L2W2 COPD Overview

Question 1

Def COPD?

Answer 1

Common preventable & treatable disease, char by persistent airflow limitation that usually progressive & asso w enhanced chronic inflammatory response in airways & lung to noxious particles/gases

Question 2

Burden COPD?(prevalence, mortality)

Answer 2

Prevalence:
•inc steeply w age
•highest(>60)
•7.8%-19.7% average range
•3-11% non-smokers 
Mortality:
•Ranked 6th coz death(1990)
•3rd(2020)
•4th in 2030

Question 3

Risk Factors COPD?(7) (PGFREA)

Answer 3

1. Susceptability genes
2. Exposure inhaled particles
   - smoking, In/outdoor, job dust, Chemical agents, fumes
3. Poor lung growth & dev
4. Inc age
5. Female
6. Recurrent chest infection
7. Low socioeconomic status

Question 4

CP COPD?(4)

Answer 4

1. Generally >40y
2. Smoker/ex-smoker
3. Presentation with:
   – cough
   – excessive sputum production
   – shortness of breath
4. Dyspnea(most pt seek medical)

Question 5

COPD Subtypes?(4)

Answer 5

1. Chronic bronchitis
2. Emphysema
3. Mixed type
4. Ashma /copd subtype

Question 6

CP Chronic Bronchitis(blue blotter)?(10)

Answer 6

1. Mild dyspnea
2. Cough before dyspnea starts
3. Copious, purulent sputum
4. More frequent infections
5. Repeated resp. insufficiency
6. PaCO2 50-60mmHg
7. PaO2 45-60mmHg
8. Hematocrit 50-60%
9. DLCO xmuch
10. Corpulmonale common

Question 7

CP Emphysema(pink puffer)?(10)

Answer 7

1. Severe dyspnea
2. Cough after dyspnea
3. Scant sputum
4. Less frequent infections
5. Terminal RF
6. PaCO2 35-40 mmHg
7. PaO2 65-75 mmHg
8. Hematocrit 35-45%
9. DLCO dec
10. Corpulmonale rare

Question 8

Diagnosis of COPD? (Symp+ risk factor+ spirometry)

Answer 8

Symptom
-SOB, chr cough, chr sputum
Risk factor
-Tobacco, job, in/outdoor
Spirometry
FEV1/FVC

Question 9

Investigation COPD?(8) (ABG SIA SLEC)

Answer 9

1. Spirometry
2. Imaging
3. ABG measurement
4. Alpha-1 antitrypsin deficiency screening
5. Lung vol & diffusing capacity
6. Sleep study
7. Exercise testing
8. Composite scores

Question 10

Spirometry useful for?(5) (SGE IDx)

Answer 10

1. Screen individual(pul dis)
2. COPD diagnosis
3. Severity pul dysfx
4. Guiding selection of treatment
5. Assess effects therapeutic intervention

Question 11

Lung volumes & diffusing capacity(DLco)

Answer 11

-fx impact emphysema in COPD & degree airflow limit
Hyperinflation & air trapping:
-Hyperinflation →Reduces IC (esp. during exercise) →↑ dyspnea & limitation of exercise capacity
Lung volumes
-IC appears to correlate more strongly to dyspnea than FEV1

Question 12

Comorbidities in COPD?(6) (SAD COG)

Answer 12

1. Skeletal Ms Dysfx
2. CV Disease
3. Osteoporosis
4. Anemia of Chronic Disease Metabolic
5. Abnormalities in COPD Depression
6. GI Disease

Question 13

DDx COPD?(6) (A,B,C,D,Tb,Ob)

Answer 13

1. Asthma
2. Congestive heart failure
3. Bronchiectasis
4. Tuberculosis
5. Obliterative bonchiolitis
6. Diffuse Panbronchiolitis

Question 14

Assessment of COPD?(4)

Answer 14

1. Current lvl pt symptoms
   - CAT≥10 more symp
   - mMRC ≥2 more symp
2. Severity spirometric abnorm
3. Frequency of exacerbations
   - ≥ 2 exa last year/ ≥ 1 hosp(high risk)
   - 1 exa last year/no exa(low risk)
4. Presence of co morbidities

Question 15

Combined assessment of COPD?(4)

Answer 15

1. Assess symp
2. Assess risk exa
3. Choose highest risk(GOLD/exa his)
4. Pt in one of four categories

Question 16

Therapeutic Options?(5)(VS PAN)

Answer 16

1. Smoking cessation
2. Nicotine replace
3. Phy act
4. Pharma thep
5. Influenza & pneumonococcal vac

Question 17

COPD Medications?(5)(BACIO)

Answer 17

1. Beta2-agonist
   - SABA/LABA
2. Anticholinergic
   - SAMA/LAMA
3. Corticosteroid
   - ICS/Sys corti
4. Inhaled combination
   - SA/LABA + AC
5. Others
   - Methylxantine
   - Phospo 4 inh

Question 18

Recent Drugs?(4)

Answer 18

1. Glycopyronim(Seebri)
2. Indacateron(onbrez)
3. Ultibro Breezhaler(Glycopyrronium bromide + indicaterol)
4. Phospho 4 inh(Roflumast)