COPD Management Flashcards
How do we assess the severity of COPD?
Airflow limitation, symptoms, exacerbation risk, and comorbidities.
How do we define airflow obstruction?
An FEV1/FVC ratio of less than 0.70
What are the GOLD categories of airflow limitation?
Based on FEV1:
GOLD 1 (mild)- >80%
GOLD 2 (moderate)- <80%
GOLD 3 (severe)- <50%
GOLD 4 (very severe)- <30%
How would we define a mild COPD exacerbation?
It can be treated with short acting bronchodilators
How would we define a moderate COPD exacerbation?
It can be treated with short acting bronchodilators plus antibiotics and/or corticosteroids.
How would we define a severe COPD exacerbation?
Patient requires hospital visit.
What is the most prevalent cause of COPD?
Smoking
What is the most effective way to reduce risk of COPD and the only intervention that will slow the rate of lung function decline?
Quitting smoking.
What are the 5 A’s of smoking cessation?
Ask, Advise, Assess, Assist, Arrange
What is Alpha 1 Antitrypsin deficiency?
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).
When is AAT replacement therapy indicated?
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).
Which two vaccines are recommended for COPD patients?
Annual influenza vaccination and Pneumococcal vaccine.
What is the target saturation for someone wit COPD?
88-92%
What is the Haldane effect?
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.
What is the optimal amount of time on oxygen therapy daily for a COPD patient?
> 15 hours a day
What is lung volume reduction surgery?
A surgical procedure to remove the most diseased sections of the lungs and restore diaphragmatic function and elastic recoil.
Who is eligible for lung volume reduction surgery?
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.
Who is eligible for lung transplant?
FEV1 >25% without reversibility, PaO2 <55mmHg, cor pulmonale
What are the consequences of AECOPD?
Reduced health-related quality of life, increased mortality, accelerated decline in lung function, increased health resource utilization and costs.
What treatments can we use for acute COPD exacerbations?
Oxygen therapy, Bronchodilators, Oral corticosteroids, oral antibiotics for infection, and mechanical ventilation.
What are some considerations when mechanically ventilating COPD patients?
Long exhalation time, higher PEEP, higher FiO2 requirements, increased suctioning due to chronic bronchitis, difficult to wean.
At what rate should we bag a COPD patient?
8-10 bpm
What is the most common cause of COPD exacerbation?
Infection
