Exam 2: COPD

Question 1

What are the two former terms for COPD?

Answer 1

Emphysema and chronic bronchitis

Question 2

What is emphysema?

Answer 2

A pathological term describing the Destruction of the gas-exchanging surfaces of the lung

Question 3

What is chronic bronchitis?

Answer 3

Presence of cough and sputum production for at least 3 months in each of two consecutive years

Question 4

A 60 year old patient presents with DOE, chronic cough, and sputum production. What are you concerned about?

Answer 4

COPD

Question 5

What are the risk factors for COPD?

Answer 5

Tobacco smoke, genetic factors, and occupational dusts

Question 6

What are the 3 genetic conditions that increase risk for COPD?

Answer 6

Alpha 1 antitrypsin deficiency, asthma, and respiratory infections in childhood

Question 7

Why does pursed lip breathing occur in COPD?

Answer 7

• 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

Question 8

What is Cor Pulmonale?

Answer 8

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

Question 9

What is the most common cause of Cor pulmonale?

Answer 9

COPD

Question 10

What is an acute exacerbation of COPD?

Answer 10

An acute change in the patients baseline dyspnea, cough, or sputum that is beyond normal variability and sufficient to warrant a change in therapy

Question 11

What test is required to establish a diagnosis of COPD?

Answer 11

Spirometry

Question 12

What is a normal FVC?

Answer 12

80-120%

Question 13

What is a normal FEV1?

Answer 13

80-120%

Question 14

A post bronchodilator FEV1/FVC ratio of *** confirms an obstructive pattern.

Answer 14

<0.7

Question 15

COPD patients may have increased ** and decreased **.

Answer 15

TLC

Diffusing capacity of CO (DLCO)

***DLCO is decreased as emphysema increases

Question 16

What is gold class 1?

Answer 16

Mild COPD with FEV1> 80%

Question 17

What is gold class II?

Answer 17

Moderate COPD with 50% < FEV1<80%

Question 18

What is gold class III?

Answer 18

Severe COPD with 30%< FEV1< 50%

Question 19

What is gold class IV?

Answer 19

Very severe COPD with FEV1< 30%

Question 20

What happens to FEV1 in obstructive disorders?

Answer 20

It is reduced

Question 21

What happens to FVC in obstructive disorders? Restrictive?

Answer 21

Obstructive: normal
Restrictive: reduced

Question 22

When should you consider ABGs for COPD?

Answer 22

If FEV1 <50%m SPO2 <92%, depressed LOC, or acute exacerbation of COPD

Question 23

What labs should you order for COPD?

Answer 23

CBC (usually normal), BNP (evaluate suspected HF), metabolic panel, and Alpha 1 antitrypsin

Question 24

What CXR signs are consistent with COPD?

Answer 24

-Signs of air trapping such as increased AP diameter, hyperinflation and hyperlucency, and flattened diaphragms

Question 25

What CXR findings are pathognomonic for emphysema?

Answer 25

Blebs or bullae

Question 26

What is the best predictor of having frequent COPD exacerbations (more than 2 per year)?

Answer 26

A history of earlier treated events

Question 27

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?

Answer 27

Low risk

Question 28

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?

Answer 28

High risk

Question 29

How can supplemental oxygen affect patients with COPD and hypoxia?

Answer 29

Long term administration (>15 hours per day) is shown to increase survival in patients with severe resting hypoxemia

Question 30

What is the recommended treatment for Grade A COPD?

Answer 30

A Short acting bronchodilator (SABA, SAMA, or combo) PRN

Question 31

What is the recommended treatment for grade B COPD?

Answer 31

LAMA or LABA

Question 32

What is the recommended treatment for Grade C COPD?

Answer 32

LAMA

Question 33

What is the recommended treatment for grade D COPD?

Answer 33

LAMA OR if severe breathlessness LABA-LAMA

Question 34

What should grade B-D also have available for symptom control PRN?

Answer 34

A SABA

Question 35

What are the two kinds of bronchodilators used?

Answer 35

Inhaled B2 agonists and anticholinergics

Question 36

Albuterol is an example of what kind of drug?

Answer 36

SABA, dose 2 puffs q 4-6 hours

Question 37

Salmeterol and formoterol are examples of what kinds of drugs?

Answer 37

LABA, dosing q 12 hours

Question 38

What are the effects of Bronchodilators?

Answer 38

Bronchodilator, mucociliary clearance, diaphragmatic action, and cardiac contracility

Question 39

What are the side effects of B2 agonists?

Answer 39

Palpitations, tachycardia, insomnia, and tremors

Question 40

Ipratropium is an example of what kind of drug?

Answer 40

Short actin anticholinergic , dosed 2 puffs BID-QID

Question 41

Tiotropium is an example of what kind of drug?

Answer 41

Long acting anticholinergic

Question 42

What are the effects of anticholinergics? Side effects?

Answer 42

Reduces air trapping, less cardiac stimulatory effect than B2 agonists. Side effects: Dry mouth, metallic taste, HA, and cough.

Question 43

ICS are often used with alone or in conjunction with what?

Answer 43

LABA or LABA-LAMA

Question 44

What kind of drug is advair?

Answer 44

LABA-ICS

Question 45

What are the side effects of ICS?

Answer 45

Thrush and bruising

Question 46

What is the treatment of patients with COPD and alpha 1 antitrypsin deficiency?

Answer 46

Antiprotease therapy, weekly infusions

Question 47

What are the two common triggers for COPD exacerbation?

Answer 47

Respiratory illness and pollution

Question 48

What are the two most common viruses that can respiratory illness and COPD exacerbation?

Answer 48

Influenza and rhinovirus

Question 49

What is the outpatient management of COPD exacerbation?

Answer 49

- Increase in frequency of SABA - PREDNISONE 40mg x5 days - Abx x 5-7 days - Possible hospitalization