COPD Management

Question 1

How do we assess the severity of COPD?

Answer 1

Airflow limitation, symptoms, exacerbation risk, and comorbidities.

Question 2

How do we define airflow obstruction?

Answer 2

An FEV1/FVC ratio of less than 0.70

Question 3

What are the GOLD categories of airflow limitation?

Answer 3

Based on FEV1:
GOLD 1 (mild)- >80%
GOLD 2 (moderate)- <80%
GOLD 3 (severe)- <50%
GOLD 4 (very severe)- <30%

Question 4

How would we define a mild COPD exacerbation?

Answer 4

It can be treated with short acting bronchodilators

Question 5

How would we define a moderate COPD exacerbation?

Answer 5

It can be treated with short acting bronchodilators plus antibiotics and/or corticosteroids.

Question 6

How would we define a severe COPD exacerbation?

Answer 6

Patient requires hospital visit.

Question 7

What is the most prevalent cause of COPD?

Answer 7

Smoking

Question 8

What is the most effective way to reduce risk of COPD and the only intervention that will slow the rate of lung function decline?

Answer 8

Quitting smoking.

Question 9

What are the 5 A’s of smoking cessation?

Answer 9

Ask, Advise, Assess, Assist, Arrange

Question 10

What is Alpha 1 Antitrypsin deficiency?

Answer 10

It is a lack of AAT that leads to increased protease levels in the lungs. These proteases eat elastic tissue in the lungs, making them floppy (emphysema).

Question 11

When is AAT replacement therapy indicated?

Answer 11

In patients with FEV1 between 35-50%, have quit smoking and are on optimal medical therapy, yet still continue to show rapid decline in FEV1 (>80mL per year).

Question 12

Which two vaccines are recommended for COPD patients?

Answer 12

Annual influenza vaccination and Pneumococcal vaccine.

Question 13

What is the target saturation for someone wit COPD?

Answer 13

88-92%

Question 14

What is the Haldane effect?

Answer 14

Oxygenation of blood in the lungs displaces carbon dioxide from hemoglobin, increasing the removal of carbon dioxide. It describes the ability of hemoglobin to carry increased amounts of carbon dioxide in the deoxygenated state as opposed to the oxygenated state. A high concentration of CO2 facilitates dissociation of oxyhemoglobin.

Question 15

What is the optimal amount of time on oxygen therapy daily for a COPD patient?

Answer 15

> 15 hours a day

Question 16

What is lung volume reduction surgery?

Answer 16

A surgical procedure to remove the most diseased sections of the lungs and restore diaphragmatic function and elastic recoil.

Question 17

Who is eligible for lung volume reduction surgery?

Answer 17

Disability from emphysema despite maximal treatment, abstinence from smoking for 4+ months, FEV1 <45%, TLC >100%, RV >155% predicted, 6-minute walk distance less than 140m.

Question 18

Who is eligible for lung transplant?

Answer 18

FEV1 >25% without reversibility, PaO2 <55mmHg, cor pulmonale

Question 19

What are the consequences of AECOPD?

Answer 19

Reduced health-related quality of life, increased mortality, accelerated decline in lung function, increased health resource utilization and costs.

Question 20

What treatments can we use for acute COPD exacerbations?

Answer 20

Oxygen therapy, Bronchodilators, Oral corticosteroids, oral antibiotics for infection, and mechanical ventilation.

Question 21

What are some considerations when mechanically ventilating COPD patients?

Answer 21

Long exhalation time, higher PEEP, higher FiO2 requirements, increased suctioning due to chronic bronchitis, difficult to wean.

Question 22

At what rate should we bag a COPD patient?

Answer 22

8-10 bpm

Question 23

What is the most common cause of COPD exacerbation?

Answer 23

Infection