COPD supplement Flashcards
COPD
- common, preventable and treatable
- persistent airflow limitation that is usually progressive
- associated with enhanced chronic inflammatory response in airways and the lung to noxious particles or gases
- Exacerbations and comorbidities contribute to overall severity in individual patients
Most commonly encountered risk factor for COPD is
- tobacco smoking!!
- Other types of tobacco (pipe, cigar, water pipe) and marijuana also risk factors
- Outdoor, occupational and indoor AIR POLLUTION (indoor from biomass fuels) are also major risk factors
A CLINICAL diagnosis of COPD should be considered in any patient who has what symptoms and history?
-dyspnea, chronic cough or sputum production and a history of exposure to risk factors for the disease
What is required to make the diagnosis of COPD in an appropriate clinical context?
-SPIROMETRY!
Assessment of COPD is based on
-the patients symptoms, risk of exacerbations, the severity of spirometric abnormality, and the identification of comorbidities!!
Effect of pharmacologic therapy on COPD
-can reduce symptoms, reduce frequency and severity of exacerbations, and improve the health status and exercise tolerance
All COPD patients with breathlessness when walking appear to benefit from what?
-rehabilitation and maintenance of physical activity
An exacerbation of COPD is an acute event characterized by
-worsening of the patients respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication!
COPD often
-coexists with other diseases (comorbidities) that may have a significant impact on prognosis
Genetic risk factor for COPD
-severe hereditary deficient of alpha-1 antitrypsin
COPD risk is related to total burden of inhaled particles a person encounters over their lifetime. Inhaled particles include?
- Tobacco smoke–cigarette, pipe, cigar, env tobacco smoke
- Indoor air pollution from biomass fuel used for cooking and heating in poorly vented dwellings–esp affects women in developing countries!
- Outdoor air pollution–contributes to total burden of inhaled particles but small effect in causing COPD
Any factor that affects lung growth during gestation and childhood (low birth weight, respiratory infections, etc) has the potential to
-increase individuals risk of developing COPD
Indicators for considering a diagnosis of COPD–present in ind over age 40, not diagnostic themselves but multiple features increases probability of COPD; Spirometry required to establish COPD diagnosis!
- Dyspnea–progressive (worsens); worse with exercise
- Chronic cough: may be intermittent and unproductive
- Chronic sputum production: any pattern
- History of exposure to risk factors: Tobacco smoke, smoke from cooking and heating fuels; occupational dusts and chemicals
- Family history of COPD
Major differential diagnosis for COPD
- Asthma–clear distinction not possible using imaging and testing
- In these patients management is similar to that of asthma
COPD and its differential diagnoses
- COPD
- Asthma
- CHF
- Bronchiectasis
COPD and its differential diagnoses–COPD
Onset in midlife
Symptoms slowly progressive
History of tobacco smoking or exposure to other types of smoke
COPD and its differential diagnoses–Asthma
Onset early in life (often childhood); symptoms vary widely from day to day
- symptoms worse at night/early morning
- Allergy, rhinitis and/or eczema also present
- Family history of asthma
COPD and its differential diagnoses–congestive heart failure
- Chest x-ray shows dilated heart, pulmonary edema
- PFT volume restriction, not airflow limitation
COPD and its differential diagnoses–Bronchiectasis
- Large volumes of purulent sputum
- Commonly associated with bacterial infection
- Chest X ray/CT shows bronchial dilation, bronchial wall thickening
COPD Global Initiative of Obstructive Lung Disease (GOLD)
- international standard for diagnosis and treatment of COPD
- current standard for diagnosis and management of COPD
- FEV1/FVC AFTER bronchodilators <70%?
GOLDI
FEV1–> 79% or greater than or equal to 80%
-MILD!
GOLD II
FEV1 bw 49% and 80%
Moderate!
GOLD III
FEV1 bw 29% and 50%
Severe!
GOLD IV
FEV1 <30%
Very severe!
MRC Breathlessness scale
- Medical Research Scale
- gauges severity of dyspnea
MRC grade 1
Breathlessness only with strenuous exercise
MRC grade 2
Breathlessness when hurrying on level ground or walking up slight hill
MRC grade 3
Breathlessness slower than other people their same age
-walking less than a mile or less than 15 min
MRC grade 4
Needs to stop after a 100 yards or a few minutes on level ground
MRC grade 5
Too breathless to leave the house or while undressing
Frequent exacerbations is defined as
More than 1 exacerbation a year
PDE-4 inhibitors
- decreases inflammation and may promote airway smooth muscle relaxation
- Roflumilast (Daliresp) is an oral PDE4 inhibitor that reduces risk of COPD exacerbations in patients with Hx of frequent exacerbations (at least 2 per year or one requiring hospitalization)
- Roflumilast may further reduce risk of COPD exacerbations when added to other respiratory meds that have also been shown to reduce exacerbations
