COPD Lecture Powerpoint Flashcards
COPD is the ___ leading cause of death, and its mortality rates are not ____
4th, decreasing
Leading cause of COPD
Smoking
COPD risk with age, gender, and socioeconomic status
Increases with age, equal between genders, low socioeconomic status associated with higher risk
Asthma COPD Overlap syndrome
Refers to fact that patients with asthma have 10-30 fold increased risk of developing COPD as well resulting in features associated with asthma and COPD both in a patient
COPD development younger than 40 years old could indicate….
….alpha 1 anti-trypsin deficiency
Smokers with a history of more than 40 pack years are at high risk for…
…COPD
Pack year
Clinical quantification of cigarette smoking used to determine exposure to tobacco and assess risk of developing pathology related to smoking, calculated by (cigs avg. smoked per day/20cigs/pack)*#YEARS smoked
COPD pathophysiology
Chronic irritation and air inflow limitation resulting in gas exchange abnormalities resulting in acidotic status (retention of CO2) that can see mucus hypersecretion, pulmonary vascular changes and scarring, and systemic effects such as osteopenia or anxiety
Patients with COPD that have ____ have a higher mortality rate
acute exacerbations
3 types of COPD
- Emphysema
- chronic bronchitis
- non reversible asthma (asthma COPD overlap syndrome)
Chronic bronchitis defining characteristic
-Increased mucus and inflammation in terminal bronchioles
Emphysema defining characteristic
-A loss of lung elasticity and destruction of lung parenchyma that sees destruction and enlargement of alvelolar sacs distal to terminal bronchioles that leads to acidotic state due to CO2 buildup
Chronic bronchitis diagnosis
Clinical diagnosis of a productive cough lasting at least 3 months in 2 consecutive years for which other causes have been excluded, irreversible condition where patients see hyperplasia and hypertrophy of goblet cells and mucus glands causing sputum buildup and narrowing of airways limiting airflow
Most patients have what type of COPD?
Overlap of emphysema and chronic bronchitis
Blue bloater syndrome
Refers to how chronic bronchitis patients often present, as overweight and cyanotic
Pink puffer syndrome
Refers to how emphysema patients often present, thin due to weight loss and muscle wasting and flattened diaphragm as they puff air and develop a reddish complexion
4 classic symptoms of COPD
- Chronic cough
- sputum production
- Dyspnea on exertion
- fatigue
Supplementary signs/symptoms of COPD (3)
- Increased AP diameter
- prolonged expiratory phase of respiration
- hyperresonance pattern on chest
Patients that present with clubbing of fingers and COPD is often indicative of….
Clubbing of the digits alone is typically not seen in….
…lung cancer
….COPD patients
Characteristics of late stage COPD (4)
- skeletal muscle wasting
- JVD and peripheral edema due to right sided heart failure (cor pulmonale) and resultant pulmonary hypertension
- tripoding
- polycythemia (measured CBC with diff)
Severe respiratory infections as a child can increase propensity of developing…
….COPD
2 common comorbid conditions in COPD patients
- depression
- Heart failure
PE findings of COPD (note that a PE for COPD is rarely diagnostic in itself) (4)
- shallow rapid breathing
- barrel shaped chest
- hyperresonance on percussion
- diminished breath sounds
Confirmatory diagnostic test to diagnose suspected COPD
Spirometry, most important value is FEV1/FVC ratio less than .70 is diagnostic***, performed pre and post bronchodilator to rule out asthma (minimally changes in COPD)
“Half moon” pattern on a PFT volume/flow graph is associated with….
…Obstructive lung disease such as COPD
Classification of COPD (4)
Based on FEV1
- class 1 is FEV>80% (patient unaware)
- class 2 FEV 50-80%
- class 3 FEV1 30-50%
- class 4 FEV1 <30% (will have barrel chest and look very very sick with terrible quality of life)
Other labs for COPD (5)
- CXR
- ABG
- a1 antitrypsin indicated for all COPD patients at least once
- BNP
- CBC
Fundamental principle goals of COPD treatment (3)
- prevent progression
- reduce exacerbations
- treat complications
COPD patients require _____ vaccines to limit….
flu and pneumococcal,
…limits risk of exacerbation of symptoms
Common 4 meds used in COPD
- inhaled short acting bronchodilators
- long acting bronchodilators
- inhaled glucocorticoids
- theophyline (oral bronchodilator more side effects used in refractory cases)
What only 2 treatments have been shown to improve survival of COPD patients? What are pharmacological treatments considered?
- Smoking cessation and o2 therapy
- relief of symptoms (palliative)
Inhaled bronchodilators for COPD
Bring short acting relief of symptoms in all stages of COPD and act either as a anticholinergic or B2 agonist
Combivent function
A combined anticholinergic and B2 agonist (Ipratropium and albuterol) used in short acting relief for acute COPD exacerbation
Inhaled corticosteroids for COPD and what is one side effect?
- Treatment for 3rd stage or more severe COPD alongside short and long acting bronchodilators
- can often cause oral thrush as a side effect
Roflumilast (daliresp) function
New medication that is a selective PDE4 inhibitor useful to reduce risk of COPD exacerbation in patients with severe COPD that cannot tolerate corticosteroids (not a bronchodilator used for acute bronchospasm)
When is pulmonary rehab recommended for COPD patients?
For symptomatic patients with FEV1 <50% predicted (class 3 or higher COPD)
Oxygen therapy for COPD patients
Used in severe COPD or exacerbations either continuously, during exercise, or to relieve acute dyspnea
COPD exacerbations
Episodic increase in frequency and severity of cough, increase in volume production and changes in character, and dyspnea increasing most often due to acute bacterial infections (up to 10% fatal due to already impaired functioning at rest)
Regardless of mild or severe COPD exacerbations, these 4 things are indicated
- Antibiotics (culture and amoxicillin)
- bronchodilators
- inhaled corticosteroids
- potentially o2 therapy
Lung parenchyma definition
The respiratory bronchioles, alveolar ducts, and sacs (areas of the lung involved in its primary function of gas exchange)
Emphysema effects the _____, different from chronic bronchitis
Lung parenchyma
Surgical intervention for COPD patients is recommended for what group?
Younger patients with a life expectancy <2 years without the intervention
Lung volume reduction surgery function
Remove damaged parts of the lung to reduce hyperinflation and improve effectiveness of respiratory muscles and elastic recoil ability of lungs
