COPD Flashcards
in COPD diagnosis, the FEV1/FVC ratio is ___ and the ___ decreases in proportion to the severity of emphysema, not sensitive for mild disease.
in COPD diagnosis, the FEV1/FVC ratio is REDUCED and the DLCO decreases in proportion to the severity of emphysema, not sensitive for mild disease.
is COPD obstructive or restrictive lung disease?
obstructive. in order to diagnose COPD, there must be FIXED airflow obstruction on spirometry; FEV1/FVC less than 0.7 or the lower limit of normal.
post bronchodilator FEV1 tells you severity of airflow obstruction.
- Asthma is still a condentor on diagnosis
DDx of COPD
- asthma
- bronchiectasis
- GERD
- cancer/malignancy/central airway obstruction
- heart failure
- TB
- possible nodules
- bronchiolitis (obliterative) post bone marrow transplant.
there are intrathoracic and extrathoracic causes of chronic cough
which side of the heart has failure if a person has chronic cough
left heart failure. recall that “systemic” problems are more likely to be LS problems
- generally, right sided heart problems result in JVP issues and edema and pulmonary edema.
risk facors for COPD
ourlint intrinsic and extrinsic airway fractors that create the COPD expiratory flow limitation
intrinsic factors: mucosal edema, inflammation, airway remodeling and secretions
extrinsic airway factors: reduced airway tethering form emphysema
is this COPD?
no. the post drug change is over 20% after bronchodilator. While it is obstructive, it’s probably asthma rathern than COPD
Is this COPD?
the FEV1/FVC ratio has to be less than .7. right now its 79. It’s restrictive lung disease– stiff lungs
Is this COPD?
Yes. Ratio below .7– indication obstruction. inspiratory curve is sloped
findings on chest X ray for COPD
– normal
– low flat diaphragms
– increased retrosternal airspace: check ribs anterior and posterior, and lateral xray
– low tapered heart shadow
– rapid tapering of the vessels with hyperlucency
of the lung – Usually characteristic changes on CXR in severe
COPD, 50% of the time in moderate COPD
T/F: COPD manifests small airway disease and parenchymal destruction
true.
interpret CT scan
there are small little gas trapping asepcts. this is COPD. Emphysematous.
irreversible and reversible causes of airflow limitation
- irreversible: fibrosis and narrowing of the airway.s loss of elastic recoil due to alveolar destruction. destruction of alveolar support that maintains patency of small airways.
- reversible
- accumulation of inflammatory cells, mcus and plasma exudate in bronchi
- smooth muscle contraction in peripheral and central airways
- dynamic hyperinflation during exercise.
whats going on
chronic bronchitis theres lots of mucous gland pits
how does the dead space change in people with COPD
patients with COPD has a higher dead space.
determination of COPD severity:
comprehensive management of COPD
- educatiton
- vaccination
- short acting bronchodilator prn
- integrated care
- inahled long acting therapies
- pulmonary rehabilitation
- oral therapies
- long term oxygen therapy
- lung transplantation.
T/F pulmonary rehabilitation increases quality of life
true. improves exercise capacity and health related quality of life.
5 A’s of smoking cessation
- Ask the patient about tobacco use
- Advise the patient to quit
- Assess the patient’s willingness to make a quit attempt
- Assist the patient to make a quit attempt by offering counselling or pharmacotherapy
- Arrange follow-up with the patien
mainstay of COPD steroids
pharmacotherapy: bronchodilators.
“They can reduce air trapping (hyperinflation) and dyspnea, and improve quality of life even if there
is no improvement in FEV1”
how does forced vital capacity and residual volume change in COPS?
there is a larger reduced volume resulting in a small forced vital capacity.
TF if there is a high chance of exacerbation, you should give a SABA
false. immediate LAMA/LABA or ICS/LABA
T/F ICS alone can be used as a treatment alone for COPD
false. there is no role for ICS alone.
- ICS/LABA combinations (evidence that they reduce AECOPD for those at high risk)
affect of metabolic rate by COPD
may have very high basal metabolic rate because it takes a lot of energy to breathe. Patients with COPD might have muscle weakness, osteoporosis, weight loss.
Compare asthma and COPD
preventing AECOPD
meds for AECOPD exacerbation
- LAMA/LABA or ICS/LABA
- SABA
- *Systemic corticosteroids**
- Oxygen
- SABA
- antibiotics
Antibiotic treatment for complicated or simple exacerbation.
