COPD -Goya

Question 1

What is COPD? What is the major risk factor?

Answer 1

cCOPD is defined as a disease characterized by airflow obstruction that is not fully reversible.

Airflow limitation is usually progressive & associated with an abnormal inflammatory response of the lungs to noxious particles or gases.

risk factor=smoking (15% of smokers develop COPD)

Question 2

What is chronic bronchitis?

Answer 2

chronic productive cough for 3 months in each of the 2 successive years in a pt in whom other causes of chronic cough have been excluded

Question 3

What is emphysema?

Answer 3

abnormal permanent enlargement of the air spaces distal to the terminal bronchioles accompanied by destruction of their walls and without obvious fibrosis

Question 4

What genetic abnormality leads to COPD?

Answer 4

alpha-1-antitrypsin deficiency (AAT)

AAT is made in the liver and found in the lungs and is important in the inhibition of the neutrophil protease

Question 5

How does the rate of decline of FEV1 in a nonsmoker compare to that of a smoker? A smoker who quit?

Answer 5

smokers have a more rapid decline in FEV1% than non-smokers

but if smokers quit, the rate of decline returns to the normal rate of decline (even though they already lost some of the reserve)

Question 6

What are some clinical presentations of COPD?

Answer 6

> 20pack year history of smoking before symptoms.

morst common age of onset is in 5th decade with productive cough or acute chest illness

dyspnea on effort in 6th or 7th decade.

sputum in the AM and daily volume < 60 cc

acute chest illness=inc cough, purulent sputum, wheezing, dyspnea, and occasional fever

Question 7

What are some PE findings associated with COPD?

Answer 7

With onset of disease only physical exam findings are: prolonged expiration & wheezing on forced expiration

As obstruction progresses, hyperinflation becomes evident, & the anteroposterior diameter of the chest increases causing barrel chest

Accessory muscles maybe used

Decreased heart & breath sounds

late stages: tripoding and cyanosis and an enlarged liver

Question 8

What is a “blue bloater” vs “pink puffer”?

Answer 8

blue bloater =typical chronic bronchitis

pink puffer =emphysema

Question 9

What x-ray findings are seen with COPD?

Answer 9

low, flat diaphragm on the lateral

enlarged retrosternal airspace

heart appears long and narrow with rapid tapering of vessels

cor pulmonale with right heart failure

Question 10

What is stage I COPD?

Answer 10

mild

most pts
many are asymptomatic

FEV1/FVC 80% predicted

With or without chronic symptoms (cough, sputum production)

Question 11

What is stage II COPD?

Answer 11

moderate

FEV1/FVC <70%

FEV1 50-80% predicted

With or without chronic symptoms (cough, sputum production)

Question 12

What is stage III COPD?

Answer 12

severe

FEV1/FVC <70%

FEV1 30-50% predicted

With or without chronic symptoms (cough, sputum production)

Question 13

What is stage IV COPD?

Answer 13

very severe

FEV1/FVC <50% predicted plus chronic respiratory failure or clinical signs of right failure

Question 14

What are the goals of COPD management?

Answer 14

Reduce long-term lung function decline

Prevent & treat exacerbation

Reduce hospitalization

Reduce mortality

Relieve disabling dyspnea

Improve exercise tolerance & quality of life

Question 15

What is the recommended treatment for mild COPD?

Answer 15

short acting bronchodilators as needed

Question 16

What is the recommended treatment for moderate COPD?

Answer 16

long acting bronchodilators and short acting bronchodilators as needed

Question 17

What is the recommended treatment for severe COPD?

Answer 17

corticosteroids

long acting bronchodilators and short acting bronchodilators as needed

Question 18

What is the recommended treatment for very severe COPD?

Answer 18

oxygen, corticosteroids,

long acting bronchodilators and short acting bronchodilators as needed

Question 19

What is the function of bronchodilators in the treatment of COPD?

Answer 19

quick symptom relief

relaxation of airway smooth mm –> dec hyperinflation –> less SOB

Question 20

Which bronchodilator is the drug of choice for COPD and how does it work?

Answer 20

anticholinergic (short acting=ipratropium bromide with albuterlol or long acting =tiotropium-spiriva)
–> reduces vagal tone, inhibits cholinergic reflex bronchoconstriction, reduces mucous hypersecretion

SE: Paradoxical bronchoconstriction, glaucoma, bitter taste, dry mouth, urinary retention, constipation

Question 21

What do inhaled corticosteroids improve? What is an important risk with ICS?

Answer 21

ICS reduces inflammation and the frequency of exacerbations by 15-20%

ICS modestly slows the progression of symptoms

Reduces the rate of decline in FEV1

Dysphonia & oral thrush are the most common adverse reactions

Increased risk of pneumonia

Question 22

Is there a benefit associated with oral /IV steroids for exacerbations?

Answer 22

YES (unknown mechanism)

Question 23

When should antibiotics be used in COPD exacerbations?

Answer 23

Worsening dyspnea, increase in cough/sputum volume, change in sputum color

Question 24

What have studies shown about the use of macrocodes in COPD pts?

Answer 24

Use of macrolides has been shown to reduce the number of COPD exacerbations

Potential concerns are hearing loss, increased QT interval, tinnitus

Question 25

What is the only drug shown to improve survival in hypoxemic pts with COPD?

Answer 25

long term oxygen therapy

helps to

• reverse secondary polycythemia
• increase body weight
• alleviate right heart failure due to cor pulmonale
• strengthen cardiac function
• enhance neuropsychological functions
• improve exercise performance and activities of daily living

Question 26

What is the goal of oxygen therapy? Why should you avoid providing too much oxygen?

Answer 26

Goal of oxygen therapy is to achieve PaO2 > 55 mm Hg without drop of pH 7.25

too much oxygen can cause hypercarbia

Question 27

When is pulmonary rehab recommended?

Answer 27

symptomatic COPD pts with FEV1 < 50%

–> improve exercise tolerance and symptoms of dyspnea and fatigue

Question 28

What are the most common causes of COPD exacerbations? How should these be treated?

Answer 28

infections and air pollutions

systemic steroids (oral or IV) improved symptoms and lung function and decreased length of stay.

antibiotics may benefit those with signs of airway infection

Question 29

When would a lung transplant be considered for COPD?

Answer 29

Age < 65

Low exercise tolerance

FEV1 <20%

No disease distribution requirements