L3W2 Dx & Ttt COPD

Question 1

Risk factor COPD?(8)

Answer 1

1. Genetic factors
2. Age & gender
3. Lung growth & development
4. Exposure to particles
5. Socioeconomic status
6. Asthma & airway hyper-reactivity
7. Chronic bronchitis
8. Infections

Question 2

Symptom COPD?(5)

Answer 2

1. Chr & progressive dyspnea
2. Cough
3. Sputum production
4. Wheezing & chest tightness
5. Others: fatigue, weight loss,
   anorexia, syncope, rib fractures, ankle swelling, depression, anxiety

Question 3

Other causes chronic cough?(intra/extrathoracic)

Answer 3

Intrathoracic
-asthma, lung cancer, tb, bronchiectasis, lt HF, ILD
Extrathoracic
-chr allergic rhinitis, PNDS, UACS, GERD, drug(acei)

Question 4

Medical History?(8)

Answer 4

1. Exposure to risk factors
2. Past medical history
3. Fam his COPD/chr resp dis
4. Pattern of symptom development
5. His exac/prev hosp(resp dis)
6. Presence comorbidities
7. Impact pt life
8. Soc & fam support available to pt
9. Possibility reduce risk factors

Question 5

COPD Prevention?(7)

Answer 5

1. Smoke cess
2. Pharma thep
3. Inhaler technique
4. Influ vac
5. Pneumococcal vac
6. Pul rehab
7. O2 thep

Question 6

Group A ttt?

Answer 6

Bronchodilator(short/long)

Question 7

Group B ttt?

Answer 7

Long act bronchodilator(LABA/LAMA)

Question 8

Group C ttt?

Answer 8

Single long act bronchodilator(LAMA)

Or + ICS

Question 9

Group D ttt?

Answer 9

LAMA/
LAMA + LABA/
LABA + ICS/
LAMA + LABA + ICS
\+ P4i(chr brois&FEV1<50%)
\+macrolide(smoker)

Question 10

Follow up?(review, assess, adjust)

Answer 10

Review
-symp, exa
Assess
-inhaler technique
-nonpharma approach
Adjust
-escalate, switch inhaler, de-escalate

Question 11

Non-Pharmacological Treatment?(9)

Answer 11

1. Education & self-management
2. Physical activity
3. Pul rehab prog
4. Exercise training
5. Self-management edu
6. End of life & palliative care
7. Nutritional support
8. Vaccination
9. O2 therapy

Question 12

Precipitating events? (3)

Answer 12

1. Resp ti
2. Expose to resp irritant & pollution
3. Co-morbid condition:
   - hf
   - pul embo
   - myocardial ischemia
   - pneumothrax
   - Pleural effusion

Question 13

Classification of hospitalized patients?(3)

Answer 13

1. No resp fail
2. Acute resp fail(xlife threat)
3. Acute resp fail(life threat)

Question 14

No respiratory failure? (5)

Answer 14

1. RR:20-30/min
2. Xaccessory ms
3. Xchange mental status
4. Hypoxemia improve 28-35% (FiO2)
5. Xinc PaCO2

Question 15

Acute respiratory failure non-life-threatening? (5)

Answer 15

1. RR:>30/m
2. Using accessory ms
3. Xchange mental status
4. Hypoxemia improve 25-30% FiO2
5. Hypercarbia: PaCO2 inc 50-60mmHg

Question 16

Acute respiratory failure life-threatening?(5)

Answer 16

1. RR:>30/min
2. Accessory ms
3. Acute changes mental status
4. Hypoxemia ximprove w Venturi mask/require FiO2 >40%
5. Hypercarbia(PaCO2 inc >60 mmHg/acidosis(pH<7.25)

Question 17

Management at home? (4)

Answer 17

1. Sputum culture xrecommend
2. Inc freq & intensity ISA BD several day(mild exa)
3. Antibiotic
4. Corticosteroids=Prednisone 30-60mg 5-7 day