COPD supplement

Question 1

COPD

Answer 1

• 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

Question 2

Most commonly encountered risk factor for COPD is

Answer 2

• 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

Question 3

A CLINICAL diagnosis of COPD should be considered in any patient who has what symptoms and history?

Answer 3

-dyspnea, chronic cough or sputum production and a history of exposure to risk factors for the disease

Question 4

What is required to make the diagnosis of COPD in an appropriate clinical context?

Answer 4

-SPIROMETRY!

Question 5

Assessment of COPD is based on

Answer 5

-the patients symptoms, risk of exacerbations, the severity of spirometric abnormality, and the identification of comorbidities!!

Question 6

Effect of pharmacologic therapy on COPD

Answer 6

-can reduce symptoms, reduce frequency and severity of exacerbations, and improve the health status and exercise tolerance

Question 7

All COPD patients with breathlessness when walking appear to benefit from what?

Answer 7

-rehabilitation and maintenance of physical activity

Question 8

An exacerbation of COPD is an acute event characterized by

Answer 8

-worsening of the patients respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication!

Question 9

COPD often

Answer 9

-coexists with other diseases (comorbidities) that may have a significant impact on prognosis

Question 10

Genetic risk factor for COPD

Answer 10

-severe hereditary deficient of alpha-1 antitrypsin

Question 11

COPD risk is related to total burden of inhaled particles a person encounters over their lifetime. Inhaled particles include?

Answer 11

• 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

Question 12

Any factor that affects lung growth during gestation and childhood (low birth weight, respiratory infections, etc) has the potential to

Answer 12

-increase individuals risk of developing COPD

Question 13

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!

Answer 13

• 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

Question 14

Major differential diagnosis for COPD

Answer 14

• Asthma–clear distinction not possible using imaging and testing
• In these patients management is similar to that of asthma

Question 15

COPD and its differential diagnoses

Answer 15

• COPD
• Asthma
• CHF
• Bronchiectasis

Question 16

COPD and its differential diagnoses–COPD

Answer 16

Onset in midlife
Symptoms slowly progressive
History of tobacco smoking or exposure to other types of smoke

Question 17

COPD and its differential diagnoses–Asthma

Answer 17

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

Question 18

COPD and its differential diagnoses–congestive heart failure

Answer 18

• Chest x-ray shows dilated heart, pulmonary edema

- PFT volume restriction, not airflow limitation

Question 19

COPD and its differential diagnoses–Bronchiectasis

Answer 19

• Large volumes of purulent sputum
• Commonly associated with bacterial infection
• Chest X ray/CT shows bronchial dilation, bronchial wall thickening

Question 20

COPD Global Initiative of Obstructive Lung Disease (GOLD)

Answer 20

• international standard for diagnosis and treatment of COPD
• current standard for diagnosis and management of COPD
• FEV1/FVC AFTER bronchodilators <70%?

Question 21

GOLDI

Answer 21

FEV1–> 79% or greater than or equal to 80%

-MILD!

Question 22

GOLD II

Answer 22

FEV1 bw 49% and 80%

Moderate!

Question 23

GOLD III

Answer 23

FEV1 bw 29% and 50%

Severe!

Question 24

GOLD IV

Answer 24

FEV1 <30%

Very severe!

Question 25

MRC Breathlessness scale

Answer 25

• Medical Research Scale

- gauges severity of dyspnea

Question 26

MRC grade 1

Answer 26

Breathlessness only with strenuous exercise

Question 27

MRC grade 2

Answer 27

Breathlessness when hurrying on level ground or walking up slight hill

Question 28

MRC grade 3

Answer 28

Breathlessness slower than other people their same age

-walking less than a mile or less than 15 min

Question 29

MRC grade 4

Answer 29

Needs to stop after a 100 yards or a few minutes on level ground

Question 30

MRC grade 5

Answer 30

Too breathless to leave the house or while undressing

Question 31

Frequent exacerbations is defined as

Answer 31

More than 1 exacerbation a year

Question 32

PDE-4 inhibitors

Answer 32

• 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