COPD Oct10 M2 Flashcards
how COPD mortality is changing with time
increasing
1st cause of hospitalization and rehospitalization
COPD
risk factors of COPD
cigarette smoke, genes, occupational dust and chemicals, ETS (environmental tobacco smoke), indoor and outdoor air pollution, infection, SES, age
pathophysiology of COPD in 3 steps
flow limitation, lung hyperinflation, dyspnea
Vicious circle in COPD
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
why lungs get hyperinflated in COPD
Exp flow limitation: alveolar emptying depends on time. End up breathing in before we’re done breathing out
why small airways collapse more easily in COPD
no traction from cartilage of lower airways to keep them open
how these vary in COPD: lung elastic recoil pressure, airway tethering, airways resistance
less recoil, less tethering, increased resistance (mucous plugging)
COPD: screening should be done using spirometry T-F
False. If asymptomatic patient, can’t change course of disease except if stop smoking
Criteria for undergoing COPD diagnostic test (2 categories)
Symptoms (shortness of breath, chronic cough sputum)
Exposure to risk factors (tobacco, occupation, indoor-outdoor pollution)
Rule for diagnosing COPD with spirometry
FEV1 to FVC ratio must be under 0.7 AFTER bronchodilator
What the ratio value of less than 0.7 shows and why is the ratio reduced
Irreversibility of the disease
Ratio reduced bc drop in FEV1 much more than drop in FVC
3 functions of spirometry
Diagnosis, Classification (of the type of obstruction) and monitoring decline in lung capacity
most important symptom in COPD and how obvious it is
dyspnea. not obvious, very insidious symptom
3 COPD stages and how grading is done
Mild, moderate, severe
Grading on 5
Mild COPD descritpon (symptoms, grade, spirometry)
short of breath when hurrying or on hill, 2 on 5, FEV1 over 80% predicted and ratio more than 0.7
Moderate COPD descritpon (symptoms, grade, spirometry)
Shortness of breath: stop walking after 100m. 3-4 on 5. FEV1 between 30 and 80% of predicted. Ratio more than 0.7
Severe COPD descritpon (symptoms, grade, spirometry)
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
Management of COPD: first important thing to do and how
smoking cessation, can refer to help group in CLSC
Management of COPD other goals than to stop smoking
Alleviate breathlessness and other symptoms
Reduce exacerbations
Improve exercise tolerance
Reduce mortality
Treatments that can change survival in COPD (3 + other one = 4)
Smoking cessation
Oxygen treatment in patients that fulfils criteria of long term oxygen treatment
Lung transplant
(Lung volume reduction)
how vaccination for pneumonia and influenza helps COPD patients
pneumonia vaccine doesn’t help patients with COPD patients but influenza vaccine
reduces hospitalization time for COPD patients
Non treatment strategy than can reduce hospitalization (due to exacerbations) in COPD
Self-management education helped by a team of health professionals (nurses, therapists, etc.)
What can be taught to COPD patient for self-management
Taking medication
Techniques to control dyspnea and preserve energy
Promoting physical activity
What physical activity can improve in COPD and what it can’t improve
Improves: Peripheral muscles (mainly legs)
Can’t improve: Lung capacity
What are the muscle changes that a COPD patient can get from exercise
More volume, more fibers
Intrinsic changes: topology of the fiber, metabolic change, microvascular change
why COPD patients breathe at higher volume (higher FRC)
because otherwise wouldn’t have enough air flow
what bronchodilators do
Shift the flow volume curve to the right and increase the maximal enveloppe.
Bronchodilators mechanism
Open airways, reduce air trapping, reduce hyperinflation
what defines moderate COPD
Infrequent acute exacerbations (less than 1 per year on average)
what defines severe COPD
frequent acute exacerbations (one or more per year)
pulmonary rehab 3 goals
Improve muscles of movement
Improve dyspnea symptoms
Improve health quality of life
Criteria for oxygen therapy for COPD
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)
Definition of acute exacerbation
change of symptoms for more than 48 hours: dyspnea, cough, sputum production
Most common reason of COPD exacerbation
infectious disease
How antibiotics and corticosteroids help in COPD exacerbation
Antibiotics: Reduce risk of mortality, failure and purulence
Corticosteroids: Reduce risk of failure to treatment, but increase risk of side effects
most important thing after treating exacerbation
act on how we can prevent exacerbations from happening
COPD prevention strategies
smoking cessation, vaccinations, bronchodilators, management plan, pulmonary rehab
