COPD - Scholting

Question 2

Obstructive Lung Diseases (3)

Answer 2

1. Asthma
2. Chronic Bronchitis
3. COPD (emphysema)

Question 3

Characterisitics of COPD

Answer 3

• chronic airway obstruction
• airflow limitation
• generally progressive over time
• may have airway hyperactivity (reversible component)

Question 4

define Emphysema

Answer 4

a pathologic diagnosis based on a permanent abnormal dilation and destruction of the alveolar ducts and air spaces distal to the terminal bronchioles

Question 5

define Chronic Bronchitis

Answer 5

a clinical diagnosis based on the presence of a cough and sputum production occurring on most days for at least a 3-month period during 2 consecutive years without another explanation. Cough is not necessarily accompanied by airflow limitation.

Question 6

Identify this condition and describe the management:

cc: shortness of breath while exercising
exam: pt is thin, breathing through pursed lips and using accessory muscles, and has no cough or sputum production

x-ray:

Answer 6

Emphysema - Pink Puffer

managment:

• stop smoking
• inhaled beta-2 agonists (Albuterol); anticholinergic (Ipratropium)
• inhaled/oral corticosteroids
• theophylline
• oxygen therapy (end-stage)
• antibiotics
• influenza and pneumococcal vaccines

on x-ray note: hyperinflation, hyperlucency, increased retrosternal air space, flat diaphragm, small heart, bullae formation

pt will also have decreased P02 and normal or decreased PCO2

Question 7

Identify this condition and describe the management:

cc: coughing up phlegm and shortness of breath while exercising and just sitting at home
exam: you note the pt is obese

x-ray:

Answer 7

Chronic Bronchitis (ain’t no body got time for that) - Blue Bloater

managment:

• stop smoking
• inhaled beta-2 agonists (Albuterol); anticholinergic (Ipratropium)
• inhaled/oral corticosteroids
• theophylline
• oxygen therapy (end-stage)
• antibiotics
• influenza and pneumococcal vaccines

x-ray findings: normal or incrased lung markings, cardiomegaly, pulmonary HTN, cor pulmonale

pt will have reduced PO2 and elevated PCO2

Question 8

Identify this condition:

pt is a 25 year old non smoker complaining of shortness of breath on exertion

CXR shows a panacinar distribution of emphysema

Answer 8

Alpha-1-antitrypsin deficiency

management: replace alpha-1-antitrypsin, eliminate exacerbating factors, COPD management (fpnotebook.com)

Question 9

Stage 1 Mild COPD

Answer 9

FEV₁/FVC < 70%

FEV₁ > 80% predicted

with or without chronic symptoms

Question 10

Stage 2 Moderate COPD

Answer 10

FEV₁/FVC < 70%

30 < FEV₁

with or without chronic symptoms

Question 11

Stage 3 Severe COPD

Answer 11

FEV_1/FVC < 70%

FEV₁ < 30% predicted or < 50% predicted plus respiratory failure or clinical signs of right heart failure

Question 12

Identify this condition and describe the managment:

pt: reports shortness of breath on exertion, chronic wet cough
exam: little or no sputum production, elevated jugular venous pressure and hepatomegaly

CXR: enlarged RV and PA

Answer 12

Cor Pulmonale

RV hypertrophy and eventual failure

results from pulmonary disease: hypoxia, pulmonary vascular disease, COPD

diagnosis:

ECHO excludes LV dysfunction

ECG changes: RVH, tall peaked P waves, right axis deviation

Question 13

Chantix (varenicline)

Answer 13

targets the same receptors as nicotine and blocks nicotine from binding

helps reduce the urge to smoke

Question 14

Clinical Strategies for Smoking Cessation (5 A’s)

Answer 14

ASK - identify smokers at each visit

ADVISE - urge smokers to quit

ASSESS - readiness to make an attempt to quit

ASSIST - counseling and meds

ARRANGE - schedule follow-up contact