H314:1700-1707-COPD Flashcards
Describe the pathogenesis of COPD
Neutrophil and macrophage recruitment –> secretion of proteinase inhibitors –> ECM degradation = lung destruction
2 areas of pathology in COPD
Large airway (goblet cell hyperplasia - cough/mucous) Small Airway (major site of resistance
Define COPD
Airway flow that is not fully reversible that includes emphysema (anatomical-destruction), chronic bronchitis (cox-cough and phlegm), and small airway disease.
Hypoxemia in COPD that is difficult to correct should cause one to ….
Search for another cause as the shunting in COPD is usually responsive to O2
4 risk factors for COPD
Cigarettes,Air pollution,occupational exposures and a1AT deficiency
3 most common symptoms in COPD
Cough
Sputum Production
Exertional dyspnea
What is the Hoover’s sign
Paradoxical motion of rib cage due to hyperinflation changing the AP diameter of the rib cage
Is clubbing of the digits a sign of COPD ?
Nope
GOLD criteria:
All stages FEV1/FVC =
Only three treatments for COPD that have been demonstrated to influence the natural history of the disease:
Oxygen, smoking cessation and lung volume reduction surgery (in select patients(
All other treatments are directed towards doing what ?
Decreasing frequency and severity of exacerbation a
What therapy has been shown to increase risk of death from respiratory causes ?
LABAs w/o concomitant corticosteroids
Two types of LAB2As + corticosteroid (Long acting Beta 2 Agonists)
Salmeterol/fluticasone (Advair)
Formoterol/mometasone (Dulera)
Formoterol+Budesonide (Symbicort)
Salmeterol (Severent)
Anti-Ach + SABAs
Albuterol+ipratropium ( Combivent/DuoNeb)
Albuterol (ProAir/Ventolin)
Levalbuterol (Xopanex)
Resting Hypoxemia definition
2 other tx for COPD (mucolytic and enzyme replacement)
N-AC (Mucinex) IV aAT1 (requires level
3 vaccines and 3 other non-medication therapies
Pneumococcal,Flu,possibly pertussis
Pulm Rehab,
LVRS not recommended for deconditioned, PA >45mmHg, CHF, DLco
Three qualifiers of COPD exacerbation
Increase in sputum
Change in color of sputum
Increased dyspnea
Define hypercarbia
.pCO2 of >45 mmHg
___ weeks of glucocorticoid tx was no different than ___ weeks of tx.
2; 8
GOLD guidelines for gstd tx
30-40 mg x 10-14d
Contraindications for NIPPV for hypercarbic/respiratory failure patients
CV instability, MS prevents, inability/copious secretions, inability to fit mask.
New Anti-ach (M3) medications
Tudorza (aclidinium)
