Lecture 12 COPD Flashcards
COPD:
____ decreases dramatically;
FVC _____;
What happens to the ratio?
FEV1; decreases;
Ratio decreases
Is COPD due to obstruction of inflow or obstruction of outflow?
outflow
Bronchitis vs Emphysema: patients are overweight and cyanotic = patients are older and thin = Peripheral edema is common = Increased AP diameter of chest =
bronchitis (blue bloater);
emphysema (pink puffer);
bronchitis;
emphysema
COPD:
____ lose their shape and become clogged with mucus;
walls of ____ are destroyed.
bronchioles;
alveoli
bronchitis vs emphysema: enlargement of air spaces = loss of elastic recoil = hyperplasia of mucus secreting glands = barrel shaped chest =
emph;
emph;
bronch;
emph
90% of patients with COPD are ____
smokers
what is required to establish diagnosis of COPD?
spirometry
What spirometric finding tells you how severe the COPD is?
FEV1; ie more decreased FEV1 = more severe disease
COPD vs asthma:
which is reversible?
persistent and productive cough seen in =
asthma;
COPD
what genetic deficiency should be screened for in patients with COPD of a young age?
alpha 1 antitrypsin
CXR of patient with COPD shows a ____ diaphragm
flattened
most important therapeutic option in treating COPD
smoking cessation
2 autonomic drugs used in treatment of COPD
beta 2 agonists, anticholinergics
____ corticosteroids are used in short term inhalers. ____ corticosteroids are used during periods of COPD exacerbation.
inhaled;
systemic
_____ inhibitors are specifically used in bronchitis patients
phosphodiesterase-4
what treatment is recommended at all stages of COPD?
exercise rehab
exercise rehab helps with improvements in _____ tolerance and symptoms of ____ and ____
exercise; dyspnea, fatigue
e.g. breaks the “spiral of disability/deconditioning”
what COPD treatment has been shown to increase survival in patients with severe, resting hypoxemia?
oxygen therapy (at least 15 hours a day)
non-invasive ventilatory support should be used in patients with pronounced day-time _____
hypercapnia (ie increased CO2)
Lung volume reduction surgery (LVRS) is more efficacious in patients with ____-lobe _____ and low _____ capacity
upper, emphysema;
exercise
what is indicated in patients with a PaO2 less than 55 and a SaO2 less than 88%?
long term oxygen therapy
what is “P” pulmonale?
tall peaked P waves;
indicates R. atrial enlargement
most common cause of exacerbation of COPD?
infection.
also edema, PE, pneumothorax, non-compliance
in patients with COPD exacerbation, ____, ____, or bleeding may be present on whole blood count
anemia, polycythemia (due to decreased O2)
what kind of test is not recommended during COPD exacerbation?
spirometric
What is the target saturation of oxygen for treatment of patients with COPD exacerbation? Why not higher?
88-92;
want to avoid CO2 narcosis
3 cardinal symptoms of bacterial COPD exacerbation (anthonisen criteria):
increased dyspnea, increased sputum volume, increased sputum purulence
antibiotics should be given
2 other indicators that antiobiotics should be given to a patient with COPD exacerbation:
mechanical ventilation; CXR indicative of pneumonia
nicotine is _____ but does not cause _____
addictive, lung damage
by ____ years after quitting smoking, all cause mortality falls to levels of a never-smoker
15
5 A’s approach to talking about quitting smoking with a patient
ask, assess, advise, assist, arrange
2 prescription medicines approved for cessation of tobacco usage
bupropion, varenicline
besides prescription meds, what is the other general type of pharmacotherapy?
nicotine-replacement therapy ie patch or gum
mechanism of action of bupropion
NE and dopamine reuptake inhibitor
mechanism of action of varenicline
nicotine receptor partial agonist
do anticholinergics work better in treatment of asthma or COPD?
COPD (not v effective in asthma)
