Lecture 57 - COPD tx and Dx Flashcards
what two diseases Comprise COPD? what is the difference between the 2?
Emphysema – Parenchymal destruction:
Enlargement of Air Spaces and Destruction of alveolar walls
Increased Compliance; Decreased Recoil
Chronic Bronchitis :
Presence of cough and sputum production for a least 3 months in two consecutive years
History and Physical of COPD
what is notably absent from the physical exam?
Dyspnea
Cough
Symptoms can worsen with stimuli
Exam: Barrel chested, pursed lips, rhonchi
notably absent: Clubbing of the fingers
what else is used to diagnose COPD?
Imaging – (CT)
and PFTs
What are some PFT findings of obstructive pulmonary disease?
what is the DLCO finding ? how does it differ for Emphysema vs Chronic bronchitis vs asthma /
PFTs - Very Decreased FEV1; Decreased FVC
Lung Volumes --- can show hyperinflation; Increased TLC, FRC and RV
DLCO – reduced by emphysema;
Not reduced is asthma and CB
Describe the physiology behind the obstruction of emphysema ?
Emphysema – loss of elastic recoil due to degradation of the collagen and elastin
airway becomes collapsible
What is the old way of staging criteria for COPD? what metric is used ?
GOLD CRITERIA FEV1/FVC < 70% == Obstructive Disease
Grade severity by FEV1 % of predicted
Mild - < 80%
Moderate - 50-79%
Severe - <50%
what are the three criteria used in the new method of risk stratification of COPD?
PFT (GOLD)
Risk (exacerbation hx)
Breathlessness Symptoms (CAT or mMRC questionnaires)
what two “treatments” are proven to improve mortality of COPD?
Smoking Cessation – improves mortality
Oxygen – Improves mortality
what medications can be used for lower 2 stages of COPD?
Higher two stages of COPD?
SABA, SAMA PRN
LABA, or LAMA
ICS + LABA
what is common complication of COPD
how is it provoked?
how is it treated?
COPD exacerbation –
Provoked – viral or bacterial respiratory infeciton; pulmonary embolism
Treatment: Beta 2 agonits; corticosteroids; abx; oxygen
What is pulmonary rehab?
○ Mutlidisciplinary program of medication and exercise to break the downward spiral of respiratory impariment leading to abstaining from exercise leading to deconditioning eventually leading to dyspnea during ADLs
what is lung volume reduction surgery?
○ Removal of emphysematous blebs, that take up space, worsening lung mechanics and don’t really do anything for gas exchange
○ Removal – can imporve elastic recoil, improve symptoms
what is the BoDE criteria?
Criteria for risk stratification and survival
• BMI
• Degree of airflow obstruction and Dypnea Exercise Capacity
