COPD (various PDFs, Harrisons)

Question 1

What is predicted to become the 3rd leading cause of death worldwide by 2020?

Answer 1

COPD

Question 2

Most COPD patients see healthcare professionals for what reason?

Answer 2

Exacerbations (acute worsening of sx)

Question 3

Frequent COPD exacerbations lead to:

Answer 3

1) Poorer quality of life
2) Faster decline in lung function
3) Increased mortality

Question 4

What is a common trigger for COPD exacerbations?

Answer 4

The common cold! (Human rhinovirus)

Question 5

What happens to the rates of deaths, hospital admissions, and consults for COPD in the winter?

Answer 5

THEY GO UP LIKE CRAZY.

That whole “winter is coming” thing is kind of a big deal among nurses. ;)

Question 6

True or false: In addition to being more frequent, COPD exacerbations are longer in the winter.

Answer 6

True.

Question 7

GOLD Classification of Airflow Limitation in COPD

Answer 7

Gold 1: Mild (FEV1 >80% of predicted)
Gold 2: Moderate (FEV1 between 50-80% of predicted)
Gold 3: Severe (FEV1 between 30-50% of predicted)
Gold 4: Very Severe (FEV1 less than 30% of predicted)

Question 8

How to assess the severity of a COPD exacerbation:

Answer 8

Arterial blood gas measurements (in hospital): PaO2 < 60 mmHg with or without PaCO2 > 50 mmHg when breathing room air indicates respiratory failure.
• Chest radiographs are useful in excluding alternative diagnoses.
• An ECG may aid in the diagnosis of coexisting cardiac problems.

Question 9

Treatment for COPD exacerbation (GOLD guidelines)

Answer 9

1) Oxygen: Supplemental oxygen should be titrated to a target saturation of 88-92%.
2) Bronchodilators: Short-acting inhaled beta2-agonists with or without short- acting anticholinergics preferred
3) Systemic Corticosteroids: Systemic corticosteroids shorten recovery time, improve lung function & hypoxemia, and reduce the risks of early relapse, etc. A dose of 40 mg prednisone per day for 5 days is recommended.
4) Antibiotics: Antibiotics should be given to patients:
• With the following three cardinal symptoms: increased dyspnea, increased sputum volume, increased sputum purulence;
• With increased sputum purulence and one other cardinal symptom;
• Who require mechanical ventilation

Question 10

Indications for hospital admission re: COPD exacerbation (GOLD guidelines)

Answer 10

• Marked increase in intensity of symptoms
• Severe underlying COPD
• Onset of new physical signs
• Failure of an exacerbation to respond to initial medical management
• Presence of serious comorbidities
• Frequent exacerbations
• Older age
• Insufficient home support