COPD Flashcards
COPD should be considered in any patient with:
Dyspnea, chronic cough, or sputum production, a history of lower respiratory tract infections, and/or a history of exposure to risk factors for the disease.
What is required to make the diagnosis of COPD?
Spirometry with the presence of a post-bronchodilator FEV1/FVC <0.70 will confirm the presence of persistent airflow limitation.
This is the permanent, alveolar damage and loss of elevation recoil that results in chronic hyperinflation of the lungs. Expiratory respiratory phase is markedly prolonged.
Emphysema
This is a condition associated with excessive tracheobronchial mucus production- defined as coughing with excessive mucus production for at least 3 or more months for a minimum of 2 or more consecutive years.
Chronic bronchitis
Clinical presentation of COPD:
Cough
Exertional dyspnea
Sputum production
Objective findings with the emphysema component?
Increased AP diameter Decreased Breath sounds and heart sounds Use of accessory muscles Purses-lip breathing Weight loss
Chest X-ray findings?
Flattened diaphragms with hyper inflation
Bullae sometimes present
Objective findings with the chronic bronchitis component?
Productive cough
Wheezing
Coarse crackles
Pink puffers are
Emphysema patients
Describe pink puffers:
May be very thin with a barrel chest
Decreased diaphragmatic excursion
Prolonged expiratory phase with expiratory wheezing
May sit in tripod posture
Purses lip breathing and use of accessory muscles
Heart sounds may be distant
Low BMI
Blue bloaters are seen with:
Chronic bronchitis
Blue bloaters May be described as:
May be obese
Frequent cough and expectoration
Use of accessory muscles common
Coarse rhonchi and wheezing may be auscultated
May have signs of heart failure such as edema and cyanosis
Lower peak flow measure with exercise
In COPD FEV1 and FEV1/FVC is:
Decreased
In COPD total lung capacity is:
Normal or increased
In COPD residual volume is:
Increased
Postbronchodilator FEV1 less than what indicated COPD?
70% predicted
What is stage I: mild COPD?
FEV1/FVC < 70%
FEV1 greater than or equal to 80% of predicted
What is stage 2: moderate COPD?
FEV1/FVC < 70%
FEV1 50-79%
What is stage 3: severe COPD?
FEV1/FVC < 70%
FEV1 30-49% predicted
What is stage 4: very severe COPD?
FEV1 <30% of predicted or FEV1 < 50% of predicted plus chronic respiratory failure
Treatment of stage 1: mild COPD?
SABA/iprateopium prn
Treatment for stage 2: moderate copd?
Saba/ipratropium prn
Add in LABA and rehab
Treatment for stage 3: severe COPD?
Saba/ipratropium as needed
LABA/ rehab
Add in ICS if repeated exacerbations
Treatment of stage 4: very severe COPD?
Saba/ ipratropium as needed
LABA/ rehab
ICS
Add long-term oxygen if chronic respiratory failure
Cardinal symptoms of COPD exacerbations?
Increased dyspnea
Increased sputum production
Increased sputum purulence
Outpatient management of COPD exacerbations:
Bronchodilator 7 days minimum
Oral steroids ( 5 day burst/10 day taper)
Oxygen prn
Antibiotics IF 2 cardinal symptoms met , including increase in sputum purulence or is severe and requiring mechanical ventilation
Gold antibiotic guidelines for group A?
Group a- mild exacerbation and no risk factors for poor outcome.
B-lactam
Tetracycline
Bactrim
Good antibiotic guideline for group b: patients with moderate exacerbations and risk factor/s for poor outcome?
Augmentin
Gold antibiotic guidelines for group c: patients with severe exacerbations and a risk for P. Aeruginosa infection?
Fluoroquinolones- watch for tendonopathy
Prognosis of exacerbation is most strongly predicted by?
Age (better under 60)
Post bronchodilator FEV1 (better greater than 50% predicted)
