COPD highlights Flashcards
List some common causes of chronic cough in adults
1) COPD
2) Smoking
3) Post infectious – CAP, bronchitis, etc.
Who should be evaluated for COPD?
Symptomatic pts
Give the onset, duration, and timing of COPD
1) Onset: slowly progressive, older adults
2) Duration: persistent, non-reversible
3) Timing: chronic with exacerbations – often associated with RTI
True or false: Signs are neither sensitive or specific for COPD
True
Bronchitis predominant:
1) What are some important things about how they generally present?
2) What drives their breathing?
1) Chronic productive cough, comfortable at rest, significant DOE
2) CO2 retainers (blue)
Emphysema predominant:
1) What are some important things about how they generally present?
2) What drives their breathing?
1) “Pink puffers”; SOB at rest, minimal coughing
2) CO2 responsive/driven
How would you Dx COPD in a patient with typical presentation (age, risk factors, symptoms)?
1) Spirometry/ PFT
2) Post SABA
3) FEV1/ FVC ratio <0.7 or 70%
FEV1 % predicted [does/ does not] demonstrate improvement in COPD with SABA (unlike in asthma)
does not
Particularly, __________ patients Dx with COPD should be tested for A1AT def
young
True or false: regular spirometry generally can’t Dx COPD, it needs to be a post-SABA test
True
True or false: There is nothing you can do as a provider to slow the progression of COPD other than providing them with home oxygen (if appropriate) and tell them to quit smoking
True
What is the 1st line treatment in COPD patients still smoking?
Smoking cessation
Varenicline (var EN i cline) (Chantix): When should you start this?
Starting in patients not ready to quit increases quit rate @ 6 months compared to waiting until ready to quit, NNT 6
Starting _____________ in patients not ready to quit smoking increases quit rate @ 6 months compared to waiting until ready to quit, NNT 6
Varenicline (Chantix)
True or false: all pts need a SABA unless it’s SMART therapy.
True (Symbicort is SMART bc it has formoterol)
Pulmonary rehab is appropriate for which COPD pts?
Appropriate for patient groups B & E
If ____________ is noted, then COPD patients benefit from long-term O2 therapy even if PaO2 > 55 mmHg or SpO2 > 88%
tissue hypoxia
Long-term O2 therapy: Does not improve outcomes or QOL in ____________
exertional hypoxia
Long term oxygen therapy recommended in COPD patients with __________________
Severe resting hypoxia
What should you do prior to recommending surgery for a COPD pt?
Refer to pulmonologist
How do you estimate COPD prognosis with validated tool?
BODE
BMI
Airflow Obstruction
Dyspnea
Exercise
What is a key characteristic of moderate respiratory acidosis?
No acidosis
What characterizes severe respiratory acidosis?
Prescence of acidosis
How would you pharmacologically Tx moderate ECOPD?
SABA +/- SAMA and OCS +/- antibiotics
For COPD, list how common the following Sx are:
1) Chronic cough and sputum
2) DOE or poor lung function
3) Onset prior to age 40
4) Tobacco use
(dr mac said this chart is “worth spending a bit of time on” so I guess it’s important?)
1) Common
2) Persistent
3) Uncommon
4) Almost always
For COPD, list how common the following Sx are:
1) Airway hyper responsiveness
2) Progression
3) Identifiable triggers
4) Bronchodilator response
(“worth spending a bit of time on”)
1) Common
2) Slow, little variability
3) Slow, little variability
4) Modest
For Asthma, list how common the following Sx are:
1) Chronic cough and sputum
2) DOE or poor lung function
3) Onset prior to age 40
4) Tobacco use
(dr mac said this chart is “worth spending a bit of time on” so I guess it’s important?)
1) Variable
2) Intermittent, reversible
3) Common
4) Sometimes
For Asthma, list how common the following Sx are:
1) Airway hyper responsiveness
2) Progression
3) Identifiable triggers
4) Bronchodilator response
(“worth spending a bit of time on”)
1) Always
2) Episodic, variable
3) Common
4) Often marked
Bronchiectasis:
1) What is it characterized by?
2) What is it?
(just know it’s a common denominator between pts that have chronic recurring resp. tract infections for Tues. exam)
1) Irreversible pathologic dilation & destruction of the bronchial walls
2) Chronic or recurring infectious process
List some CXR findings of Bronchiectasis
(not sure if on exam but it’s highlighted)
1) Lack of tapering = Tram-track markings
2) Air-fluid levelsmay be seen in cystic bronchiectasis.
3) Generally = Dilated thickened airways and scattered irregular opacities
