COPD Oct10 M2

Question 1

how COPD mortality is changing with time

Answer 1

increasing

Question 2

1st cause of hospitalization and rehospitalization

Answer 2

COPD

Question 3

risk factors of COPD

Answer 3

cigarette smoke, genes, occupational dust and chemicals, ETS (environmental tobacco smoke), indoor and outdoor air pollution, infection, SES, age

Question 4

pathophysiology of COPD in 3 steps

Answer 4

flow limitation, lung hyperinflation, dyspnea

Question 5

Vicious circle in COPD

Answer 5

Air trapping (Exp flow limitation), hyperinflation of lungs gives breathlessness. This reduces exercise endurance which leads to inactivity which leads to deconditioning and leads to more breathlessness

Question 6

why lungs get hyperinflated in COPD

Answer 6

Exp flow limitation: alveolar emptying depends on time. End up breathing in before we’re done breathing out

Question 7

why small airways collapse more easily in COPD

Answer 7

no traction from cartilage of lower airways to keep them open

Question 8

how these vary in COPD: lung elastic recoil pressure, airway tethering, airways resistance

Answer 8

less recoil, less tethering, increased resistance (mucous plugging)

Question 9

COPD: screening should be done using spirometry T-F

Answer 9

False. If asymptomatic patient, can’t change course of disease except if stop smoking

Question 10

Criteria for undergoing COPD diagnostic test (2 categories)

Answer 10

Symptoms (shortness of breath, chronic cough sputum)

Exposure to risk factors (tobacco, occupation, indoor-outdoor pollution)

Question 11

Rule for diagnosing COPD with spirometry

Answer 11

FEV1 to FVC ratio must be under 0.7 AFTER bronchodilator

Question 12

What the ratio value of less than 0.7 shows and why is the ratio reduced

Answer 12

Irreversibility of the disease

Ratio reduced bc drop in FEV1 much more than drop in FVC

Question 13

3 functions of spirometry

Answer 13

Diagnosis, Classification (of the type of obstruction) and monitoring decline in lung capacity

Question 14

most important symptom in COPD and how obvious it is

Answer 14

dyspnea. not obvious, very insidious symptom

Question 15

3 COPD stages and how grading is done

Answer 15

Mild, moderate, severe

Grading on 5

Question 16

Mild COPD descritpon (symptoms, grade, spirometry)

Answer 16

short of breath when hurrying or on hill, 2 on 5, FEV1 over 80% predicted and ratio more than 0.7

Question 17

Moderate COPD descritpon (symptoms, grade, spirometry)

Answer 17

Shortness of breath: stop walking after 100m. 3-4 on 5. FEV1 between 30 and 80% of predicted. Ratio more than 0.7

Question 18

Severe COPD descritpon (symptoms, grade, spirometry)

Answer 18

shortness of breath: can’t leave house, hard to get dressed. grade 5 on 5. FEV1 less than 30% predicted and FEV1 over FVC is less than 0.7

Question 19

Management of COPD: first important thing to do and how

Answer 19

smoking cessation, can refer to help group in CLSC

Question 20

Management of COPD other goals than to stop smoking

Answer 20

Alleviate breathlessness and other symptoms
Reduce exacerbations
Improve exercise tolerance
Reduce mortality

Question 21

Treatments that can change survival in COPD (3 + other one = 4)

Answer 21

Smoking cessation
Oxygen treatment in patients that fulfils criteria of long term oxygen treatment
Lung transplant
(Lung volume reduction)

Question 22

how vaccination for pneumonia and influenza helps COPD patients

Answer 22

pneumonia vaccine doesn’t help patients with COPD patients but influenza vaccine
reduces hospitalization time for COPD patients

Question 23

Non treatment strategy than can reduce hospitalization (due to exacerbations) in COPD

Answer 23

Self-management education helped by a team of health professionals (nurses, therapists, etc.)

Question 24

What can be taught to COPD patient for self-management

Answer 24

Taking medication
Techniques to control dyspnea and preserve energy
Promoting physical activity

Question 25

What physical activity can improve in COPD and what it can’t improve

Answer 25

Improves: Peripheral muscles (mainly legs)

Can’t improve: Lung capacity

Question 26

What are the muscle changes that a COPD patient can get from exercise

Answer 26

More volume, more fibers

Intrinsic changes: topology of the fiber, metabolic change, microvascular change

Question 27

why COPD patients breathe at higher volume (higher FRC)

Answer 27

because otherwise wouldn’t have enough air flow

Question 28

what bronchodilators do

Answer 28

Shift the flow volume curve to the right and increase the maximal enveloppe.

Question 29

Bronchodilators mechanism

Answer 29

Open airways, reduce air trapping, reduce hyperinflation

Question 30

what defines moderate COPD

Answer 30

Infrequent acute exacerbations (less than 1 per year on average)

Question 31

what defines severe COPD

Answer 31

frequent acute exacerbations (one or more per year)

Question 32

pulmonary rehab 3 goals

Answer 32

Improve muscles of movement
Improve dyspnea symptoms
Improve health quality of life

Question 33

Criteria for oxygen therapy for COPD

Answer 33

15 hrs a day or more to achieve a sat of 90%+ in O2
COPD patient with stable disease
Hypoxemia (O2 less than 55% or less than 60% with cor pulmonale, right CHF or increased hematocrit)

Question 34

Definition of acute exacerbation

Answer 34

change of symptoms for more than 48 hours: dyspnea, cough, sputum production

Question 35

Most common reason of COPD exacerbation

Answer 35

infectious disease

Question 36

How antibiotics and corticosteroids help in COPD exacerbation

Answer 36

Antibiotics: Reduce risk of mortality, failure and purulence
Corticosteroids: Reduce risk of failure to treatment, but increase risk of side effects

Question 37

most important thing after treating exacerbation

Answer 37

act on how we can prevent exacerbations from happening

Question 38

COPD prevention strategies

Answer 38

smoking cessation, vaccinations, bronchodilators, management plan, pulmonary rehab