Exam 2: COPD Flashcards
What are the two former terms for COPD?
Emphysema and chronic bronchitis
What is emphysema?
A pathological term describing the Destruction of the gas-exchanging surfaces of the lung
What is chronic bronchitis?
Presence of cough and sputum production for at least 3 months in each of two consecutive years
A 60 year old patient presents with DOE, chronic cough, and sputum production. What are you concerned about?
COPD
What are the risk factors for COPD?
Tobacco smoke, genetic factors, and occupational dusts
What are the 3 genetic conditions that increase risk for COPD?
Alpha 1 antitrypsin deficiency, asthma, and respiratory infections in childhood
Why does pursed lip breathing occur in COPD?
- Ordinary breathing allows for early bronchial collapse on exhalation
- Pursed lip breathing achieves resistance to outflow at the lips raising intrabronchial pressure keeping the bronchi open
What is Cor Pulmonale?
Altered structure and/or impaired function of the right ventricle that results from pulmonary HTN associated diseased of the lung (COPD), vasculature, upper airway, or chest wall
What is the most common cause of Cor pulmonale?
COPD
What is an acute exacerbation of COPD?
An acute change in the patients baseline dyspnea, cough, or sputum that is beyond normal variability and sufficient to warrant a change in therapy
What test is required to establish a diagnosis of COPD?
Spirometry
What is a normal FVC?
80-120%
What is a normal FEV1?
80-120%
A post bronchodilator FEV1/FVC ratio of *** confirms an obstructive pattern.
<0.7
COPD patients may have increased ** and decreased **.
TLC
Diffusing capacity of CO (DLCO)
***DLCO is decreased as emphysema increases
What is gold class 1?
Mild COPD with FEV1> 80%
What is gold class II?
Moderate COPD with 50% < FEV1<80%
What is gold class III?
Severe COPD with 30%< FEV1< 50%
What is gold class IV?
Very severe COPD with FEV1< 30%
What happens to FEV1 in obstructive disorders?
It is reduced
What happens to FVC in obstructive disorders? Restrictive?
Obstructive: normal
Restrictive: reduced
When should you consider ABGs for COPD?
If FEV1 <50%m SPO2 <92%, depressed LOC, or acute exacerbation of COPD
What labs should you order for COPD?
CBC (usually normal), BNP (evaluate suspected HF), metabolic panel, and Alpha 1 antitrypsin
What CXR signs are consistent with COPD?
-Signs of air trapping such as increased AP diameter, hyperinflation and hyperlucency, and flattened diaphragms
What CXR findings are pathognomonic for emphysema?
Blebs or bullae
What is the best predictor of having frequent COPD exacerbations (more than 2 per year)?
A history of earlier treated events
If a patient has had 0-1 exacerbations in the last 12 months, what is their risk of developing frequent exacerbations and risk of death?
Low risk
If a patient has had 2 or more exacerbations OR 1 hospitalization for COPD in the last 12 months, what is their risk of developing frequent exacerbations and risk of death?
High risk
How can supplemental oxygen affect patients with COPD and hypoxia?
Long term administration (>15 hours per day) is shown to increase survival in patients with severe resting hypoxemia
What is the recommended treatment for Grade A COPD?
A Short acting bronchodilator (SABA, SAMA, or combo) PRN
What is the recommended treatment for grade B COPD?
LAMA or LABA
What is the recommended treatment for Grade C COPD?
LAMA
What is the recommended treatment for grade D COPD?
LAMA
OR if severe breathlessness LABA-LAMA
What should grade B-D also have available for symptom control PRN?
A SABA
What are the two kinds of bronchodilators used?
Inhaled B2 agonists and anticholinergics
Albuterol is an example of what kind of drug?
SABA, dose 2 puffs q 4-6 hours
Salmeterol and formoterol are examples of what kinds of drugs?
LABA, dosing q 12 hours
What are the effects of Bronchodilators?
Bronchodilator, mucociliary clearance, diaphragmatic action, and cardiac contracility
What are the side effects of B2 agonists?
Palpitations, tachycardia, insomnia, and tremors
Ipratropium is an example of what kind of drug?
Short actin anticholinergic , dosed 2 puffs BID-QID
Tiotropium is an example of what kind of drug?
Long acting anticholinergic
What are the effects of anticholinergics?
Side effects?
Reduces air trapping, less cardiac stimulatory effect than B2 agonists.
Side effects:
Dry mouth, metallic taste, HA, and cough.
ICS are often used with alone or in conjunction with what?
LABA or LABA-LAMA
What kind of drug is advair?
LABA-ICS
What are the side effects of ICS?
Thrush and bruising
What is the treatment of patients with COPD and alpha 1 antitrypsin deficiency?
Antiprotease therapy, weekly infusions
What are the two common triggers for COPD exacerbation?
Respiratory illness and pollution
What are the two most common viruses that can respiratory illness and COPD exacerbation?
Influenza and rhinovirus
What is the outpatient management of COPD exacerbation?
- Increase in frequency of SABA
- PREDNISONE 40mg x5 days
- Abx x 5-7 days
- Possible hospitalization
