COPD Intro Flashcards
What IS COPD
A _____and _______disease
Characterized by __________ airflow limitation (obstruction)
Is not fully _______
Associated with an abnormal _________ of the lungs to noxious particles or gas.
treatable and preventable
progressive
reversible
abnormal inflamm response
Chronic Bronchitis (CB) Inflammation of bronchioles
● Defined clinically
● a chronic productive cough
● for at least 3 months in each 2 successive years
● other causes of chronic cough have been
excluded
Emphysema (E)
Destruction of alveoli
● Defined anatomically
● Abnormal permanent enlargement of the
airspaces distal to the terminal bronchioles
● accompanied by destruction of their walls and
without obvious fibrosis
Chronic Bronchitis (CB) pathophys
Chronic inflammation
understand
● Cigarette smoke damages epithelial cells
● Tissue damage attracts inflammatory cells
release enzymes damage epithelial cells and
stimulate goblet cells to ↑ in number and to ↑
mucus production
● Airway obstruction blockage by mucus,
inflammation, progressive scarring (fibrosis),
and/or narrowing (constriction) of the airways
Emphysema (E) - Loss of elastic recoil
understand
● Cigarette smoke attracts inflammatory cells
(WBC, including neutrophils, lymphocytes, and
macrophages) into the lung
● Inflammatory cells release proteases
proteases dissolve the proteins in the alveolar
walls (septae) and thereby destroy the septae
Screening: Identifying Patients with possible COPD
Spirometry is required to establish diagnosis
what is the starting question
5 questions?
Smoker or ex-smoker (or have history of occupational exposure to dust/chemicals) that is ≥ 40 years old
AND answer “yes” to 1 of any of the following:
- Regular cough “Do you cough regularly”
- Productive cough with sputum “Do you cough up phlegm regularly”
- SOB even from simple chores “Do even simple chores make you SOB?”
- Wheezes on exertion or at bedtime “Do you wheeze when you exert yourself or at night?”
- Frequent colds that persist longer than other people. “Do you get frequent colds that
persist longer than those of other people you know?
what FEV1/FVC confirms persistent airflow limitation/obstruction
FEV1/FVC <0.70
GOLD recommends assessment of 3 following factors for improving and managing COPD?
- Assess lung function (degree of airflow limitation)
- Assess frequency of exacerbations
- Assess symptom severity (mMRC dyspnea scale*/CAT)
- Classification of airflow limitation severity (obstruction of air flow- degree of airflow limitation)
o FEV1/FVC < 0.70 = COPD
o GOLD GRADE: Based on post bronchodilator FEV1
what is classified as: mild (GOLD 1) moderate (GOLD 2) severe (GOLD 3) very severe (GOLD 4)
GOLD 1 FEV1> 80% predicted
GOLD 2 FEV1 > 50% - <80%
GOLD 3 FEV1> 30% - <50%
GOLD 4 FEV1< 30% predicted
- Assess risk of exacerbations
o A thorough review of exacerbation history in the last 12 months
o > 2 exacerbations in the last 12 months OR >1 leading to hospital admission
o 0 or 1 exacerbations not leading to hospital admission
- Assess symptoms
which 2 ways to do this?
a) MRC dyspnea scale - useful clinical measure that better reflects overall disease impact
b) COPD Assessment Test (CAT); Classification by over-all well being
- Includes 8 statements about symptoms and activities. Patient scores each statement on a scale of 0 to 5 and the impact of COPD is assessed by the cumulative score (0-20)
ABC Tool for Assessment
A: low risk; less symptoms
MMRC?
CAT?
exacerbations per year?
either MMRC <0-1
or CAT <10
exacerbations per year: 0 or 1 not leading to hospital admission
ABC Tool for Assessment
B: low risk; more symptoms
MMRC?
CAT?
exacerbations per year?
either MMRC >/= 2
or CAT >/= 10
exacerbations per year: 0 or 1 not leading to hospital admission
ABC Tool for Assessment
C: high risk; less symptoms
MMRC?
CAT?
exacerbations per year?
either MMRC <0-1
or CAT <10
exacerbations per year: >/= 2 or >/= 1 leading to
hospital admission
ABC Tool for Assessment
D: high risk; more symptoms
MMRC?
CAT?
exacerbations per year?
either MMRC >/= 2
or CAT >/= 10
exacerbations per year: >/= 2 or >/= 1 leading to
hospital admission
asthma vs COPD
airway inflamm
asthma: eosinophilic
COPD: neutrophilic
asthma vs COPD
response to ICS
a: Essential for optimal control
c: Helpful in patients with moderate to severe disease and frequent AECOPD
asthma vs COPD
role of bronchodilators
a: as needed only
c: regular therapy usually necessary
asthma vs COPD
role of exercise training
a: rarely formally used
c: essential therapy
asthma vs COPD
end of life discussions
a: rarely necessary
c: often essential
goals of therapy
see summary of goals table for more
Symptoms:
Alleviate breathlessness and other respiratory symptoms Symptoms
Improve exercise tolerance and daily activity
Improve health status
Risk:
Prevent disease progression
Reduce the frequency and severity of exacerbations
Treat exacerbations and complications of the disease
Reduce mortality
Non-pharm
Smoking Cessation (reduce risk factors) (+/- pharmacologic interventions)
single most effective intervention to reduce the risk of developing COPD and only intervention shown to slow it’s progression
Non-pharm
Education (Health Literacy)
read
o Tailor to individual patient
o Education alone does not improve exercise performance or lung function
o Plays a role in improving skills, ability to cope with illness, and health status
o Improves patient response to exacerbation
Non-pharm
Rehabilitation
All COPD patients should be encouraged to maintain an active lifestyle:
▪ FITT: (frequency) 3-5 sessions/week, (intensity) to moderate SOB; (timing) 30- 45 min; (type of exercise) walk, cycle, swim
components: exercise, psychosocial support, nutrition counseling, occupational therapy, energy conversation strat, education
