COPD & Asthma Flashcards
COPD Definition
-Defined by persistent respiratory symptoms due to limitation in the airflow in the airway and/or alveolar abnormalities.
-2 most common types: Chronic Bronchitis and Emphysema
COPD-Spectrum of Disease
-Large airway condition: chronic bronchitis, tracheomalacia, asthma, cystic fibrosis, bronchiectasis
-Small airway disease: bronchiolitis, bronchiolectasis
-Distal airspace disease: emphysema
Signs/Symptoms COPD
-Dyspnea, cough (chronic) +/- sputum production
-Recurrent respiratory infections
-Signs of malnutrition (BMI<19) or obesity
-Edema or cyanosis in the extremities
-Nasal polyps, cobblestoning in the airway, stridor, dysphonia
-Lung crackles, wheezing, expiratory slowing, decreased breath sounds
Initial COPD workup
-PFTs with bronchodilators
-Hyperinflated lungs, diaphragm may appear lower and flat on imaging
-Lung cancer screening
-CBC, BMP, Fasting glucose, NT-ProBNP
Alpha-1Antitrypsin Deficiency
-Most common cause of emphysema
Spirometry: FVC
-Measures the volume of air that can forcibly be exhaled from the point of maximal inspiration (forced vital capacity, FVC)
Spirometry: FEV1
Measures the volume of air exhaled during the first second of FVC (forced expiratory volume in one second, FEV1)
FEV1/FVC Ratio
The presence of an FEV1/FVC ratio of < 0.70 postbronchodilator confirms there is airflow limitation
GOLD Stage 1 (mild)
-FEV1/FVC <70%
-Can be managed w/ SABA, hospitalization not required
GOLD Stage 2 (moderate)
–FEV1/FVC <70%,
-FEV1 <50-70%
-Requires SABA, antibiotics and/or oral corticosteroids, hospitalization likely
GOLD Stage III (severe)
-FEV1/FVC <70%
-FEV1 <30-50%
-Evidence of acute respiratory failure
GOLD Stage IV (very severe)
-FEV1/FVC <70%
-FEV1 <30% or <insufficiency
Short Acting Beta2-Agonist (SABA) Bronchodilator -Albuterol containing
-Rescue Inhaler
-ProAIR
-Proventil
-Ventolin
-Xopenex
Long Acting Beta2-Agonist (LABA) Bronchodilator
(offers relief of coughing, wheezing, dyspnea for at least 12 hours)
Servant diskus
Striverdi Respimat
Inhaled Corticosteroids
reduce and prevent swelling of airways, does not provide relief for acute symptoms such as coughing, dyspnea, wheezing
-Flovent, Pulmicort
Arnuity Ellipta, Alvesco
Armon Air, Asmanex
QVAR
Muscarinic Antagonists (LAMA)
-anticholinergic, relieves cough, sputum production, wheeze, and chest tightness
-Short acting (SAMA)
Atrovent
-Long Acting (LAMA)
Incruse Ellipta
Spiriva
Tudorza
COPD Exacerbation
-Oxygen: 88-92%
-Blood gas, CBC, BMP, CXR
-Increase bronchodilators for symptomatic relief (DuoNebs)
-Consider oral steriods (typically prednisone 40 mg x 5 days_
-Consider abx (Azithromycin or Doxy x 5 days)
-Provide VTW ppx
-Manage other comorbidities
Asthma Definition
Respiratory condition in which airways become swollen and narrow. There may also be excess mucus production.
Asthma Signs and Symptoms
coughing, wheezing, chest tightness, SOB
Asthma Diagnostic Tests
-Spirometry: >200mL and 12% improvement in FEV1after bronchodilator
-Methacholine challenge if spirometry normal-decrease in FEV1 of 20%
-Exhaled nitric oxide
Mild Intermittent Asthma Lung Function
-FEV 1 or PEF > OR Equal 80% predicted
-PEF variability <20%
Mild Persistent Asthma Lung Function
-FEV1 or PEF >80% predicted
-PEF variability 20-30%
Moderate Persistent
-FEV1 or PEF < or equal to 70% predicted value
Severe Persistent
-FEV1 or PEF < or equal to 50% predicted
