Dyspnea (Chronic Obstructive Pulmonary Disease)

Question 1

Chronic bronchitis

Answer 1

Cough and sputum production on most days for at least 3 months during at least 2 consecutive years

Question 2

SOB caused by the enlargement of respiratory bronchioles and alveoli caused by destruction of lung tissue

Answer 2

emphysema

Question 3

COPD

Answer 3

airway obstruction that is NOT FULLY REVERSIBLE (unlike asthma), is usually progressive and is associated with chronic bronchitis or emphysema or both

usually presents mid to late in life, associated with heavy smoking history

Question 4

If COPD occurs in age under 45 in someone who doesn’t smoke, what is the likely (rarer) etiology?

Answer 4

a1-antitrypsin deficiency

Question 5

Pathologic changes seen in COPD

Answer 5

mucous gland hypertrophy with hypersecretion, ciliary dysfunction, destruction of lung parenchyma, and airway remodeling

Question 6

Physical symptoms of COPD

Answer 6

narrowing of airway, fixed airway obstruction, poor mucous clearance, cough, wheezing, and dyspnea

Question 7

Progression of COPD symptoms

Answer 7

Cough (most common initlal symptom) first interittent then becoming a daily occurence, with change in mucus from clear to yellow/green and often wheezing (exacerbations caused often by bacterial/viral infection)…

then DYSPNEA that progressives over time; first with exertion, then little exertion, then at rest.

Question 8

By the time dypsnea develops in COPD what is the FEV/FVC rate?

Answer 8

less than 50%

Question 9

Ddx for dyspnea

Answer 9

COPD
CHF
asthma
interstitial lung disease
pneumonia
psychogenic (anxiety)

Question 10

Physical exam findings for severe COPD

Answer 10

• barrel chest and distant heart sounds (increased anteriorposterior diameter due to hyperinflation)
• expiratory wheezing
• prolonged expiratory phase
• tachypnea, anxiety, use of accessory muscles during acute exacerbation
• may have signs of cyanosis (perioral or digits)

Question 11

Chest x ray in COPD

Answer 11

initially normal until disease progresses

increased PA diameter, flattening of diaphragm, bullae (areas of parenchymal destruction)

Question 12

What happens to FVC and FEV1 in COPD

Answer 12

Both are reduced and ratio is less than 0.7

Reversibility (greater than 12% improvement or 200 mL with bronchodilator) is NOT seen on spirometry indicating fixed obstruction

Question 13

What components of treatment are common to all stages of COPD?

Answer 13

• SMOKING CESSATION (slows detrioration)
• pneumococcal and influenza vaccines to prevent exacerbations
• regular exercise and weight control
• avoiding environmental triggers (pollution, occupational exposures, second hand smoke)

Question 14

Stage 0 COPD

Answer 14

• at risk
• cough, sputum production, normal spirometry
• vaccines and address risk factors

Question 15

Stage I COPD

Answer 15

• mild COPD
• FEV1/FVC 80% predicted, with or without symptoms
• short acting bronchodilators

Question 16

Stage II COPD

Answer 16

• moderate COPD

- FEV1/FVC

Question 17

Stage III COPD

Answer 17

• severe COPD

- FEV1/FVC

Question 18

Stage IV COPD

Answer 18

• very severe COPD

- FEV1/FVC

Question 19

Examples of short acting bronchodilators

Answer 19

b2 agonists like albuterol and muscarinc antagonists like ipratropium

Question 20

Examples of long acting bronchodilators

Answer 20

salmeterol (b2 agonist), tiotroprium (anticholinergic)….more expensive

Question 21

Recommended treatment for COPD III and IV that reduce frequency of exacerbations

Answer 21

inhaled steroids (flucitasone, triamcinolone, mometasone)

Question 22

What is the only intervention that has been shown to decrease mortality and must be worn for at least 15 hr/day?

Answer 22

o2 therapy reserved for stage IV COPD

Question 23

Best way to monitor lung function as COPD progresses?

Answer 23

spirometry

Question 24

Signs of COPD exacerbation

Answer 24

increased dyspnea, change in sputum color/amount, cough, wheezing

Question 25

Common triggers for COPD exacerbation

Answer 25

viral/bacterial infxn (most common), air pollutants, second hand smoke

Question 26

Diagnoses similar to COPD

Answer 26

PE, CHF, MI, pneumonia, pneumothorax, pleural effusion

Question 27

Treatment for acute exacerbations

Answer 27

short acting bronchodilators (combos with different mechanisms)

Question 28

T/F: Systemic steriods do not shorten the course of exacerbations

Answer 28

FALSE THEY DO and they reduce risk of relapse

Question 29

most common bacteria implicated in COPD exacerbations

Answer 29

pneumococcus, haemophilus influenza, moraxella catarrhalis

sputum culture should be performed!