COPD Case

Question 1

Paroxysmal nocturnal dyspnea (PND)

Answer 1

Sudden, severe shortness of breath at night that awakens a person from sleep, often with coughing and wheezing.

Question 2

Paroxysmal nocturnal dyspnea (PND) is most closely associated with…

Answer 2

congestive heart failure

Question 3

………commonly occurs several hours after a person with heart failure has fallen asleep. PND is often relieved by sitting upright, but not as quickly as simple orthopnea. Also unlike orthopnea, it does not develop immediately upon lying down.

Answer 3

Paroxysmal nocturnal dyspnea (PND)

Question 4

Dyspnea which occurs when lying flat, forcing the person to have to sleep propped up in bed or sitting in a chair. It is commonly measured according to the number of pillows needed to prop the patient up to enable breathing (Example: “three pillow orthopnea”).

Answer 4

Orthopnea

Question 5

Productive cough lasting 1-3 weeks

Answer 5

Acute Bronchitis

Question 6

Productive cough for at least three months for the past two years

Answer 6

Chronic Bronchitis

Question 7

gold standard for diagnosing COPD

Answer 7

Pulmonary function testing (PFT)

also best screening tool

Question 8

It makes sense to get a chest x-ray when a patient presents with shortness of breath, not to rule in or out COPD, but to look for other diagnoses.

Answer 8

…

Question 9

COPD encompasses ….

Answer 9

chronic bronchitis and emphysema

Question 10

Which clinical diagnosis should be considered in any middle-aged or older adult who has:

dyspnea
chronic cough or sputum production, or
a history of tobacco use

Answer 10

COPD

Question 11

Often related to rhinitis, allergy, or eczema

Answer 11

Asthma

Question 12

play a role in what appears to be an allergic bronchoconstrictive response in asthma

Answer 12

Mast cells, T helper cells, and eosinophils

Question 13

play a role in an inflammatory and destructive process in COPD

Answer 13

Macrophages, T killer cells, and neutrophils

Question 14

Therapy for Mild Symptomatic COPD

Answer 14

Prescribe an albuterol metered-dose inhaler on an as needed basis.
(essential for symptom management in COPD)

All symptomatic patients with COPD should be prescribed a short-acting bronchodilator (e.g., albuterol) on an as-needed basis.
If symptoms are still inadequately controlled, a daily dose of long-acting bronchodilator should be added.
The choice between beta-2-agonist, anticholinergic, theophylline, or combination therapy depends on availability and individual response in terms of symptom relief and side effects. (See below.)
Combining bronchodilators of different pharmacological classes may improve efficacy and decrease the risk of side effects compared to increasing the dose of a single bronchodilator.

Question 15

when a patient younger than 45 years old is diagnosed with COPD…what should you consider?

Answer 15

alpha-1 antitrypsin deficiency

Question 16

Since significant reversibility is defined as an increase in FEV1 of….

Answer 16

≥ 12%

as in the case of asthma…not COPD

Question 17

Therapy for Moderate COPD

Answer 17

maintenance therapy of inhaled anticholinergics (ipratroprium or tiotroprium) alone or in combination with short-acting beta agonists may be utilized.

Question 18

Therapy for Severe COPD

Answer 18

it is recommended that inhaled glucocorticosteroids be added to bronchodilator treatment.

The combination of an inhaled glucocorticosteroid combined with a long-acting ß2-agonist is more effective than each individual component, without increased side effects.

Question 19

Recommended Immunizations for Patients with COPD

Answer 19

Influenza and pneumococcal vaccines are recommended for adults with COPD. If the patient is due for a tetanus booster, then he should receive TdaP

Question 20

in a setting of COPD exacerbation, an individual may find…

Answer 20

Difficulty catching his or her breath
Chest tightness
Fever
Increased coughing or
A change in the cough (more productive, more mucus expelled)

An exacerbation of COPD is defined as an event in the natural course of the disease characterized by a change in the patient’s baseline dyspnea, cough, and/or sputum that is beyond normal day-to-day variations and is acute in onset. An exacerbation may warrant a change in regular medication in a patient with underlying COPD.

Question 21

most common causes of COPD exacerbation

Answer 21

infection of the tracheobronchial tree and air pollution, but the cause of about a third of severe exacerbations cannot be identified.

Question 22

effective treatments for exacerbations of COPD.

Answer 22

Inhaled bronchodilators (particularly inhaled beta 2-agonists with or without anticholinergics) and oral glucocorticosteroids are effective treatments for exacerbations of COPD.

Question 23

Antibiotics should be given in COPD exacerbation when:

Answer 23

Patients with exacerbations of COPD with the following three cardinal symptoms: increased dyspnea, increased sputum volume, and increased sputum purulence, change in sputum color

Question 24

one of the major complications of COPD

Answer 24

Heart Failure.

Chronic hypoxia (1) causes pulmonary vasoconstriction (2), which increases blood pressure in the pulmonary vessels. This elevation in blood pressure causes permanent damage to the vessel walls and leads to irreversible hypertension (3). The right heart eventually fails (4) because the pump cannot sustain flow effectively against this pressure. Right heart failure leads to an increase in preload, with peripheral edema and increased jugular venous distention.

Question 25

The evidence isn’t 100% clear, but how often should a patient with COPD get PFTs?

Answer 25

at least annually for a patient who has COPD.