

when do we offer oxygen therapy for COPD pts?

Answer 7

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.

Question 8

GOLD grade 1 COPD

Answer 8

mild FEV1>80% of predicted

Question 9

GOLD grade 2 COPD

Answer 9

moderate FEV1 is between 50-80% of predicted

Question 10

GOLD grade 3 COPD

Answer 10

severe FEV1 is between 30-50% predicted

Question 11

GOLD grade 4 COPD

Answer 11

very severe FEV1<30% predicted

Question 12

palliative care in COPD principles

Answer 12

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

Question 13

pts with advanced COPD should be on

Answer 13

triple inhaler therapy (long acting beta agonist, long acting anticholinergic, and glucosteroid)

Question 14

what can help relieve dyspena or sense of breathlessness in pts with end stage lung disease

Answer 14

opioids - underused by clinicians for fear or respiratory depression, addiction and dependence. societal and patient factors also limit their use.

Question 15

roflumilast therapy provides what benefit for COPD pts?

Answer 15

decreases risk for COPD exacerbation in pts with frequent exacerbations.

Question 16

chronic azithromycin therapy provides what benefit for pts who have COPD?

Answer 16

helps decrease risk for COPD exacerbations in pts who frequently have exacerbations.

Question 17

Management of COPD

Answer 17

Question 18

Indications for starting oxygen therapy in COPD pt?

Goal therapy SaO2 and duration of oxygen use?

Answer 18

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.

Question 19

Side effects of inhaled corticosteroid inhalers for COPD

Answer 19

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.

Question 20

what helps to improve long term survival in COPD

Answer 20

stop smoking

long term home oxygen therapy for people who have chornic hypoxemia

Question 21

what does severe COPD would benefit from?

Answer 21

agressive pharmacology, pulmonary rehab and smoking cessation.

Question 22

what does pulmonary rehab do?

How long is it?

Answer 22

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

Question 23

Benefits of pulmonary rehab for pt and for healthcare

Answer 23

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.

Question 24

COPD recommended therapy

Answer 24

Question 25

COPD can cause pulmonary HTN and this is seen in pts who have

Answer 25

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

Question 27

Criteria for hospice in COPD

Answer 27

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

Question 28

criteria for lung transplantation for COPD

Answer 28

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.

Question 29

lung volume reduction surgery is

Answer 29

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.