EXAM #1: COPD Flashcards
What defining feature of COPD differentiates it from asthma?
Airflow obstruction is NOT fully reversible (vs. asthma)
Also, AIR-TRAPPING
What is the primary risk factor for COPD?
Smoking
What is the definition of chronic bronchitis?
Chronic productive cough for at least 3 months for 2 consecutive years
What is the definition of emphysema?
Destruction of alveolar sacs/ lung parenchyma
What are the clinical features of chronic bronchitis?
1) Productive cough
2) Cyanosis i.e. “blue boaters”
*Increased risk of infection and cor pulmonale
What are the clinical features of emphysema?
1) Dyspnea with cough (minimally productive)
2) Prolonged expiration with pursed lips
3) Weight loss
4) Increased AP diameter
In a patient with history and exam that are suspicious for COPD, what is the next step in the diagnostic work-up?
Spriometry
What happens to FVC, FEV1, and TLC in COPD?
FVC= decreased FEV1= markedly decreased TLC= increased
What is the FEV1/FVC ratio in COPD?
Decreased (less than 0.7)
What are the tools that are used to assess the severity of COPD?
1) COPD Assessment Test (CAT)
2) Clinical COPD Questionnaire (CCQ)
3) mMRC Breathless Scale
What post-bronchodilator FEV1 % indicates severe COPD?
Less than 50%
Draw the flow-volume loop that you would expect to see in COPD.
N/A
What are three indications of high risk in COPD?
1) 2+ exacerbations in last year
2) FEV1 less than 50%
3) 1+ hospitalizations
How do you risk stratify COPD?
1) Assess symptoms
2) Assess risk of exacerbations
*Categorize based off of these findings into A, B, C, and D
What is the single most important intervention in COPD?
Smoking cessation
What is the first line treatment for COPD?
Bronchodilators
When are inhaled corticosteroids recommended in COPD?
1) Severe COPD (III or IV/ C or D)
2) Patient with recurrent exacerbations
3) Patient has a reversible element to COPD (asthmatic component)
What class of drug is Roflumilast?
PDE-4 inhibitor
What is the first line therapy for a COPD Class A?
SAMA PRN or SABA PRN
What is the first line therapy for a COPD Class B?
LAMA or LABA
What is the first line therapy for a COPD Class C?
ICS + LABA or LAMA
What is the first line therapy for a COPD Class D?
ICS + LABA and/or LAMA
Are routine systemic steroids recommended in the management of COPD?
NO–associated with increased morbidity and mortality
When is home oxygen therapy recommended in the setting of COPD?
1) PaO2 less than 55 mmHg on room air
2) SpO2 less than or equal to 88% with exertion
What are the clinical signs of a severe COPD exacerbation?
1) AMS
2) Single word sentances
3) Silent chest
4) Hemodynamic instability
5) Laborded/ paradoxial breathing
What are the standard tests to order in the setting of an acute COPD exacerbation?
1) ABG
2) CXR
3) Pulse oximetry
4) EKG
5) CBC, Chem 7 (BMP)
How is a mild COPD exacerbation managed?
1) Systemic steroids
2) Increased SABA
3) Add abx if purulent sputum
What patients require inpatient management of COPD?
1) Failure of outpatient mgmt
2) Dyspnea at rest
3) Tachypnea
4) Accessory muscle use at rest
5) Tachycardia
6) Hypoxemia
What is the average number of intercostal spaces that should be visible on CXR? What indicates hyperinflation?
Normal= 8-9 Hyperinflation= 10+
Why don’t you want to over-oxygenate a patient with COPD?
Exacerbation of V/Q mismatch
Relieve hypoxic vasoconstriction and shift blood to poorly ventilated region of the lung
