Lecture 4: COPD Flashcards
How many pack/years smoking hx, age, and maximum laryngeal height are the most predictive of COPD?
- >40 pack-year smoking hx
- ≥45 y/o
- Maximum laryngeal height ≤4 cm
All patients who have unexplained dyspnea and cough should be evaluated for what?
α1-AT deficiency
Cardiac exam of pt with COPD may show what?
- Cor pulmonale
- ↑ intensity of the pulmonic sound, persistently split S2
- Parasternal lift due to RVH
Using the GOLD criteria for staging COPD what are the characteristics of stage I through stage IV?
- I (mild) = FEV1 ≥80% of predicted
- II (moderate) = 50% ≤FEV1 <80%
- III (severe) = 30% ≤FEV1 <50%
- IV (very severe) = FEV1 <30% of predicted or FEV1 <50% of predicted plus chronic respiratory failure
*All have FEV1/FVC <70%
Using the GOLD criteria for staging COPD what are the characteristics of stage II - moderate?
- FEV1/FVC <70%; 50% ≤FEV1 <80% of predicted
Which postbronchodilator value of FEV1 and FEV1/FVC ratio confirms the presence of nonreversible obstruction?
- FEV1 <80% of predicted
- FEV1/FVC ratio <70%
Severity of COPD can be graded using the BODE index which consists of what?
- BMI
- Airflow Obstruction
- Dyspnea
- Exercise capacity (the 6-minute walk distance)
Which BMI gives you 1 point using the BODE index?
≤21 = 1 point
Using the BODE index which FEV1 % predicted after bronchodilator gives 0-3 points?
- ≥65% = 0
- 50-64% = 1
- 36-49% = 2
- <35% = 3
Using the BODE index which 6-minute walk distances are associated with a score of 0-3?
- ≥350 meters = 0
- 250-349 = 1
- 150-249 = 2
- ≤149 = 3
Using the points from the BODE index, how many points are associated with 4-year survival % of 80, 67, 57, and 18?
- 0-2 = 80%
- 3-4 = 67%
- 5-6 = 57%
- 7-10 = 18%
What is Hoover’s sign?
- Inward movement of the lower rib cage during inspiration, instead of outward as is normal
- Implies a flat, but functioning, diaphragm
What are the 2 suffixes for inhaled corticosteroids?
- -asone (i.e., fluticasone)
- -ide (i.e., budesonide)
In milder and younger pt’s w/ COPD (FEV1 >50% and age <65) which 4 antibiotic classes are used?
- Doxycycline
- TMP-SMX
- Cephalosporin (cefuroxime, cefdinir, cefopodoxime)
- Advanced macrolide (azithromycin, clarithromycin)
In sicker older pt’s with COPD which 2 antibiotic classes are utilized?
- Amoxicillin-clavulunate
- Fluoroquinolones (FDA warning - Achilles tendon rupture)
Which PaO2 or SpO2 values measured 2x over a 3-week period would be indications for supplemental O2?
- PaO2 ≤55 mmHg
or
- SpO2 ≤88%
Supplemental O2 is indicated in pt’s with PaO2 >56 but <60 any time with evidence of what 3 underlying conditions?
- Pulmonary HTN
- CHF
- Erythrocytosis Hct >55%
For patient with GOLD I: mild COPD what is the standard tx?
Either SABA or SAMA prn; often ordered together as Combivent
For patient with GOLD II: moderate COPD what is the standard tx?
LABA or LAMA
For patient with GOLD III: severe COPD what is the standard tx?
- ICS + LABA or ICS + LAMA (NEVER use ICS alone in COPD)
- With or without either roflumiast or theophylline
Which drug used in tx of COPD is NEVER used alone in COPD?
ICS
For patient with GOLD IV: very severe COPD what is the standard tx?
- ICS + LABA or ICS + LAMA or ICS + LAMA + LABA
- With or without roflumilast or theophylline
What 3 surgical interventions may improve sx’s of COPD in highly selected pt’s?
- Bullectomy
- Lung volume reduction surgery
- Lung transplantation
Treatment of COPD is stepwise and largely based on what?
PFT’s
What are the 3 most common bacteria responsible for pneumonia in COPD?
- S. pneumoniae
- M. catarrhalis
- H. influenzae
